June 23rd, 2014

Selections from Richard Lehman’s Literature Review: June 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.

NEJM 19 Jun 2014 Vol 370

Antidepressant Use in Pregnancy and the Risk of Cardiac Defects (pg. 2397): The serotonin reuptake inhibitors have been one of pharma’s greatest success stories of the last quarter century. Easy to start and hard to stop, they can be tried for almost anything that makes people feel down, and at almost any age. As a result, a large number of women become pregnant while taking an SRI. Within the Medicaid system alone, 64 389 women (6.8%) used antidepressants during the first trimester between the years 2000 and 2007. What happened to their babies? It seems that they have no significant added risk of cardiovascular abnormalities. If there are other harms, we don’t yet know.

JAMA 18 Jun 2014 Vol 311

Thrombolysis for PE and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Hemorrhage (pg. 2414): Geoffrey Rose said that “There is no disease that you either have or don’t have—except perhaps sudden death or rabies. All other diseases you either have a little or a lot of.” This is true of pulmonary embolism, as I keep pointing out. It is demonstrated by this meta-analysis of “Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial Haemorrhage.” “Among patients with pulmonary embolism, including those who were hemodynamically stable with right ventricular dysfunction, thrombolytic therapy was associated with lower rates of all-cause mortality and increased risks of major bleeding and ICH. However, findings may not apply to patients with pulmonary embolism who are hemodynamically stable without right ventricular dysfunction.”

The BMJ 21 Jun 2014 Vol 348

Effect of Screening and Lifestyle Counselling on Incidence of Ischemic Heart Disease in General Population: Here is a truly important study that needs to be mulled over. In a Danish group of 6000 people at high risk of cardiovascular disease, “After five years of counselling a significant effect on lifestyle was seen, with a substantial reduction in the prevalence of smoking, improved dietary habits, sustained physical activity (among men), and a decrease in binge drinking. Furthermore, a significant improvement in self reported mental health and sustained self reported physical health occurred. These findings indicate that counselling promotes beneficial changes at the individual level for at least a limited period of time.” But this intervention had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years. The individuals benefited, but the “population” did not. Does this negate the value of the intervention? I think not, but then I am not a public health physician.


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