CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

November 5th, 2012

Selections from Richard Lehman’s Literature Review: November 5th

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.

BMJ 3 Nov 2012 Vol 345

Fish Consumption, Omega-3 Fatty-Acids, and Cerebrovascular Disease: Yes, Jeeves was right: fish is good for the brain. I have told you this before: here is a systematic review of the protection afforded by fish consumption against the risk of cerebrovascular disease. It’s not just the oils: “the beneficial effect of fish intake on cerebrovascular risk is likely to be mediated through the interplay of a wide range of nutrients abundant in fish.” But actually I couldn’t give a hoot: “dietary science” is just a mess of confounders: I eat fish because I like fish.

HRT and Cardiovascular Events in Recently Post-Menopausal Women: This week sees the print version of the now-famous Danish randomized trial of hormone replacement therapy that contradicts the Women’s Health Initiative and shows a cardiovascular protective effect from the early use of HRT. I will leave it to others to discuss the timing hypothesis and so forth. What we need are some good decision aids for women. I nearly said “patients” – but why should taking HRT turn people into patients? Why should doctors in fact have anything to do with an informed woman’s decision about using HRT for postmenopausal symptoms?

Using a Meta-Analysis of Coronary CT Angiography Studies to Assess Diagnostic Tests with a 3×2 Table: All doctors need to become competent diagnosticians. Yet most that I have encountered find it difficult even to use a two-by-two table to assess diagnostic tests. This is not going to change. This important article, based on a meta-analysis of coronary CT angiography studies, urges the adoption of 3 by 2 tables, with an intermediate category of “non-evaluable”. I believe the authors are right: and I believe also that once we have made this move forward, we then have to find ways of making it intuitive and practical for jobbing clinicians.

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One Response to “Selections from Richard Lehman’s Literature Review: November 5th”

  1. Tina Dobsevage, MD says:
    November 5, 2012 at 7:53 pm

    I couldn’t agree more with the first two subjects:

    Eat fish because it tastes good and is good for us as part of the long time recommended Mediterranean diet. AND

    A well informed woman can make her own decisions about HRT for menopausal symptoms. My observation as a clinician is that HRT, especially for women with early menopause is essential to good health through mid life.

    I am very interested in hearing more about the 3×2 table to evaluate diagnostic tests.