April 22nd, 2013

Selections from Richard Lehman’s Literature Review: April 22nd

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  17 Apr 2013  Vol 309

Prevalence of a Healthy Lifestyle Among Individuals with CV Disease in High-, Middle-, and Low-Income Countries (pg. 1613): As the saying goes, death is Nature’s way of telling you to slow down. Short of death, coronary heart disease and stroke could be thought of as timely reminders to get fit. But people who have CHD or stroke seem remarkably resistant to heed Nature’s warning: in rich countries and poorer countries alike, they continue to have sedentary lifestyles, and few alter their diet. But at least 50% of them give up smoking.

NEJM  18 Apr 2013  Vol 368

Nonemergency PCI at Hospitals with or without On-Site Cardiac Surgery (pg. 1498): Many hospitals in the USA offer percutaneous coronary intervention although they lack on-site cardiac surgery facilities should things go wrong. This study of Massachusetts hospitals shows that non-emergency PCI has now become such a safe procedure that it there is no difference in outcomes between hospitals with or without on-site surgical rescue.

BMJ  21 Apr 2013  Vol 346

Coronary Artery Calcium Score Prediction of All Cause Mortality and CV Events in People with Type 2 Diabetes: Here’s a systematic review of coronary calcium scoring in type 2 diabetes. The BMJ likes to publish systematic reviews, which are supposed to tell us what to believe from close study and aggregation of the best randomized trials. To read what I think about that, you’ll need to look at a piece of mine called Nullius in Verba which is out in the forthcoming issue of JAMA Internal Medicine. Systematic reviews need taking with a pinch of salt, as last week’s BMJ offerings proved. But back to coronary calcium scoring in diabetes: why do it in the first place? The obvious answer is to select high risk patients for more intensive treatment—the excuse always given for doing all sorts of futile prognostic testing. Coronary calcium scoring is useless for this—it has high sensitivity, but low specificity. Right then, don’t despair—let’s use it for identifying low risk patients for less intensive treatment. In theory, you could do this—but in practice, would you really want to subject all your diabetic patients to an expensive, high radiation procedure which would cause unnecessary anxiety in 20 for every lucky one who could then be offered one (statin) tablet less a day?

Comments are closed.