September 6th, 2012
Selections from Richard Lehman’s Literature Review: September 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.
NEJM 30 Aug 2012 Vol 367
Aspirin Plus Clopidogrel in Patients with Recent Lacunar Stroke (pg. 817): Aspirin is an annoyingly good drug, which may have made Bayer’s fortune over a century ago but makes nobody much money now. Nonetheless, drug companies continue to seek for a marketable antiplatelet drug to replace or complement aspirin, and clopidogrel has been a very nice little earner during the period of its patent. This trial sought to establish whether combining clopidogrel with aspirin would reduce recurrent stroke after recent lacunar stroke. The aspirin dose was set high at 325mg, and adding clopidogrel to this made no difference to stroke recurrence but did cause more intracranial haemorrhage and was associated with higher mortality.
Lancet 1 Sep 2012 Vol 380
Risk of Coronary Events in Patients with CKD or Diabetes (pg. 807): In my last two weekly reviews, I’ve railed against the use of the expression chronic kidney disease without further explanation of what is actually meant. This paper adds a new twist to the crime: it uses a cut off eGFR of less than 60 in some places, and an eGFR of 45 in others. It refers to 3 grades of proteinuria, and finds that only the top level is predictive; but elsewhere the authors freely use the word “proteinuria,” without specifying its precise meaning or its relationship to eGFR. Most annoyingly of all, the authors talk about CKD in terms of how it compares with type 2 diabetes as a risk for myocardial infarction, usually without adjustment for age. As a result, this analysis of data from the Alberta Kidney Disease Network and the National Health and Nutrition Examination Survey (NHANES) 2003-06 manages to be exceedingly cumbrous while failing to convey any clear clinical message. It will no doubt be used by advocates of universal screening for CKD—ignoring the fact the mean age of the “at-risk” group here was 71, an age at which most people should have been taking statins for 20 years if they wish to reduce their odds of cardiovascular disease—irrespective of their kidney function, or indeed their blood sugar.