March 23rd, 2015
Selections from Richard Lehman’s Literature Review: March 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.
JAMA 17 Mar 2015 Vol 313
Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting Coronary Stents (pg. 1113): This paper is based on the DAPT trial which randomised people to receive long-term or standard duration dual antiplatelet treatment after coronary stenting. The title of the paper implies that we’ll get a full report of the trial but in fact we only get the subset of 1687 patients who received bare metal stents (BMS) rather than drug-eluting stents. Continuing a combination of aspirin and a thienopyridine (clopidogrel or pasugrel) for 30 months in these patients achieved “no statistically significant differences in rates of stent thrombosis, major adverse cardiac and cerebrovascular events, or moderate or severe bleeding. However, the BMS subset may have been underpowered to identify such differences, and further trials are suggested.” Hmm.
The BMJ 21 Mar 2015 Vol 385
School Based Education Program to Reduce Salt Intake in Children and Their Families: “There is compelling evidence in adults that a modest reduction in salt intake lowers blood pressure and reduces the risk of cardiovascular disease. Indeed, salt reduction is one of the most cost effective measures to prevent cardiovascular disease in both developed and developing countries.” The first author on this study is also the first author of a Cochrane review which recommends salt reduction, as opposed to other Cochrane reviews which find insufficient evidence. If looking at his references convinces you this is true, read the rest of the paper. It is all about an intervention that reduces salt intake in Chinese children. Even I think this may be a good thing, because the one thing I have against Chinese food is that it’s often too salty to enjoy properly. And that is the only valid end-point when it comes to diet.
“Thrombolysis in acute ischaemic stroke: time for a rethink?” is a pretty challenging title, but it turns out that Brian Alper and colleagues are only questioning its use after the three-hour mark. If you like this kind of thing, this is a very well-ordered and referenced piece of argument.