{"id":47889,"date":"2015-04-20T15:59:35","date_gmt":"2015-04-20T19:59:35","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=47889"},"modified":"2015-05-15T18:11:12","modified_gmt":"2015-05-15T22:11:12","slug":"selections-from-richard-lehmans-literature-review-april-20th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2015\/04\/20\/selections-from-richard-lehmans-literature-review-april-20th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: April 20th"},"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

NEJM<\/em> 16 April 2015 Vol 372<\/strong><\/p>\n

Efficacy and Safety of Alirocumab in Reducing Lipids and Cardiovascular Events (pg. 1489):<\/strong> Your learning task this week is to memorise \u201cproprotein convertase subtilisin\u2013kexin type 9 (PCSK9).\u201d The next big lipid lowering debate will be all about inhibitors of PCSK9, and somebody should urgently invent a popular name for them. I suggest fatins (fat lowering injections), to rhyme with statins. There are two of them at the moment: alirocumab and evolocumab. In this trial, alirocumab was given as an injection every two weeks to two thirds of 2341 patients<\/a> at high risk for cardiovascular events who had LDL cholesterol levels of 1.8 mmol per litre or more and were receiving treatment with statins at the maximum tolerated dose. The rest had a placebo injection. \u201cAt week 24, the difference between the alirocumab and placebo groups in the mean percentage change from baseline in calculated LDL cholesterol level was \u221262 percentage points (P<0.001); the treatment effect remained consistent over a period of 78 weeks.\u201d The trial was not powered to detect a fall in actual cardiovascular events over this period, but as its name ODYSSEY LONG TERM implies, it means to go on: To strive, to seek, to find, and not to yield<\/em>. (Last line of Ulysses<\/em> by Tennyson)<\/p>\n

Efficacy and Safety of Evolocumab in Reducing Lipids and Cardiovascular Events (pg. 1500):<\/strong> And now for fatin number two. Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin\u2013kexin type 9 (PCSK9), as you already know: the phrase is already tripping off your tongue. This is Amgen\u2019s answer to Sanofi and Regeneron\u2019s alirocumab, and it has chosen to call its trial OSLER<\/a>. The effect of the two antibodies seems to be very similar. Again, the early signals point to a substantial fall in cardiovascular events, but only time will tell. This will be a hard fight, but it isn\u2019t clear how big the potential market will be. After all, the real Osler is quoted as saying \u201cThe first duty of the physician is to educate the masses not to take medicine.\u201d The statins wars will soon become the fatins wars; and I hereby declare copyright on the word fatin. I am willing to sell this to either drug company for a million dollars. Everyone has their price and mine is very reasonable.<\/p>\n

JAMA<\/em> 14 April 2015 Vol 313<\/strong><\/p>\n

Survival and Outcomes Following Bioprosthetic vs Mechanical Mitral Valve Replacement in Patients Aged 50 to 69 Years (pg. 1435):<\/strong> I have a kind of d\u00e9ja-vu feeling about this report on 15 year outcomes in \u201cnonelderly\u201d patients with mitral disease requiring valve replacement<\/a> who have been treated with either bioprosthetic and mechanical prosthetic valves. Maybe it\u2019s because I have read too much cardiac outcomes research, or because I am approaching the end of nonelderliness. Anyway, in patients aged 50 to 69 years undergoing mitral valve replacement in New York State, there was no significant survival difference at 15 years in patients matched by propensity score who underwent mechanical prosthetic vs bioprosthetic mitral valve replacement.<\/p>\n

Acute Stroke Intervention (pg. 1451):<\/strong> \u201cAcute stroke intervention: a systematic review\u201d is a very good update article<\/a> because it goes a bit further and wider than simply a systematic review. This is a really fast moving subject, and the necessary rush to get patients assessed and treated means that primary care doctors are not involved except occasionally to ring for a blue light ambulance on behalf of the patient. But it\u2019s an area of interest to everyone, since anyone can have a stroke. The two studies of thrombectomy that I recently commented on are still sitting on the NEJM<\/em> website<\/a>, and it\u2019s only a week or two since a paper appeared which should be practice changing in a different way<\/a>. This describes a computerised decision aid, which can help patients and their relatives make very fast decisions about thrombolysis on an individualised basis. It was developed in Newcastle (UK) and every stroke unit around the world needs to know about it.<\/p>\n

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

This week’s topics include the efficacy and safety of both alirocumab and evolocumab in reducing lipids and CV events, survival and outcomes following bioprosthetic vs. mechanical mitral valve replacement, and more.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[2547,2357,2545,1488,2264,2544,2546],"class_list":["post-47889","post","type-post","status-publish","format-standard","hentry","category-general","tag-acute-stroke-intervention","tag-alirocumab","tag-bioprosthetic-mitral-valve-replacement","tag-cardiovascular-events","tag-evolocumab","tag-lipid-reduction","tag-mechanical-mitral-valve-replacement"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/47889","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=47889"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/47889\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=47889"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=47889"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=47889"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}