{"id":45727,"date":"2014-10-27T16:37:11","date_gmt":"2014-10-27T20:37:11","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=45727"},"modified":"2014-10-27T16:37:11","modified_gmt":"2014-10-27T20:37:11","slug":"selections-from-richard-lehmans-literature-review-october-27th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/10\/27\/selections-from-richard-lehmans-literature-review-october-27th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: October 27th"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

Ann Intern Med<\/em> 21 October 2014 Vol 161<\/strong><\/p>\n

Behavioral Counseling to Promote a Healthy Lifestyle in Persons With Cardiovascular Risk Factors (pg. 568):<\/strong> Golly. Here is a systematic review that shows human behaviour can be changed<\/a> by an intensive intervention, or, to be more accurate, by a range of intensive interventions. Their aim was to reduce cardiovascular disease in high risk people. This is a really thorough review of 74 trials, done for the US Preventive Services Task Force. The effect sizes found for intermediate outcomes are small, except for preventing diabetes, and few trials report long term cardiovascular outcomes data. But this may be an area where people can benefit from being motivated through suitable exhortation and support. Do I mean getting fitter? Yes, that and reporting proper endpoints in trials.<\/p>\n

Lancet<\/em> 25 October 2014 Vol 384<\/strong><\/p>\n

Long-Term Outcomes After Stenting Versus Endarterectomy for Treatment of Symptomatic Carotid Stenosis (OL):<\/strong> Here\u2019s what a trial should look like<\/a>. It was well designed and conducted and paid out of public funds, except for carotid stents, which were donated by Sanofi. As a result, we know that carotid endarterectomy and carotid stenting for symptomatic stenosis have very similar long term outcomes. It\u2019s taken a while\u2014the trial started in 2001\u2014but it\u2019s been worth the wait to get a wealth of long term data. Both procedures have possible harms but they are well balanced. On the basis of this trial, patients can have a very clear conversation with health professionals about which treatment to have.<\/p>\n

Efficacy of Nitric Oxide, With or Without Continuing Antihypertensive Treatment, for Management of High Blood Pressure in Acute Stroke (OL):<\/strong> Fashions in stroke medicine come and go, although the discipline itself is only about 20 years old. We\u2019ve known for ages that high blood pressure is associated with bad outcome after stroke. So is it best to lower blood pressure as much as possible after an ischaemic stroke? Or to desist, on the basis that the brain needs all the perfusion pressure it can get while it is recovering? The ENOS trial also began in 2001<\/a>, and as a result we can say that it really doesn\u2019t matter what you do, or whether you use glyceryl trinitrate patches as well. Outcomes were the same whether pre-stroke blood pressure lowering drugs were stopped or continued, and although the GTN patches were well tolerated and lowered blood pressure, they too made no difference to functional outcome.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include behavioral counseling for those with CV risk factors, long-term outcomes after stenting vs. endarterectomy for treatment of symptomatic carotid stenosis, and more.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[694,718,2407,389,714,1524,2408,437,2409],"class_list":["post-45727","post","type-post","status-publish","format-standard","hentry","category-general","tag-acute-stroke","tag-antihypertensive-therapy","tag-behavioral-counseling","tag-endarterectomy","tag-high-blood-pressure","tag-lifestyle-intervention","tag-nitric-oxide","tag-stents","tag-symptomatic-carotid-stenosis"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/45727","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=45727"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/45727\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=45727"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=45727"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=45727"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}