July 23rd, 2012

Selections from Richard Lehman’s Literature Review: July 23rd

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.

Lancet  21 July 2012  Vol 380

The Effect of Physical Inactivity on Worldwide Health (pg. 219):  The dear old Lancet has the usual spread of articles this week, beginning with a global modelling paper from six prestigious centres which tells us to get off our bottoms and jolly well increase the average world life expectancy by 0.68 years. A surprisingly exact figure, given that nobody can possibly quantify the earth’s store of human idleness: but of course it is the sort of thing that gets into the news media and spawns a fine range of puritanical commentary pieces elsewhere in this Lancet. Why, it nearly had me going for a walk.

Transplantation of a Vein Bioengineered with Autologous Stem Cells (pg. 230): Another Horton favourite follows: clever men grow new vein on dead man’s, child’s life is saved. Or to put it another way, this is a proof-of-concept study demonstrating clinical transplantation of a deceased donor iliac vein graft repopulated with recipient autologous stem cells in a patient with extrahepatic portal vein obstruction. An interesting technical feat which has succeeded in one ten year old girl, needing no immune suppression. Why, you could almost say that further studies are needed.

Flecainide for Preventing AF after Electrical Cardioversion (pg. 238):  Now for a randomized controlled trial: the question it seeks to answer is whether a 4-week course of flecainide is as good as a long-term flecainide for preventing the recurrence of atrial fibrillation after electrical cardioversion. For good measure, there was a no-treatment arm as well—not placebo, because allocation was not blinded. In fact, short-term flecainide is probably not as good as long-term flecainide at preventing recurrent AF (but long-term has other dangers). The excellent editorial that accompanies the paper says that “non-inferiority could not be established.” This may sound ugly but is a necessary use of the technical term “non-inferiority”, because in this case actual inferiority was not established (95% CI -1.7 to 17.7, p=0.208).

BMJ  21 July 2012  Vol 345

Bevacizumab and Ranibizumab Not Associated with Certain CV Risks: An increasing number of high-risk, mostly elderly individuals are receiving treatment with vascular endothelial factor inhibitors by intravitreal injection, usually for macular degeneration, but increasingly for diabetic macular oedema too. So it was a good idea on the part of these Canadian investigators to examine a large cohort of Ontarians who had received treatment with bevacizumab or ranibizumab to see if they showed an excess incidence of ischaemic stroke, acute myocardial infarction, congestive heart failure, or venous thromboembolism. They didn’t.



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