October 21st, 2013
Selections from Richard Lehman’s Literature Review: October 21st
CardioExchange is pleased to reprint this selection 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 14 Oct 2013 Vol 173
Cholecalciferol Treatment to Reduce BP in Older Patients With Isolated Systolic Hypertension (pg. 1672): Vitamin D is a most annoying vitamin. Observational studies link it to all sorts of things, like cognitive function, cardiovascular health, muscular strength, and pretty well everything else you want to hang on to. There are vitamin D receptors all over the body, with lots in the brain and arteries. But if you give extra vitamin D to people, it generally doesn’t do anything measurable. I suspect that this is because you need to have had enough early in life, perhaps even prenatally. By the time you are old and have systolic hypertension, meaning your arteries are stiff, it is a tall order to expect vitamin D to bring back their bounce. And indeed this trial of cholecalciferol to improve isolated systolic hypertension in the over-70s achieved nothing.
JAMA 16 Oct 2013 Vol 310
Quality of Life After PCI vs. CABG Among Patients With Diabetes and Multivessel CAD (pg. 1581): The FREEDOM trial showed that in patients with type 2 diabetes and multi-vessel coronary disease, coronary artery bypass graft (CABG) surgery resulted in lower rates of death and myocardial infarction, but a higher risk of stroke when compared with percutaneous coronary intervention (PCI) using drug-eluting stents. There is complete equipoise between the options, so the patient should be the one to decide. And thanks to the use of the Seattle Angina Questionnaire throughout the follow-up period, we have a very good idea of how the two procedures affected the way patients felt and functioned after the two procedures. For the first two years, there was a slight advantage in the CABG group, but after that it was no longer discernible. There’s a crying need for a decision aid to be used by all patients and doctors facing these alternatives.
BMJ 19 Oct 2013 Vol 347
BP Lowering and Major CV Events in People With and Without CKD: What is the best blood pressure treatment for lowering cardiovascular risk in people with mildly lowered renal function and raised BP? An ACE inhibitor? An angiotensin blocking agent? Not according to this meta-analysis of individual patient data from 23 randomized trials, with summary data from another three. “The results were similar irrespective of whether blood pressure was reduced by regimens based on angiotensin converting enzyme inhibitors, calcium antagonists, or diuretics/β blockers. There was no evidence that the effects of different drug classes on major cardiovascular events varied between patients with different eGFR.”