October 27th, 2014

Selections from Richard Lehman’s Literature Review: October 27th

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.

Ann Intern Med 21 October 2014 Vol 161

Behavioral Counseling to Promote a Healthy Lifestyle in Persons With Cardiovascular Risk Factors (pg. 568): Golly. Here is a systematic review that shows human behaviour can be changed by an intensive intervention, or, to be more accurate, by a range of intensive interventions. Their aim was to reduce cardiovascular disease in high risk people. This is a really thorough review of 74 trials, done for the US Preventive Services Task Force. The effect sizes found for intermediate outcomes are small, except for preventing diabetes, and few trials report long term cardiovascular outcomes data. But this may be an area where people can benefit from being motivated through suitable exhortation and support. Do I mean getting fitter? Yes, that and reporting proper endpoints in trials.

Lancet 25 October 2014 Vol 384

Long-Term Outcomes After Stenting Versus Endarterectomy for Treatment of Symptomatic Carotid Stenosis (OL): Here’s what a trial should look like. It was well designed and conducted and paid out of public funds, except for carotid stents, which were donated by Sanofi. As a result, we know that carotid endarterectomy and carotid stenting for symptomatic stenosis have very similar long term outcomes. It’s taken a while—the trial started in 2001—but it’s been worth the wait to get a wealth of long term data. Both procedures have possible harms but they are well balanced. On the basis of this trial, patients can have a very clear conversation with health professionals about which treatment to have.

Efficacy of Nitric Oxide, With or Without Continuing Antihypertensive Treatment, for Management of High Blood Pressure in Acute Stroke (OL): Fashions in stroke medicine come and go, although the discipline itself is only about 20 years old. We’ve known for ages that high blood pressure is associated with bad outcome after stroke. So is it best to lower blood pressure as much as possible after an ischaemic stroke? Or to desist, on the basis that the brain needs all the perfusion pressure it can get while it is recovering? The ENOS trial also began in 2001, and as a result we can say that it really doesn’t matter what you do, or whether you use glyceryl trinitrate patches as well. Outcomes were the same whether pre-stroke blood pressure lowering drugs were stopped or continued, and although the GTN patches were well tolerated and lowered blood pressure, they too made no difference to functional outcome.


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