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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Using the Watchman device to close the left atrial appendage reduces risk of stroke in atrial fibrillation, compared to using warfarin
Commentary to: Reddy VY, Sievert H, Halperin J, et al.; PROTECT AF Steering Committee and Investigators. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 2014;312:1988–98 . Context Atrial fibrillation (AF) is a common arrhythmia in clinical practice. The major complication of AF is thromboembolic stroke. Patients with AF have a fivefold higher risk of stroke and a twofold increase in mortality.1 As complete cure for AF is never certain, the aims of AF therapy are symptom relief and prevention of thromboembolic events. The latter can be managed by vitami...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Swaans, M. J., Alipour, A., Boersma, L. V. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research
Atrial fibrillation is associated with an increased risk of cognitive impairment and dementia with or without a history of clinical stroke
Commentary on: Kalantarian S, Stern TA, Mansour M, et al.. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med 2013;158(5 Pt 1):338–46. Context Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. The estimated US prevalence of 2.7–6.1 million is expected to increase to 5.6–12.1 million by the middle of the current century. In addition, AF prevalence dramatically increases with age: <1% in individuals aged 50–59 years are affected, whereas about 10% of those aged 80–84 years and 11–18% of those ≥85 ...
Source: Evidence-Based Medicine - January 22, 2014 Category: Internal Medicine Authors: Forti, P. Tags: EBM Aetiology, Epidemiologic studies, Drugs: cardiovascular system, Dementia, Drugs: CNS (not psychiatric), Stroke, Memory disorders (psychiatry), Psychiatry of old age, Arrhythmias Source Type: research
Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62. Context Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabig...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Connective tissue disease, Musculoskeletal syndromes, Diabetes, Arrhythmias Therapeutics Source Type: research
Rate and rhythm control have comparable effects on mortality and stroke in atrial fibrillation but better data are needed
Commentary on: Al-Khatib SM, Allen LaPointe NM, Chatterjee R, et al.. Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review. Ann Intern Med 2014;160:760–73. Context Atrial fibrillation (AF) represents a large and growing burden on cardiovascular healthcare and leads to a substantial impact on quality-of-life, increased cardiovascular events and a doubling of hospitalisation and death rates.1 Unlike many other cardiac conditions, the evidence base for treatment in AF remains patchy with clear gaps relating to a number of clinically important management strategies. Current practic...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Kotecha, D., Kirchhof, P. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Radiology, Clinical diagnostic tests, Arrhythmias Therapeutics Source Type: research
Closure of a patent foramen ovale with a device does not offer a greater benefit than medical therapy alone for the prevention of recurrent cerebrovascular events
Commentary on: Furlan AJ, Reisman M, Massaro J, et al.. CLOSURE I Investigators. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012;366:991–9. Context Stroke can rarely be caused by paradoxical emboli passing from the right side of the circulatory system to the left side. Case reports have shown that the most common site of right to left shunt is the patent foramen ovale (PFO), and case control studies have shown a higher prevalence of PFO in patients with cryptogenic stroke as compared to stroke victims with a known cause or non-stroke controls. Therefore, the question ari...
Source: Evidence-Based Medicine - January 17, 2013 Category: Internal Medicine Authors: Mattle, H. P., Mono, M.-L. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Lipid disorders, Arrhythmias, Health education, Smoking Therapeutics Source Type: research
Stroke rates vary substantially across cohorts of patients with atrial fibrillation
Commentary on: Quinn GRSeverdija ONChang Y. Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation 2017;135:208–19. Context Oral anticoagulants (OACs) substantially reduce stroke risk in patients with atrial fibrillation (AF); however, they remain globally underused.1 One of the main reasons is the difficulty in stratifying AF-related ischaemic stroke risk at the individual patient level.1 2 Among scores stratifying AF-related stroke risk, CHA2-DS2-Vasc prevails in most recent international AF guidelines.3 4 Still, it remains unknown whether AF-related stroke risk ...
Source: Evidence-Based Medicine - June 9, 2017 Category: Internal Medicine Authors: Sposato, L. A., Saposnik, G. Tags: EBM Prognosis Source Type: research
Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances
We congratulate Alper et al for their reanalysis of the Third European Cooperative Acute Stroke Study.1 They found that after adjusting for baseline imbalances in history of prior stroke and stroke severity, there was no statistical benefit with alteplase, but the harms were reconfirmed. So, the difference in outcome could be fully explained by the baseline imbalance. It is worth remembering that a clinical trial has internal validity if and only if the imbalance between groups, bias in the assessment of outcome, and chance have been excluded as possible explanations for the difference in outcomes. It also reaffirms the fr...
Source: Evidence-Based Medicine - November 25, 2021 Category: Internal Medicine Authors: Fatovich, D. M., Milne, W. K. Tags: Letters Source Type: research
Atrial fibrillation is associated with an increased risk of cognitive and functional decline
Commentary on: Marzona I, O'Donnell M, Teo K, et al.. Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studies. CMAJ 2012;184:E329–36. Context Stroke (clinical and subclinical) is associated with increased risk of dementia and cognitive decline. The thromboembolic risk for stroke from atrial fibrillation (AF) is modifiable. The prevalence of AF has been estimated at up to 8% in a large retrospective cohort study of those aged 67 and over, with incidence rising with increasing age (mean age at diagnosis was 80 years).1 A recent meta-ana...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Peters, R., Beckett, N. Tags: Epidemiologic studies, Drugs: cardiovascular system, Dementia, Drugs: CNS (not psychiatric), Stroke, Memory disorders (psychiatry), Psychiatry of old age, Diabetes Online articles Source Type: research
Vitamin E is ineffective in preventing stroke
Stroke is a leading cause of death and long-term disability worldwide. Vitamin E (tocopherol) is an antioxidant which may protect against atherogenesis by acting as a scavenger of free radicals with subsequent reduced oxidation of low-density lipoprotein cholesterol and several other favourable effects on plaque stability, platelet aggregation and tendency to thrombosis. However, a recent meta-analysis of 13 randomised controlled trials (166 282 participants) showed that, compared with placebo, vitamin E supplementation does not significantly prevent stroke of any type (RR 1.01; 95% CI 0.96 to 1.07).1 The statistical quest...
Source: Evidence-Based Medicine - November 21, 2013 Category: Internal Medicine Authors: Brigo, F., Storti, M., Tezzon, F., Nardone, R. Tags: Letters Source Type: research
Low-dose second-generation oral contraceptives are associated with the lowest increased risk of cardiovascular adverse effects
Commentary on: Weill A, Dalichampt M, Raguideau F, et al.. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016;353:i2002 . Context Oral contraceptives (OCs) are associated with an increased risk of cardiovascular disease. The association varies depending on whether the cardiovascular disease is arterial or venous and with varying progestogens and dosages of the oestrogen compound ethinyloestradiol. A recent Cochrane review concluded that OCs with the progestogens gestodene, desogestrel, cyproterone acetate or d...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Lokkegaard, E. Tags: Health policy, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Contraception, Drugs: obstetrics and gynaecology, Pregnancy, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism Aetiology/Harm Source Type: research
Opposite impacts of dietary versus supplemental calcium on cardiovascular health
Commentary on: Li K, Kaaks R, Linseisen J, et al.. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European prospective investigation into cancer and nutrition study (EPIC-Heidelberg). Heart 2012;98:920–5. Context Calcium supplementation is widely used to maintain bone health. Growing data suggests that calcium supplementation, but not dietary calcium intake, may harm cardiovascular (CV) health.1 2 There is no randomised controlled trial (RCT) that addressed CV events as primary endpoints...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Guessous, I., Bochud, M. Tags: EBM Prognosis, Clinical trials (epidemiology), Epidemiologic studies, General practice / family medicine, Drugs: cardiovascular system, Stroke, Diet, Ischaemic heart disease Source Type: research
Blood pressure reduction in elderly patients with hypertension decreases risk of adverse cardiovascular outcomes
Commentary on: Briasoulis A, Agarwal V, Tousoulis D, et al.. Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies. Heart 2014;100:317–23. Context In individuals over 65-years old, uncontrolled hypertension has been associated with increased risk of stroke, as well as all-cause and cardiovascular death.1–3 However, optimal blood pressure (BP) targets in the elderly remain uncertain.4 Briasoulis and colleagues examine the effect of antihypertensive treatment on outcomes in individuals over the age of 65. Methods This systematic review of 18 ...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Bangalore, S., Doran, B. Tags: Geriatric medicine, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Guidelines Therapeutics Source Type: research
NSAIDs increase bleeding risk in patients with atrial fibrillation on antithrombotic therapy
This study determined the risk...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: McGrath, E. R. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Drugs: musculoskeletal and joint diseases, Arrhythmias Aetiology/Harm Source Type: research
The risk of arterial thrombosis increases with the use of combined oral contraceptives
Commentary on: Roach RE, Helmerhorst FM, Lijfering WM, et al.. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015;8:CD011054. Context While the risk of venous thrombosis with use of combined oral contraceptives (COC) is now convincingly quantified to be threefold to sixfold increased, depending mainly on the type of progestogen, there are few and less consistent studies on the risk of arterial endpoints. Therefore, a meta-analysis on available evidence might be relevant. Method This Cochrane review includes data from 24 studies assessing the risk of thrombot...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Lidegaard, O. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Ischaemic heart disease, Venous thromboembolism Aetiology/Harm Source Type: research
Physical activity reduces cardiovascular disease risk in older adults
Commentary on: Soares-Miranda L, Siscovick DS, Psaty BM, et al.. Physical activity and risk of coronary heart disease and stroke in older adults: the cardiovascular health study. Circulation 2016;133:147–55 . Context Currently, at least 150 min per week of moderate-to-vigorous physical activity is recommended for adults of all ages to beneficially influence individual and population health and cardiovascular mortality.1 Adhering to current physical activity guidelines has been shown to be associated with a 20% lower mortality risk compared to physically inactive persons.2 A physically active lifestyle is linked ...
Source: Evidence-Based Medicine - September 22, 2016 Category: Internal Medicine Authors: Endes, S. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Sports and exercise medicine Aetiology/Harm Source Type: research
