May 27th, 2014
Selections from Richard Lehman’s Literature Review: May 27th
Richard Lehman, BM, BCh, MRCGP
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 14-21 May 2014 Vol 311
Effect of Evolocumab or Ezetimibe Added to Moderate- or High-Intensity Statin Therapy on LDL-C Lowering in Patients With Hypercholesterolemia (pg. 1870): “This trial was funded by Amgen Inc, which was responsible for the design and conduct of the study as well as data collection and interpretation, management, and analysis.” For some reason, JAMA, which rarely get papers like this, chose to print this statement way down amongst the final credits. Well, you kind of knew it anyway. When it takes 198 sites in 17 countries to collect just over 2000 people with the commonest kind of “dyslipidaemia” and the trial is run for just 12 weeks with a surrogate marker as the primary outcome, you know this is an old fashioned, business-as-usual, spread-our-influence, place-our-product type of exercise. The stuff, by the way, is called evolocumab and it will be many years before we know if it helps or harms people in the long term, besides lowering LDL-cholesterol. Let’s hope it isn’t licensed until we do know.
JAMA Intern Med May 2014
National Trends in US Hospital Admissions for Hyperglycemia and Hypoglycemia Among Medicare Beneficiaries, 1999 to 2011 (OL): Hypoglycaemia has overtaken hyperglycaemia as a cause of Medicare diabetic admissions in the USA. The figures are taken from the records of almost 34 million beneficiaries aged 65 or over, analyzed from 1999 to 2010, and the first author of the study is Kasia Lipska, a young diabetologist from Yale. I must declare an interest because she has been a friend ever since she first welcomed John Yudkin and me on our first trip to Yale. This is a great bit of outcomes research, reflecting changes in the management of elderly diabetics over that period. It will be interesting to map trends over the next 10 years, as patient-centred care gradually pervades this corner of medicine.
Decade-Long Trends in Mortality Among Patients With and Without Diabetes Mellitus at a Major Academic Medical Center (OL): Some things are already going right with diabetes care. Another Yale paper looks at mortality trends in diabetic patients admitted to Yale New Haven hospital over the same period, 1999-2011. Here the trend is very striking indeed: for most of that period, you were twice as likely to die in hospital if you had diabetes, but in the last four years the difference has disappeared.
Lancet 17/24 May 2014 Vol 383
Cardiovascular Remodelling in CAD and HF (OL): Cardiovascular remodelling in coronary artery disease and heart failure is a favourite topic with cardiologists on both sides of the Atlantic—hi over there, yes, make that remodeling and favorite. The article begins: “‘The heart is the beginning of life, for it is by the heart the blood is moved…the source of all action,’ wrote William Harvey in 1673.” Since Harvey died on June 3, 1657, this is very remarkable. The article ranges widely, and probably isn’t of huge interest to most generalists, but for those who like this sort of thing, there is a wealth of mechanistic detail which goes much further than the usual simple accounts of cardiac remodelling. In fact the main focus is more on the arterioles and the microvasculature. Therapeutic consequences from all this new knowledge are repeatedly described as “disappointing.”