February 4th, 2013

Selections from Richard Lehman’s Literature Review: February 4th

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 Intern Med  28 Jan 2013  Vol 173

Blood Transfusion and Increased Mortality in MI (pg. 132):  One treatment that we are learning to be meaner with is blood transfusion. Several studies in different contexts over the last year have shown that a restrictive transfusion policy is often associated with better survival than a liberal transfusion policy. In this systematic review, the authors look at the literature on transfusion at the time of myocardial infarction. The trials are of variable quality but in terms of all-cause mortality, the message is that less blood is more beneficial.

NEJM  31 Jan 2013  Vol 368

Proteotoxicity and Cardiac Dysfunction (pg. 455):  How nice to read another article about organ failure in old age. Mechanisms of Disease: Proteotoxicity and Cardiac Dysfunction—Alzheimer’s Disease of the Heart? If you trespass beyond the age of 75, your heart may well begin to fail for reasons that are little to do with ischaemia but much to do with stiffening and the general clogging up of cardiomyocytes with defunct protein. At the same time, your brain may be forming plaques and tangles. Bah. Ripe old age means ripe old proteins and time to pack up.
Come Fate with thine abhorrèd shears
And take them to my telomeres.

Lancet  2 Feb 2013  Vol 381

Combined Fitness and Statin Treatment on Mortality Risk in Veterans with Dyslipidaemia (pg. 394):  Ten thousand American veterans with dyslipidaemia in their late fifties were observed for a mean period of 10 years in this cohort study. As expected, those who took a statin had a lower mortality over this period of 9.2% in absolute terms, or in relative terms one third. Fitness, as based on peak metabolic equivalents (MET) achieved during exercise test, demonstrated even larger mortality benefits in this highly selected male population. So although I am not a black American army recruit, I can’t altogether ignore the message that keeps coming back from every observational and interventional study: even quite modest amounts of exercise in older men can lead to big gains in survival.

BMJ   2 Feb 2012  Vol 346

Benefits of β Blockers in Patients with HF and Reduced EF: After the first trials using bisoprolol and carvedilol in heart failure with reduced ejection fraction appeared, great efforts were made to change stable heart failure patients over from other beta-blockers to these particular “evidence-based” agents. I believe this still goes on throughout the UK, consuming the time and effort of numerous heart failure specialist nurses. Desist, dear ladies: several observational studies and now this network meta-analysis have shown that there are probably no mortality differences whatever between different ß-blockers in systolic HF, or if there are, they may even favour atenolol. Nor is the up-titrating of doses based on firm evidence. I have seen no hard data to persuade me that heart failure patients benefit significantly from more than a smallish dose of any ACE inhibitor and a smallish dose of any ß-blocker.

One Response to “Selections from Richard Lehman’s Literature Review: February 4th”

  1. Hari Fondekar, MBBS, MD says:

    I would tend to agree with the above comments.I have a few patients doing well-now in their eighties- and MIs as old as 15 years with poor
    ejection fraction and symptoms of HF improving clinicaly and remainig
    symptomfree on Propranolol as low 10mg.BID.