August 28th, 2012
Selections from Richard Lehman’s Literature Review: August 28th
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.
JAMA 22-29 Aug 2012 Vol 308
Biolimus-Eluting Stents with Biodegradable Polymer vs. Bare-Metal Stents (pg. 777): A new stent from Switzerland! Don’t all leave the room at once. Sit down and make yourselves COMFORTABLE while I tell you the story of poor little Bi, who got parted from the rest of the Olimus family early on in life and remained lonely and stranded in Europe. Meanwhile, her brothers and sisters Sir, Zotar, Ever and Tacr were leading a high old life in America. How could poor little Bi Olimus ever get to join them? Well, one day she met a group of Swiss Mountain Wizards called Biosensors Europe SA: they devised a special stent with a biodegradable coating and put little biolimus right inside it. Then they tested their new stent on people who had heart attacks in places around Europe and Israel. And do you know, exactly the same number of people died if they had the new stents as they did if they had bare metal stents, but the ones who had biolimus stents had fewer blockages later on. So now little Bi Olimus has bought her plane ticket and has high hopes of joining the other Olimusses in the Land of the Free, to make her fortune in the Great Stent Market.
Risk Markers to Improve CV Event Prediction (pg. 788): Novel risk markers to improve cardiovascular event prediction in intermediate risk individuals! Don’t all leave the room this time either! I will try to make this interesting. Actually, on second thoughts I won’t attempt the impossible: just look at the ROC curves. If you add coronary artery calcium, ankle-brachial index, high-sensitivity CRP, and family history to the Framingham Risk score you increase the area under the curve. It still isn’t that great, but out of this lot, coronary calcium adds the most. Maybe you find this useful.
Common Carotid Intima-Media Thickness and CV Risk Prediction (pg. 796): And then of course there is common carotid intima-media thickness. No, please please stay in the room! I shall be very brief. Once we were all persuaded that CIMT was the bee’s knees in risk prediction. Now we are all dumping it because, as this meta-analysis shows, “The addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.” Someone needs to remind me how we got fooled by this surrogate in the first place; it was all so long ago.
Lancet 25 Aug 2012 Vol 380
Aspirin with Alteplase for Acute Ischemic Stroke? (pg. 731): Here’s a trial aimed at solving the question of whether to give intravenous aspirin together with alteplase in acute ischaemic stroke. The answer is a clear no: neurological outcomes are not improved and there is a greater risk of symptomatic intracranial bleeding.
Ann Intern Med 21 Aug 2012 Vol 157
Lipid-Lowering Therapy in Patients with CKD (pg. 251): If you’re particularly interested in lipid-lowering therapy in people with “chronic kidney disease” then the next two papers may be for you. Decrements in eGFR tend to cause increments in cardiovascular risk, though this is mostly mediated by other factors, such as LDL-cholesterol. I can’t make much sense of the eGFR cut-off of 60, but I’m quite happy to believe the message of this meta-analysis that overall, statins lower cardiovascular risk in this population while having no effect on the progression of kidney disease.
Benefits and Harms of Statins in Patients with CKD (pg. 263): The next meta-analysis (of 80 studies) puts a slightly different twist on the issue: “Statins decrease mortality and cardiovascular events in persons with early stages of CKD, have little or no effect in persons receiving dialysis, and have uncertain effects in kidney transplant recipients.” It would be nice to know that eGFR cut-off.
Tags: alteplase, aspirin, bare metal stents, cardiovascular risk prediction, chronic kidney disease, common carotid intima-media thickness, drug-eluting stents, ischemic stroke, risk markers, statins
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