Friday, February 28, 2014

"Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome"
JAMA IM
https://archinte.jamanetwork.com/article.aspx?articleid=1770522
"Conclusions and Relevance  These findings suggest that overweight and obesity are risk factors for MI and IHD regardless of the presence or absence of metabolic syndrome and that metabolic syndrome is no more valuable than BMI in identifying individuals at risk."  

Thursday, February 27, 2014

"Outcomes of Temporary Interruption of Rivaroxaban Compared with Warfarin in Patients with Nonvalvular Atrial Fibrillation: Results from ROCKET AF"
Circ
http://circ.ahajournals.org/content/early/2014/02/18/CIRCULATIONAHA.113.005754.abstract
"Conclusions—TI of oral anticoagulation is common and associated with substantial stroke risks and bleeding risks that were similar among patients treated with rivaroxaban or warfarin. Further investigation is needed to determine the optimal management strategy in AF patients requiring TI of anticoagulation."

Wednesday, February 26, 2014

"Eprotirome in patients with familial hypercholesterolaemia (the AKKA trial): a randomised, double-blind, placebo-controlled phase 3 study"
Lancet
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70006-3/fulltext 
"Interpretation
Our findings show that eprotirome can lower LDL cholesterol concentrations in patients with familial hypercholesterolaemia when added to conventional statin treatment with or without ezetimibe, but that it has the potential to induce liver injury. These findings, along with findings of cartilage damage in dogs, raise serious doubts about selective thyroid hormone mimetics as a therapeutic approach to lower LDL cholesterol concentrations."  

Tuesday, February 25, 2014

"Improved Survival with Bevacizumab in Advanced Cervical Cancer"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1309748?query=featured_home 
"CONCLUSIONS  

The addition of bevacizumab to combination chemotherapy in patients with recurrent, persistent, or metastatic cervical cancer was associated with an improvement of 3.7 months in median overall survival. (Funded by the National Cancer Institute; GOG 240 ClinicalTrials.gov number, NCT00803062.)"

Monday, February 24, 2014


"Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2)"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1829990 
"Conclusions and Relevance  Among patients with paroxysmal AF without previous antiarrhythmic drug treatment, radiofrequency ablation compared with antiarrhythmic drugs resulted in a lower rate of recurrent atrial tachyarrhythmias at 2 years. However, recurrence was frequent in both groups."

Saturday, February 22, 2014

Weekly Guideline: Stage 1 to 3 Chronic Kidney Disease

"Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the American College of Physicians"
Annals 2013
http://annals.org/article.aspx?articleid=1757302
"Recommendation 1: ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence)
Recommendation 2: ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II–receptor blocker. (Grade: weak recommendation, low-quality evidence)Recommendation 3: ACP recommends that clinicians select pharmacologic therapy that includes either an angiotensin-converting enzyme inhibitor (moderate-quality evidence) or an angiotensin II–receptor blocker (high-quality evidence) in patients with hypertension and stage 1 to 3 chronic kidney disease. (Grade: strong recommendation)Recommendation 4: ACP recommends that clinicians choose statin therapy to manage elevated low-density lipoprotein in patients with stage 1 to 3 chronic kidney disease. (Grade: strong recommendation, moderate-quality evidence)"

Friday, February 21, 2014

"Microsporidiosis Acquired Through Solid Organ TransplantationA Public Health Investigation"
Annals
http://annals.org/article.aspx?articleid=1829789
"Conclusion: Microsporidiosis is now recognized as an emerging transplant-associated disease and should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing. Donor-derived disease is critical to assess when multiple recipients from a common donor are ill."

Thursday, February 20, 2014


"Angiotensin-Converting Enzyme Inhibitor, Angiotensin Receptor Blocker Use, and Mortality in Patients With Chronic Kidney Disease"     

J Am Coll Cardiol. 2014;63(7):650-658. doi:10.1016/j.jacc.2013.10.050.
JACC Feb 7, 2014  http://jacc.org/"Conclusions  In this large contemporary cohort of nondialysis-dependent patients with CKD, ACEI/ARB administration was associated with greater survival."

Wednesday, February 19, 2014


"Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial"
BMJ
http://www.bmj.com/content/348/bmj.g366
"Conclusion Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial."

Tuesday, February 18, 2014


"Risk of a Thrombotic Event after the 6-Week Postpartum Period"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1311485?query=featured_home 
"CONCLUSIONS

Among patients in our study, an elevated risk of thrombosis persisted until at least 12 weeks after delivery. However, the absolute increase in risk beyond 6 weeks after delivery was low. (Funded by the National Institute of Neurological Disorders and Stroke.)"

Monday, February 17, 2014


"Risk of End-Stage Renal Disease Following Live Kidney Donation"  
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1829682
"Conclusions and Relevance  Compared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation."

Friday, February 14, 2014

Weekly Guideline: Risk Assessment of Stable Ischemic Heart Disease

"ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease"
JACC
http://content.onlinejacc.org/article.aspx?articleID=1789799

Thursday, February 13, 2014

"A National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation"
Circ
http://circ.ahajournals.org/content/early/2014/01/30/CIRCULATIONAHA.113.002601.abstract
"Conclusions—This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States."

Wednesday, February 12, 2014


"Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial"
http://www.bmj.com/content/348/bmj.f7661
BMJ
"Conclusions A strategy of endovascular repair was not associated with significant reduction in either 30 day mortality or cost. Longer term cost effectiveness evaluations are needed to assess the full effects of the endovascular strategy in both men and women."

Tuesday, February 11, 2014

"Romosozumab in Postmenopausal Women with Low Bone Mineral Density"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1305224
"CONCLUSIONS

In postmenopausal women with low bone mass, romosozumab was associated with increased bone mineral density and bone formation and with decreased bone resorption. (Funded by Amgen and UCB Pharma; ClinicalTrials.gov number, NCT00896532.)"

Monday, February 10, 2014


"Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Patients With Acute Ischemic Stroke"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1778674
"Conclusion and Relevance  Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge."

Friday, February 7, 2014

Weekly Guideline: Red Blood Cell Transfusion

"Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB"
Annals 2012
http://annals.org/article.aspx?articleid=1206681&resultClick=3
"Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence).
Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence).Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence).Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence)."

Thursday, February 6, 2014

"Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients on Oral Anticoagulant: A Nationwide Cohort Study"
Circ
http://circ.ahajournals.org/content/early/2014/01/27/CIRCULATIONAHA.113.004834.abstract
"Conclusions—In AF patients with stable CAD, adding antiplatelet therapy on top of VKA is not associated with a reduction in risk of recurrent coronary events or thromboembolism, while risk of bleeding is significantly increased. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with AF and stable CAD warrants reassessment."

Wednesday, February 5, 2014

"Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study"
BMJ
http://www.bmj.com/content/348/bmj.g445
"Conclusions Lower dose opioids are not associated with increased admissions or deaths in patients with COPD and might be safe for symptom reduction in severe respiratory disease."

Tuesday, February 4, 2014

"Incidence of Childhood Obesity in the United States"
NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1309753?query=featured_home
"CONCLUSIONS

Incident obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight."

Monday, February 3, 2014

"Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events"
JAMA
http://jama.jamanetwork.com/article.aspx?articleid=1780017
"Conclusions and Relevance  CAC volume was positively and independently associated with CHD and CVD risk. At any level of CAC volume, CAC density was inversely and significantly associated with CHD and CVD risk. The role of CAC density should be considered when evaluating current CAC scoring systems."