Nicholas Downing, MD

All posts by Nicholas Downing, MD

February 27th, 2014

U.K. Geriatrician: Statins, Antihypertensives “Greatly” Overprescribed for Adults 80 and Older

“The data strongly suggest that we are over-treating many healthy patients aged 80+ regarding stroke prevention,” concludes U.K. geriatrician Kit Byatt in a perspective published in Evidence-Based Medicine. Byatt offers a brief review of the evidence, noting that the large HYVET study in China and Europe showed only modest stroke-prevention benefits with antihypertensive therapy in those […]

February 11th, 2014

FDA Advisers: Meta-Analysis Does Not Prove That Naproxen Carries Lower CV Risk

Data from a meta-analysis suggesting that naproxen carries lower cardiovascular risk than other nonsteroidal anti-inflammatory drug are not reliable, FDA advisers concluded on Tuesday. Consequently, they voted that naproxen should not get a new label based on those data, Reuters reports. The meta-analysis, published in the Lancet in 2013, found that coxibs or diclofenac conferred increased […]

February 6th, 2014

First-Ever Guidelines Issued on Stroke Prevention in Women

The American Heart Association and American Stroke Association have issued the first stroke-prevention guidelines that focus on women’s unique risks. Among the recommendations: Pregnant women with chronic hypertension or a history of pregnancy-related hypertension should take low-dose aspirin, beginning at 12 weeks’ gestation, to reduce pre-eclampsia risk. Preeclampsia is a risk factor for stroke later in life, […]

February 3rd, 2014

Intensive BP, Lipid Lowering Does Not Protect Against Cognitive Decline in Diabetics

Intensive treatment of blood pressure or cholesterol does not slow the rate of cognitive decline in adults with type 2 diabetes, according to a substudy of the ACCORD trial published in JAMA Internal Medicine. Some 3000 older adults with poorly controlled diabetes, high cardiovascular risk, and no evidence of cognitive impairment were assigned to one of […]

January 27th, 2014

USPSTF Issues Draft Recommendations on Abdominal Aortic Aneurysm Screening

The U.S. Preventive Services Task Force now says that the evidence is insufficient to weigh the benefits and harms of screening for abdominal aortic aneurysm (AAA) in women aged 65 to 75 who’ve ever smoked. In its previous 2005 guideline the USPFSTF clearly advised against screening for all women. An updated review by the Task Force […]

November 6th, 2013

FDA Issues Recommendations on Spinal Catheters & Enoxaparin

The FDA is advising clinicians to “carefully consider” the timing of spinal catheter insertion and removal in patients taking low-molecular-weight heparins (e.g., Lovenox and generic enoxaparin), with an additional recommendation to delay dosing these drugs after catheter removal to lower the risk for spinal column bleeding and paralysis. Among the specific recommendations: Spinal catheter placement […]

November 6th, 2013

ACE Inhibitors, Angiotensin-Receptor Blockers Tied to Increase in Kidney Admissions

Increases in prescriptions for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in recent years may have contributed to an increase in hospital admissions for acute kidney injury, according to a PLoS ONE study. U.K. researchers examined national prescription and hospital admission data from April 2007 through March 2011. Nationwide, ACE-inhibitor and ARB prescriptions increased […]

October 8th, 2013

Screen Kids for High Blood Pressure? USPSTF Says There’s Still Not Enough Evidence

In a reaffirmation of its 2003 guidance, the U.S. Preventive Services Task Force maintains that the evidence is insufficient to “assess the balance of benefits and harms” of screening for hypertension in asymptomatic children and adolescents to help lower their future risk for cardiovascular disease. The group’s statement is published in the Annals of Internal […]

September 19th, 2013

Clopidogrel’s Benefits Seen Mainly in Smokers

Clopidogrel appears to offer more protection against cardiovascular events among smokers than nonsmokers, according to a systematic review in BMJ. Researchers examined data from six randomized trials comparing clopidogrel (alone or with aspirin) with control treatments (namely, aspirin alone or lower-dose clopidogrel plus aspirin). Nearly 75,000 patients with established cardiovascular disease, 30% of whom were smokers, […]

August 29th, 2013

Statins Reduce Cardiovascular Events in Elders Without Established CVD

Statins are associated with lower risks for myocardial infarction and stroke among elders without established cardiovascular disease, according to a meta-analysis in the Journal of the American College of Cardiology. The analysis included eight randomized, placebo-controlled trials comprising nearly 25,000 patients aged 65 and older without CVD at baseline. During 3.5 years’ follow-up, statin use was […]