November 25th, 2013

Selections from Richard Lehman’s Literature Review: November 25th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

Lancet  23 Nov 2013  Vol 382

DAPT Cessation and Coronary Events After PCI (pg. 1714): This article describes the results of a prospective study of just over 5,000 patients who underwent coronary stenting in Europe and the USA. As the stents were all drug-eluting, everybody received aspirin plus a thienopyridine (usually clopidogrel): this is called dual anti-platelet therapy or DAPT, and was meant to continue for 2 years. But over this period, more than half the cohort gave up DAPT at some point, usually continuing aspirin and dropping the thienopyridine. Now comes the analysis, and I defy anyone to summarise it simply. The take home message seems to be that after the first few weeks it seems to make remarkably little difference to restenosis rates whether or not you comply fully with DAPT, but it’s still just a bit safer to carry on if you can.

Ann Intern Med  19 Nov 2013  Vol 159

Association Between Exposure to Low to Moderate Arsenic Levels and Incident CVD (pg. 649): Funny how some words get people reading. “Arsenic” was one of Agatha Christie’s favourites, and in England at any rate it is hard to think of arsenic without Old Lace. The website of Annals this week features a blackboard with As written in red and surrounded by its atomic properties. And that’s about as good as it gets. The actual study featuring arsenic consists of a single measurement of inorganic and methylated arsenic species in urine at baseline in a cohort of Native Americans, compared with their incidence of cardiovascular disease in subsequent years. That’s it. There might be some association, but the more you adjust for confounding factors, the less it gets. Next: Old Lace.

Comparative Safety of Vascular Closure Devices and Manual Closure Among Patients Having PCI (pg. 660): The closest I ever come to being involved with percutaneous coronary intervention is when I see patients with nasty femoral haematomas following the procedure. This study looks at 85 048 PCIs done in Michigan from 2007 to 2009. It would be interesting to know how many of them were really needed, but that’s not the point of this study. Just over a third of these patients had a vascular closure device placed over the site of femoral puncture, and these patients had fewer complications and fewer transfusions. If you’re an interventional cardiologist, read on for the subgroup effects, etc.

Statins and Cognitive Function (pg. 688): Nine systematic reviewers trawl through the literature to see if there is any evidence to support the FDA’s warning about possible cognitive impairment due to statins. There is not: all the evidence is less than first rate, but none of it supports an association. In particular, “Examination of the FDA postmarketing surveillance databases revealed a low reporting rate for cognitive-related adverse events with statins that was similar to the rates seen with other commonly prescribed cardiovascular medications.” I have no idea why people are currently going to such lengths to suggest that statins have hidden harms and should not be “overprescribed.” Personally I can’t see any reason why anybody should be worried about taking a statin if they so wish, but that may be because I am really a rare example of statin-related cognitive impairment.


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