February 6th, 2012

Selections from Richard Lehman’s Weekly Review: Week of February 6th

CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

Week of February 6th

JAMA  1 Feb 2012  Vol 307

483   Shock horror: Americans are not getting fatter. Brits like me can no longer console themselves that however bad the obesity epidemic may be in the UK, it will always be worse in the USA. Mind you, we are quite a way behind; and Americans still cherish their obesogenic environment by never serving portions that are less than twice the amount required. It’s just that nowadays in middle class circles it tends to contain a lot of unidentifiable greenery and some grated carrot. A plateau has been reached at every age group in the US, according to the latest figures from NHANHES. The 2010 obesity level was 17% overall in children and adolescents, and 36% in adults, with higher levels in black and Mexican Americans. The awful fact is that for those already obese, this is virtually irreversible by any non-surgical intervention, individual or societal.

Lancet  4 Feb 2012  Vol 379

453    I recommend the editorial on this study of cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC). State-of-the-art cardiac MRI is pretty amazing at spotting coronary atheroma, and better than state-of-the-art CT (SPECT); but that is no reason to rush to adopt the new technology. Robert Bonow’s words have resonances far beyond cardiac imaging: “Enhanced diagnostic accuracy of CMR must be balanced against availability and cost-effectiveness, and there is a need for evidence of measurable improvements in patient outcomes. Diagnosis of coronary artery disease alone is not sufficient to determine the need for revascularisation. To show value, advances in imaging must be coupled with enhanced patient well-being or a reduction in unnecessary downstream testing and procedures.”

BMJ  4 Feb 2012  Vol 344

Three papers in this week’s BMJ examine the decline in mortality from myocardial infarction in European countries. The first is England, a part of the United Kingdom which was oddly missing from the European MONICA study in the 1980s and 1990s. This record linkage study shows an astonishing fall in standardized mortality from myocardial infarction of one half between 2002 and 2010. This is unevenly spread across England, as most things are, but in this case there is no evidence of a clear North/South divide. Nearly half of the drop is attributed to improved survival at 30 days. Most deaths from MI in England are now sudden deaths outside hospital.

In Denmark, a similar decline has occurred, but measured over 25 years rather than 8.

The investigators from Poland prefer to measure their halving of cardiac mortality from 1991: “Over half of the recent fall in mortality from coronary heart disease in Poland can be attributed to reductions in major risk factors and about one third to evidence based medical treatments” they conclude. By means of different kinds of modelling, they attribute this to “socioeconomic transformation”, i.e. liberation from the yoke of socialism. Perhaps we in England should attribute ours to Tony Blair, though I would rather not.

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