January 20th, 2014

Selections from Richard Lehman’s Literature Review: January 20th

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  15 Jan 2014  Vol 311

Calcium Density of Coronary Artery Plaque and Risk of Incident CV Events (pg. 271): My take on coronary calcium scoring is simple: if you are worried enough to think about it, just swallow a statin every night and take more exercise. But like the medieval theologians who supposedly argued about how many angels could fit on the end of a pin, the coronary artery calcium scorers have taken to arguing about how thick the calcium needs to be. Bizarrely, the thinner the calcium, the more dangerous it seems to be. You can read the full paper for nothing. But you’d be better off going for a walk and eating an orange.

Prevalence of Vascular Complications Among Patients With Glucokinase Mutations and Prolonged, Mild Hyperglycemia (pg. 279): This British study looks at a set of individuals who are genetically programmed to run at a higher “normal” level of blood glucose than the rest of us, because they carry heterozygous, inactivating glucokinase (GCK) mutations. They run at a mean HbA1c of 6.9% and provide an interesting insight into the long-term significance of high sugar in isolation: “Despite a median duration of 48.6 years of hyperglycemia, patients with a GCK mutation had low prevalence of microvascular and macrovascular complications.” By contrast, a cohort of similar age who had developed type 2 diabetes of youth had a horrific rate of macrovascular and microvascular complications. There is so much more to “type 2 diabetes” than sugar.

BMJ  18 Jan 2014  Vol 347

Dietary Fiber Intake and Risk of CV Disease: You have to be very old to remember the fibre needle. It was used to play shellac discs revolving at 78rpm on machines which produced sound by mechanical amplification. I am reminded of them by this systematic review of dietary fibre intake and cardiovascular disease. As far as I am concerned, this is just another case of medieval theologians counting angels on the head of a fibre needle. In the real world, we eat food, not fibre. Things that we know are good for the heart, like fresh fruit and vegetables, happen to contain a lot of cellulose. This counts as insoluble fibre—or is it soluble?—who cares. If you want the theology, turn to an editorial which worries about people not eating enough brown rice. If you want a life, go for a walk and eat an orange. Play some 78s. Drink wine. Eat fish. Dig the garden, using plenty of fibre as compost, because this is the best way for fibre to help your heart.


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