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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Statins in patients with CKD prove beneficial in reducing cardiovascular events and mortality but show no benefit in patients on dialysis
Commentary on: Palmer SC, Craig JC, Navaneethan SD, et al.. Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med 2012;157:263–75. Context High-quality evidence suggests that chronic kidney disease (CKD) should now be considered a coronary heart disease (CHD) risk equivalent. Although statin therapy consistently reduces coronary events in the general population, the clinical benefits of lipid lowering in persons with CKD are less certain. Although multiple studies have shown possible benefit from statin therapy in early-stage CKD patients, ...
Source: Evidence-Based Medicine - September 19, 2013 Category: Internal Medicine Authors: Krishnan, S., Jacobson, T. A. Tags: Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Renal medicine Therapeutics Source Type: research
While hormone therapy unlikely harmful in younger postmenopausal women at low CV risk, protective effects cannot be claimed
Commentary on: Schierbeck LL, Rejnmark L, Tofteng CL, et al.. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012;345:e6409. Context The last 10 years have clarified the issues regarding postmenopausal hormone therapy (HT) and cardiovascular disease (CVD). Prior to the large, randomised women's health initiative (WHI),1 observational studies had suggested a protective cardiovascular (CV) effect. The WHI showed no benefit, and increased thromboembolic and CV events in women taking HT. The WHI findings have been challenged because of the older age of the...
Source: Evidence-Based Medicine - September 19, 2013 Category: Internal Medicine Authors: Abramson, B. L. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism Therapeutics Source Type: research
N-3 fatty acids did not reduce major cardiovascular events in patients with dysglycaemia
Commentary on Bosch J, Gerstein HC, Dagenais GR, et al.. ORIGIN Trial Investigators. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med 2012;367:309–18 Context N-3 fatty acids have beneficial effects on elevated triglyceride levels, impaired endothelial function, inflammation, atherosclerotic plaque and severe arrhythmias. Prospective cohort studies have shown a lower risk of cardiovascular events among persons who consumed fish regularly. These studies were followed by clinical trials evaluating the effects of supplements with the fish fatty acids eicosapentaenoic acid (EPA) and d...
Source: Evidence-Based Medicine - July 5, 2013 Category: Internal Medicine Authors: Kromhout, D. Tags: Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Venous thromboembolism, Drugs: musculoskeletal and joint diseases, Diabetes, Lipid disorders Prevention Source Type: research
Single surgical procedure with general anaesthesia early in life is associated with subsequent impaired language development and cognitive function
Commentary on: Ing C, Dimaggio C, Whitehouse A, et al.. Long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics 2012;130:e476–85. Context Thus far, more than 250 studies in immature animals have demonstrated that exposure to commonly used anaesthetics produces neuronal cell death, alters brain development and may lead to neurocognitive impairment.1 2 Similarly, in humans, an association between learning disabilities and two or more anaesthetic exposures has been observed in some studies, as most recently reported in children under 2 years of age.3 Methods Ing a...
Source: Evidence-Based Medicine - July 5, 2013 Category: Internal Medicine Authors: Loepke, A. W. Tags: Rehabilitation medicine, Stroke, Developmental paediatrics, Child and adolescent psychiatry, Other anaesthesia Harm Source Type: research
Lung cancer screening with low-dose CT: benefits and potential risks
Commentary on: Bach PB, Mirkin JN, Oliver TK, et al.. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012;307:2418–29. Context Lung cancer is the leading cause of cancer death worldwide.1 The majority of patients present with advanced disease and the current 5-year survival is only 15%.2 Previous research showed no mortality benefit to screening with chest radiography and sputum cytology. The recent results of the National Lung Screening Trial (NLST) are the first to show a significant reduction in lung cancer mortality with the use of low-dose CT (LDCT) in high risk individuals. The po...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Tanner, N. T., Silvestri, G. A. Tags: Smoking and tobacco, Clinical trials (epidemiology), Epidemiologic studies, Stroke, Screening (oncology), Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Guidelines, Health education, Screening (public health), Smo Source Type: research
Hormone therapy not recommended for chronic disease prevention in menopausal women
Commentary on: Nelson HD, Walker M, Zakher B, et al.. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the US Preventive Services Task Force recommendations. Ann Intern Med 2012;157:104–13. Context In 2005, the US Preventive Services Task Force (USPSTF) updated its 2002 hormone replacement therapy recommendations, advising against the routine use of oestrogen and progestin (E+P) and unopposed oestrogen (E) to prevent chronic conditions in menopausal women. Menopausal hormone therapy (MHT) had been commonly prescribed to prevent conditions such as cardiovascula...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Wenger, N. K. Tags: Pancreas and biliary tract, Epidemiologic studies, Drugs: cardiovascular system, Dementia, Stroke, Contraception, Drugs: obstetrics and gynaecology, Menopause (including HRT), Ischaemic heart disease, Venous thromboembolism, Memory disorders (psychiatry), 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
Long-term coffee consumption associated with reduced risk of total and cause-specific mortality
Commentary on: Freedman ND, Park Y, Abnet CC, Hollenbeck AR, Sinha R, et al.. Association of coffee drinking with total and cause-specific mortality. N Engl J Med 2012;366:1891–904. Context The effect of coffee consumption on health is being re-examined based on new evidence suggesting a beneficial effect of components in coffee other than caffeine,1–3 an effect that may be seen in the long term after the acute harmful effects of caffeine have disappeared. Supporting this idea, several recent well-designed cohort studies have found an inverse association between long-term coffee consumption and the risk of all-...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Lopez-Garcia, E. Tags: EBM Aetiology, Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Sleep disorders (neurology), Stroke, Hypertension, Diet, Sleep disorders, Sleep disorders (respiratory medicine), Health education, Smoking Source Type: research
Lack of association between proton pump inhibitors and adverse events in patients taking clopidogrel and aspirin
Commentary on Douglas IJ, Evans SJ, Hingorani AD, et al.. Clopidogrel and interaction with proton pump inhibitors: comparison between cohort and within person study designs. BMJ 2012;345:e4388 Context Clopidogrel inhibits the P2Y12 platelet receptor and is used in patients with acute coronary syndromes or ischaemic stroke to prevent recurrent vascular events. Proton pump inhibitors (PPIs), however, have been shown to reduce the pharmacodynamic effect of clopidogrel upon platelet inhibition, and have been linked in retrospective studies to a higher rate of ischaemic outcomes in patients taking clopidogrel. Methods A total o...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Waksman, R., Gaglia, M. A. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Health education, Smoking Aetiology Source Type: research
Metformin may not reduce cardiovascular risk or all-cause mortality
Commentary on: Boussageon R, Supper I, Bejan-Angoulvant T, et al.. Reappraisal of metformin efficacy in the treatment of Type 2 diabetes: a meta-analysis of randomised controlled trials. PLoS Med 2012;9:268–82. Context The treatment of hyperglycaemia is considered as one of the tools for preventing cardiovascular disease in Type 1 and Type 2 diabetic (T2D) patients.1 2 Metformin is recommended as the first-line drug for T2D by most international guidelines (IDF.2005. http://www.idf.org, 2007. http://www.aace.com, http://www.diabetesjournals.org, http://www.nice.org.uk/CG66). The preference for metformin over other av...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Monami, M. Tags: Geriatric medicine, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Diabetes Online articles Source Type: research
Aspirin prophylaxis in people without prior cardiovascular disease does not lead to reductions in cardiovascular death or cancer mortality
Commentary on: Seshasai SR, Wijesuriya S, Sivakumaran R, et al.. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012;172:209–16. Context Prophylactic antiplatelet therapy with aspirin reduces the risk of non-fatal myocardial infarction (MI), non-fatal stroke and vascular death in patients with known cardiovascular disease (CVD) and is of net benefit. The absolute reduction in recurrent events significantly exceeds the increase in major bleeding.1 However, the role of aspirin in primary prevention of CVD is not clear. According to the Antithrombot...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Prevention, Ischaemic heart disease Online articles 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
Thrombolytic therapy with or without a vena cava filter results in a lower case fatality rate in unstable patients with acute pulmonary embolism
Commentary on: Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med 2012;125:465–70. Context Acute pulmonary embolism (PE) is a major health problem and is associated with significant morbidity and mortality. This is particularly true for patients with acute PE who are haemodynamically unstable.1 For instance, acute PE is associated with a 70% risk of death if cardiopulmonary arrest occurs and up to a 50% risk of death in those with shock secondary to PE.1 2 Several trials have evaluated the prognostic impact of thrombolytic therapy compared w...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Mean, M., Ibrahim, S. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests Online articles Source Type: research
Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain
Commentary on: Ker K, Edwards P, Perel P, et al.. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054. Context Surgical trauma leads to the activation of local fibrinolysis, and surgical bleeding can be significant in certain types of surgery leading to acute anaemia and the need for blood transfusion. Clinical trends have led to reductions in acceptable haemoglobin transfusion thresholds. However, growing evidence from clinical and experimental studies suggests that acute haemodilutional anaemia may reduce tissue oxygen delivery and increase perioperative morb...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Raveendran, R., Wong, J. Tags: Clinical trials (epidemiology), Epidemiologic studies, Haematology (incl blood transfusion), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Pulmonary embolism Therapeutics Source Type: research
Thromboprophylaxis in heart failure patients with sinus rhythm: aspirin and warfarin lead to similar cardiovascular outcomes
Commentary on: Homma S, Thompson JL, Pullicino PM, et al.. WARCEF Investigators. Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med 2012;366:1859–69. Context Chronic heart failure (CHF) is common, affecting 1–2% of the population and 10% of people >70 years. Patients with CHF have an increased risk of thromboembolism. Those with atrial fibrillation (AF) should receive warfarin but whether CHF patients with sinus rhythm (SR), whose risk is 1.5–3.5%,1 should receive thromboprophylaxis is unclear. Previous studies, Warfarin/Aspirin Study in Heart failure (warfarin, asp...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Witte, K. K. A., Jamil, H. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes, Arrhythmias Therapeutics Source Type: research
