January 5th, 2015
Selections from Richard Lehman’s Literature Review: January 5th
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 24-31 December 2014 Vol 312
Metformin in Patients With Type 2 Diabetes and Kidney Disease (pg. 2668): Back in the mists of time, when I was a long haired medical student with sideburns, there was a drug for type 2 diabetes called phenformin. We were taught not to use it for fear of lactic acidosis, which could be fatal, but to use the newer biguanide metformin instead. By the time I did any actual prescribing for type 2 diabetes, phenformin had disappeared, but some of its ill repute had rubbed off on metformin, which (incredibly) was not licensed for use in America until 1994. Observationally, metformin is the least bad drug to give to people with T2DM, with more favourable cardiovascular outcomes than its rivals and a rate of lactic acidosis indistinguishable from the base rate in diabetes. But its use in people with renal impairment is still hedged with cautions. This excellent review of the evidence suggests that in people with an eGFR above 30, metformin is the first choice drug for T2DM provided that regular monitoring is in place.
Arch Intern Med January 2015 Vol 175
Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings (OL): There used to be a joke doing the rounds in my junior doctor days about the local teaching hospital cardiologist: “What is the difference between a consultant cardiologist and God?”—pause for deep thought—”God is everywhere but Dr X is never here.” Cardiologists do indeed seem to have more conferences than other mortals. And a rather detailed study of the absent cardiologist effect suggests that this may be a good thing: “High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with AMI admitted to teaching hospitals during meetings were less likely to receive PCI, without any mortality effect.”
Association of Cardiovascular Trial Registration With Positive Study Findings (OL): A Research Letter gives the conclusions of a survey of cardiovascular trials published in December 2012. Doug Altman and colleagues find that fewer than 50% had been registered according to the definition of the International Committee of Medical Journal Editors. The studies that had been registered were larger and more likely to show strong methodological characteristics, but were less likely to report significant positive findings.
Lancet 3 January 2015 Vol 385
A Bioresorbable Everolimus-Eluting Scaffold vs. a Metallic Everolimus-Eluting Stent for Ischemic Heart Disease Caused by De-Novo Native Coronary Artery Lesions (pg. 43): “A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim one year analysis of clinical and procedural secondary outcomes from a randomised controlled trial.” How the world has longed for this trial! How deeply readers will regret that it is behind a paywall. Abbott Vascular funded the study and “was involved in study design, data collection, data analysis, data interpretation, and writing of this report.” They tell us that it was a draw: “The everolimus-eluting bioresorbable scaffold showed similar one year composite secondary clinical outcomes to the everolimus-eluting metallic stent.” But actually: “There were 17 (5%) major cardiac adverse events in the bioresorbable scaffold group compared with five (3%) events in the metallic stent group, with the most common adverse events being myocardial infarction (15 cases [4%] vs two cases [1%], respectively) and clinically indicated target-lesion revascularisation (four cases [1%] vs three cases [2%], respectively).” So, just four times as many MIs in the first year then. If I were a stentist, I wouldn’t go near these biodegradable things for a long time yet. And by the way, to be at all meaningful, those last percentages should have been 1.2% vs 1.8%.
Tags: bioresorbable everolimus-eluting scaffold, cardiovascular trial registration, hospitalization, ischemic heart disease, kidney disease, metallic everolimus-eluting stent, metformin, mortality, national cardiology meetings, type 2 diabetes
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