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Total 186 results found since Jan 2013.
Correspondence Surgery for cerebral haemorrhage—STICH II trial
In the STICH II trial, an absolute benefit of 3·7% in favourable outcome and 5·6% in mortality were reported for the early surgery group, but a significant difference between surgery and conservative treatment was not reached for the primary outcome. Glasgow coma scale was the only scoring clinical indicator. Other stroke scales assessing clinical severity—ie, the National Institutes of Health scale, could be considered. Neurological severity, also in a conscious patient, is an important prognostic indicator.
Source: LANCET - October 26, 2013 Category: Journals (General) Authors: Simone Vidale, Silvio Bellocchi, Angelo Taborelli Tags: Correspondence Source Type: research
Editorial Statins: new US guideline sparks controversy
Statins reduce cholesterol and are prescribed to many millions of people in high-income countries—not only high-risk patients with familial hypercholesterolaemia, for example, but also for primary prevention of atherosclerotic cardiovascular disease. Adverse events such as statin-induced myopathy are rare, and statins are likely to have contributed to the substantial fall in cardiovascular events, including stroke, at population level in recent decades.
Source: LANCET - November 23, 2013 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Correspondence Premature mortality in patients with epilepsy
We commend Seena Fazel and colleagues on their study highlighting the risk of premature death in people with epilepsy and the role of psychiatric comorbidity in increasing this mortality. Although the observed odds ratio for premature mortality was similar to that in a previous study using similar methods, we wonder to what extent the mortality estimates were inflated by inclusion of status epilepticus in the epilepsy cohort. In most cases, status epilepticus is a symptom of an acute brain insult (ie, stroke, anoxia) and does not fulfil criteria for epilepsy.
Source: LANCET - February 8, 2014 Category: Journals (General) Authors: Torbjörn Tomson, Dale C Hesdorffer Tags: Correspondence Source Type: research
Correspondence Lessons from the SPS3 trial
We read with interest the results of the SPS3 trial (Aug 10, p 507). The SPS3 Study Group concluded that the use of a systolic-blood-pressure (SBP) target of less than 130 mm Hg is likely to be beneficial for patients with recent lacunar stroke. However, several comments should be made before we encourage clinicians to achieve more intensive blood pressure reduction.
Source: LANCET - February 8, 2014 Category: Journals (General) Authors: Luis Castilla-Guerra, María del Carmen Fernandez-Moreno Tags: Correspondence Source Type: research
Correspondence Refining the American guidelines for prevention of cardiovascular disease
The recent American Heart Association (AHA) and American College of Cardiology (ACC) guidelines recommend that more people are offered treatment to prevent heart attacks and strokes; they do this by lowering the risk cutoff from a 20% 10-year risk to 7·5% (the approximate risk of a person aged 60 years). Paul Ridker and Nancy Cook state that the risk calculator in the guidelines overestimates risk about two-fold. This variation, however, has little effect on discriminating between who will and will not have a heart attack or stroke (ie, on screening performance).
Source: LANCET - February 15, 2014 Category: Journals (General) Authors: Nicholas Wald, Joan Morris Tags: Correspondence Source Type: research
Articles Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial
The ARUBA trial showed that medical management alone is superior to medical management with interventional therapy for the prevention of death or stroke in patients with unruptured brain arteriovenous malformations followed up for 33 months. The trial is continuing its observational phase to establish whether the disparities will persist over an additional 5 years of follow-up.
Source: LANCET - February 15, 2014 Category: Journals (General) Authors: J P Mohr, Michael K Parides, Christian Stapf, Ellen Moquete, Claudia S Moy, Jessica R Overbey, Rustam Al-Shahi Salman, Eric Vicaut, William L Young, Emmanuel Houdart, Charlotte Cordonnier, Marco A Stefani, Andreas Hartmann, Rüdiger von Kummer, Alessandra Tags: Articles Source Type: research
Editorial Statins for millions more?
Last week, the National Institute for Health and Care Excellence (NICE) in the UK unveiled draft guidance on cardiovascular risk assessment and, in particular, on lipid modification for the primary and secondary prevention of cardiovascular disease. In an update to the existing guideline, the new proposal is that the threshold be halved for prescribing statins to prevent cardiovascular disease, which includes coronary heart disease and stroke.
Source: LANCET - February 21, 2014 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Department of Error Department of Error
Giroud M, Jacquin A, Béjot Y. The worldwide landscape of stroke in the 21st century. Lancet 2013; published online Oct 24. http://dx.doi.org/10.1016/S0140-6736(13)62077-2—In this Comment, in the fifth paragraph, the second sentence should have read “…had increased significantly since 1990 (increases of 68%, 84%, 26%, and 12%, respectively)”. This correction has been made to the online version as of Oct 25, and will be made to the printed Comment.
Source: LANCET - February 21, 2014 Category: Journals (General) Authors: The Lancet Tags: Department of Error Source Type: research
Seminar Intracranial atherosclerosis
Atherosclerotic disease often involves the intracranial arteries including those encased by cranial bones and dura, and those located in the subarachnoid space. Age, hypertension, and diabetes mellitus are independent risk factors for intracranial atherosclerosis. Intracranial atherosclerosis can result in thromboembolism with or without hypoperfusion leading to transient or permanent cerebral ischaemic events. High rates of recurrent ischaemic stroke and other cardiovascular events mandate early diagnosis and treatment.
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Adnan I Qureshi, Louis R Caplan Tags: Seminar Source Type: research
Review The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective
On Sept 29, 2013, the Framingham Heart Study will celebrate 65 years since the examination of the first volunteer in 1948. During this period, the study has provided substantial insight into the epidemiology and risk factors of cardiovascular disease. The origins of the study are closely linked to the cardiovascular health of President Franklin D Roosevelt and his premature death from hypertensive heart disease and stroke in 1945. In this Review we describe the events leading to the foundation of the Framingham Heart Study, and provide a brief historical overview of selected contributions from the study.
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Syed S Mahmood, Daniel Levy, Ramachandran S Vasan, Thomas J Wang Tags: Review Source Type: research
Comment NAVIGATOR: physical activity for cardiovascular health?
In The Lancet, Thomas Yates and colleagues report new findings from the NAVIGATOR trial, a multicentre, international, randomised, placebo-controlled trial that examined the effect of nateglinide, valsartan, or both, on cardiovascular events in patients with impaired glucose tolerance and either existing cardiovascular disease or at least one additional risk factor. The results of this cohort analysis of the association between daily ambulatory activity, as assessed by pedometer, and a composite of death from cardiovascular causes, non-fatal myocardial infarction, and non-fatal stroke, show a graded and independent inverse...
Source: LANCET - March 21, 2014 Category: Journals (General) Authors: Giuseppe Pugliese, Stefano Balducci Tags: Comment Source Type: research
World Report Profile: Australia's Baker IDI Heart and Diabetes Institute
Cardiovascular disease kills one Australian every 11 minutes, and 3·4 million of the country's 23 million population are affected, with rates 30% higher in Indigenous Australians. One in six Australians will have a stroke in their lifetime, and 1·5 million are estimated to have diabetes. No surprise then that Australia has one of the most well known cardiovascular disease research institutes: the Baker IDI Heart and Diabetes Institute based in Melbourne.
Source: LANCET - April 25, 2014 Category: Journals (General) Authors: Tony Kirby Tags: World Report Source Type: research
Correspondence Management of brain arteriovenous malformations – Authors' reply
ARUBA is the first-ever randomised controlled trial comparing clinical outcome in patients with unruptured brain arteriovenous malformations managed either with or without preventive interventional therapy. The as-treated analysis showed a more than 5-fold increased risk of primary outcome events (ie, death or symptomatic stroke) for patients undergoing invasive therapy (hazard ratio 5·26, 95% CI 2·63–11·11), as well as a significantly increased risk of, at times, devastating neurological deficits after intervention (relative risk 2·77, 95% CI 1·20–6·25).
Source: LANCET - May 9, 2014 Category: Journals (General) Authors: Christian Stapf, Michael K Parides, Alan J Moskowitz, J P Mohr Tags: Correspondence Source Type: research
Correspondence Radiotherapy for breast cancer, the TARGIT-A trial
Javant Vaidya and colleagues report an increased risk of non-breast cancer deaths with external beam radiotherapy (EBRT) compared with intraoperative radiotherapy, highlighting the difference in cardiac events in the two treatment groups. Although the log-rank statistics show a significant difference in non-breast cancer deaths in the EBRT group, these deaths included stroke, bowel ischaemia, and other events unrelated to breast irradiation. Therefore, the number of cardiac events are small, and to suggest that the risk of cardiac death differs between EBRT and intraoperative radiotherapy would be premature.
Source: LANCET - May 16, 2014 Category: Journals (General) Authors: Penny Mackenzie, Anthony Fyles, Caroline Chung Tags: Correspondence Source Type: research
Comment Focus on blood pressure as a major risk factor
The main risk factor for disease and premature death worldwide is high blood pressure. The associations between blood pressure and fatal coronary artery disease and fatal stroke have been well demonstrated. However, little evidence exists from contemporary clinical practice on the associations between blood pressure and morbidity and mortality from specific cardiovascular disease conditions in different age groups. Also missing are results concerning lifetime risk for specific cardiovascular complications associated with hypertension.
Source: LANCET - May 30, 2014 Category: Journals (General) Authors: Thomas Kahan Tags: Comment Source Type: research
