December 23rd, 2013
Selections from Richard Lehman’s Literature Review: December 23rd
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 18 Dec 2013 Vol 310
Three vs. Twelve Months of Dual Antiplatelet Therapy After Zotarolimus-Eluting Stents (pg. 2510): Ah, and now for some industry based research. The mechanistic model that industry loves is that coronary arteries are like blocked pipes. You put in a device to unblock them, and people get better. Then you add an agent to thin the blood and stop the stent blocking. Now consider all the different kinds of stent, and all the different kinds of blood thinning agents, and all the doses you can use them at, and all the different durations you can devise, and every comparison you could make between each. I doubt whether you could actually do all the possible trials before the sun burns itself up and the human race becomes extinct. Consider then the importance of the OPTIMIZE trial, comparing Three versus Twelve Months of Dual Antiplatelet Therapy After Zotarolimus-Eluting Stents. I would suggest that in the context of eternity (sub specie aeternitatis) this trial is not worth the time it takes you to read about it; but as a source of reprint income it may have some importance to JAMA.
Low-Dose Dopamine or Low-Dose Nesiritide in Acute HF With Renal Dysfunction (pg. 2533): The acutely failing heart is not much good at maintaining a circulation, but it is very good at pumping out large amounts of natriuretic peptides. That’s why I’ve always thought it a bizarre idea that adding extra natriuretic peptide analogues would make any difference to the treatment of acute heart failure; and in fact the BNP analogue nesiritide all but fell out of use when a properly conducted trial showed that it did nothing. But still they try. In this trial, nesiritide was compared with dopamine or placebo in patients admitted with acute HF and renal dysfunction, who were given diuretics as needed. Decongestion was measured by urine output and renal function by cystatin C. There was no difference between groups.
BMJ 21 Dec 2013 Vol 347
A Statin a Day Keeps the Doctor Away: The Christmas BMJ this year is a classic. Much publicity has attended the semi-serious article comparing an apple a day with a statin. The references are really helpful and I intend to use them in a decision tool.