December 8th, 2014
Selections from Richard Lehman’s Literature Review: December 8th
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 4 December 2014 Vol 371
Surgical Treatment of Moderate Ischemic Mitral Regurgitation (pg. 2178): When I first read about “functional” mitral regurgitation in echo reports of my heart failure patients in the 1990s, I wondered if anybody had done a trial to see if mitral valve repair might help this. Well, it’s now been done and the answer is no, probably. The trial randomly assigned 301 patients with moderate ischaemic mitral regurgitation to coronary artery bypass alone or CABG plus mitral-valve repair. The mean age of the patients was 64-5, and most of them had New York Heart Association (NYHA) grade 3-4 heart failure, although those in the group randomised to valve surgery were slightly younger and fitter. Despite that, they showed no benefit at one year judged by left ventricular end-systolic volume index (a surrogate for adverse remodelling), and inevitably had longer hospital stays and more neurological complications.
JAMA 3 December 2014 Vol 312
Effect of Screening for CAD Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes (pg. 2234): Find and cure: identify those at greatest peril and save their lives by early intervention. That’s the great sales pitch for screening but it’s seldom true. To be sure, lots of people with type 1 or 2 diabetes have silent coronary artery disease and many of them will die from it, but it does not follow that picking it up early with CT angiography will work better than giving preventive drugs to everybody. The FACTOR-64 trial shows that “among asymptomatic patients with type 1 or type 2 diabetes, use of CCTA to screen for CAD did not reduce the composite rate of all cause mortality, nonfatal MI, or unstable angina requiring hospitalization at 4 years. These findings do not support CCTA screening in this population.”
The BMJ 6 December 2014 Vol 349
Mediterranean Diet and Telomere Length in Nurses’ Health Study: Telomeres tell us how long we’ve got left, right? And they can be shortened by bad behaviour but never lengthened by good? I hope I understand the telomere, since it is the latest vehicle for trying to prove that the Mediterranean diet is a good thing. As I have told you almost every week, the Nurses’ Health Study enrolled 121 700 American nurses in 1976, and not one was male. Many of them kept food diaries and most had lots of blood tests. From these we can assess the “Mediterraneity” of their diets, and also measure how their telomeres changed over time, as the Fates snipped at them with their abhorred shears until the day of their personal doom. It seems that if you eat the necessary amount of whatever diet dweebs deem to be Mediterranean, the Fates will do less snipping. I tell you this because it is in The BMJ.