January 13th, 2014

Selections from Richard Lehman’s Literature Review: January 13th

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 Internal Medicine  Jan 2014  Vol 174

MI and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome (pg. 15): I can remember chatting with a cardiology professor about fifteen years ago, when the concepts of “insulin resistance” and the “metabolic syndrome” were becoming fashionable. “It’s just a way of calling people fat, isn’t it?” he said. And that, by and large, is what this Danish population study finds. “We examined 71 527 individuals from the Copenhagen General Population Study and categorized them according to body mass index (BMI) as normal weight, overweight, or obese and according to absence or presence of metabolic syndrome.” “Conclusions and Relevance:  These findings suggest that overweight and obesity are risk factors for MI and IHD regardless of the presence or absence of metabolic syndrome and that metabolic syndrome is no more valuable than BMI in identifying individuals at risk.”

Lower Risk of CV Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens (pg. 25): Ever since the Women’s Health Initiative trial showed increased risk in women randomised to postmenopausal hormone replacement, doctors have been beating themselves up for prescribing oestrogens so widely for menopausal symptoms. But actually we were often prescribing different drugs from those used in WHI to women quite different from the WHI subjects. In the trial, the oestrogen used was the old fashioned one derived from pregnant mares’ urine—Premarin or conjugated equine estrogens (CEEs). Moving to American spellings, the alternative is synthetic estradiol. And here is another North American study showing that the two have different risks: “In an observational study of oral hormone therapy users, CEEs use was associated with a higher risk of incident venous thrombosis and possibly myocardial infarction than estradiol use.”

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