September 29th, 2014

Selections from Richard Lehman’s Literature Review: September 29th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

JAMA 24 September 2014 Vol 312

Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 Years, United States, 1980-2012 (pg. 1218): A survey of new diagnosis of diabetes in the USA shows a doubling between 1990 and 2008, followed by a plateau, and even, wonder of wonders, a dip thereafter. This is virtually the same plot as obesity over there. And what about over here? I can’t find an up to date plot, although Diabetes UK declares that “Most health experts agree that the UK is facing a huge increase in the number of people with diabetes.” I guess if I looked at the Tesco website a while ago I might have found that “most experts agree that Tesco is facing a huge increase in profits,” but I would have done better to look at the account books.

Lancet 27 September 2014 Vol 384

Losmapimod, a Novel p38 Mitogen-Activated Protein Kinase Inhibitor, in Non-ST-Segment Elevation Myocardial Infarction (pg. 1187): I’ve already warned you that we would be coming upon losmapimod. It is a p38 mitogen activated protein kinase inhibitor. Understand? It doesn’t matter whether you do or not, because losmapimod did nothing at all in this phase 2 trial, where it was given for 12 weeks after non-ST elevation myocardial infarction. At this rate, it won’t even be around long enough to form a useful rhyme word with god.

Ann Intern Med 16 September 2014 Vol 161

Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction (pg. 392): I have been a bit neglectful towards the Annals of Internal Medicine of late, but a sparse week in the other journals led me to look at it. It’s perhaps worth pointing your attention to a randomised trial, which shows that coronary artery bypass surgery can be beneficial for some high risk patients with ischemic left ventricular dysfunction. That was certainly my experience with two youngish patients who were constantly decompensating before they had surgery, but general practice can provide a very misleading sample, and most of my reading since then has suggested that “hibernating myocardium” generally stays asleep, revascularise it as you may. But this trial, on patients with ejection fraction less than 35%, randomly assigned 602 patients to medical therapy alone and 610 to medical therapy plus CABG. The main sustained improvement in the CABG group was in quality of life—very worthwhile, since it can be pretty awful in this patient group.

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