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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Intermediate and long-term cognitive effects in older adults secondary to cardiovascular procedures is uncommon but current evidence is insufficient
Commentary on: Fink HA, Hemmy LS, MacDonald R, et al. Intermediate- and long-term cognitive outcomes after cardiovascular procedures in older adults: a systematic review. Ann Intern Med 2015;163:107–17 . Context Cardiovascular procedures are common in the older population.1 There is suspicion that these procedures may have a negative outcome on cognition.2 However, further research has indicated that there may have been pre-existing cognitive deficits as cognitive impairment is common in the older population.3 This systematic review examines the evidence of the relationship of coronary and carotid revascularisation, ...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Charles, L. Tags: Health policy, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Dementia, Stroke, Interventional cardiology, Memory disorders (psychiatry), Radiology, Clinical diagnostic tests, Health service research Aetiology/Harm Source Type: research
Risk of new-onset diabetes with statin use should not be overemphasised
This study examined diabetes outcomes among Tricare beneficiaries who were evaluated between 1 October 2003 and 1 March 2012. Participants were divided into statin users and non-users. Patients who, at baseline, had a pre-existing disease indicative of cardiovascular diseases, or any positive element of the Charlson comorbidity index, were excluded. A propensity score, using 42 baseline characteristics, was generated to match statin users and non-users. The main measurements included new-onset diabetes, diabetic complications and overweight/obesity. Findings...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Chiang, C.-E., Wang, K.-L. Tags: Health policy, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Aetiology/Harm Source Type: research
Sugar-sweetened beverage consumption is linked to global adult morbidity and mortality through diabetes mellitus, cardiovascular disease and adiposity-related cancers
Commentary on: Singh GM, Micha R, Khatibzadeh S, et al., Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation 2015;132:639–66 . Context Obesity and obesity-related non-communicable diseases are global health burdens associated with all-cause and cause-specific mortality, economic costs and impaired quality of life.1–3 Sugar-sweetened beverage (SSB) consumption has been linked with obesity and has long been thought to contribute to cardiometabolic diseases th...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Ruff, R. R. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Obesity (nutrition), Dentistry and oral medicine, Diabetes, Health education Aetiology/Harm Source Type: research
Current 10-year atherosclerotic cardiovascular disease risk threshold for statin eligibility is cost-effective for primary prevention
Commentary on: Pandya A, Sy S, Cho S, et al. Cost effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA 2015;314: 142–50 . Context The American College of Cardiology American Heart Association (ACC/AHA) cholesterol guidelines replaced the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) in 2013,1 a change that was accompanied by significant controversy.2 Notable among the criticisms was that the pooled cohort equations (PCE) overestimates risk and coupled with the relatively lenient risk threshold (10-year PCE &g...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Yeboah, J. Tags: Health policy, Epidemiologic studies, Drugs: cardiovascular system, Neuromuscular disease, Stroke, Ischaemic heart disease, Musculoskeletal syndromes, Health economics, Health service research Economic analysis Source Type: research
Restrictive red blood cell transfusion strategies appear safe in most clinical settings
Commentary on: Holst LB, Petersen MW, Haase N, et al. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015;350:h1354. Context Substantial progress has been made in generating data to make evidence-based recommendations for red blood cell (RBC) transfusion. Findings from clinical trials suggest that in most clinical settings, a restrictive transfusion strategy, where RBCs are transfused once haemoglobin levels fall below either 7 or 8 g/dL, does not impact mortality compared with liberal transfus...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Roubinian, N. H., Carson, J. L. Tags: Clinical trials (epidemiology), Epidemiologic studies, Haematology (incl blood transfusion), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Renal medicine Therapeutics/Prevention Source Type: research
An IVC filter and anticoagulation for 3 months is unlikely to show a benefit over anticoagulation alone for high-risk patients with acute pulmonary embolism
Commentary on: Mismetti P, Laporte S, Pellerin O, et al; PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA 2015;313:1627–35. Context Placement of an inferior vena cava (IVC) filter to prevent pulmonary embolism (PE) is recommended by multidisciplinary consensus guidelines only when anticoagulation is contraindicated, has resulted in a complication or has failed.1 2 Oddly, the only prospective randomised long-term filter efficacy study that demonstrated a reduction in the recurr...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Hoffer, E. K. Tags: Journalology, Clinical trials (epidemiology), Drugs: cardiovascular system, Heart failure, Stroke, Venous thromboembolism, Pulmonary embolism, Ethics Therapeutics/Prevention Source Type: research
Ezetimibe provides incremental reduction in risk for cardiovascular events and need for revascularisation following an acute coronary syndrome
Commentary on: Cannon CP, Blazing MA, Giugliano RP, et al., IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015;372:2387–97. Context Use of statin therapy to treat dyslipidemia in patients with established coronary artery disease is the standard of care worldwide. Given the negative results of a number of trials that tested the use of adjuvant lipid-lowering therapies against a statin background, there has been great scepticism about whether or not non-statin drugs provide incremental benefit.1–3 Ezetimibe inhibits the absorption of both dietary and bili...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Toth, P. P. Tags: Health policy, Epidemiologic studies, Genetics, Immunology (including allergy), Vaccination / immunisation, Stroke, Diet, Ischaemic heart disease, Health economics, Health service research, Lipid disorders Therapeutics/Prevention Source Type: research
Blood pressure lowering in patients with type 2 diabetes improves cardiovascular events including mortality, but more intensive lowering to systolic blood pressure less than 130 mm Hg is associated with further reduction in stroke and albuminuria without further reduction in cardiac events
Commentary on: Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015;313:603–15. Context Hypertension and diabetes are independent risk factors for cardiovascular disease.1 Although lowering blood pressure (BP) reduces cardiovascular events,1 thresholds to initiate antihypertensive therapy and BP targets have been areas of controversy. Until recently, guideline recommendations for BP targets have been more stringent in patients with diabetes. Methods Emdin and colleagues report information from a systematic review of 45 randomised trials. The t...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Toklu, B., Bangalore, S. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Renal medicine, Diabetes Therapeutics/Prevention 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
Combined oral contraceptives and risk of venous thromboembolism: there is higher risk in new generations compared to second generations, but paradoxically not in norgestimate-containing-pills
This study examines the VTE risk associated with COC use in two large UK databases. Methods...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Plu-Bureau, G. Tags: Smoking and tobacco, Epidemiologic studies, General practice / family medicine, Drugs: cardiovascular system, Stroke, Contraception, Drugs: obstetrics and gynaecology, Family planning, Alcohol, Health education, Smoking Aetiology/Harm Source Type: research
Cannabinoids fail to show evidence of slowing down the progression of multiple sclerosis
Commentary on: Ball S, Vickery J, Hobart J, et al. The Cannabinoid Use in Progressive Inflammatory brain disease (CUPID) trial: a randomised double-blind placebo-controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis. Health Technol Asess 2015;19:1–187. Context Despite the increasing number of effective disease modifying therapies for multiple sclerosis (MS), there are no effective therapies for the progressive, neurodegenerative phase of the disease. There is now abundant experimental evidence that cannabinoids and the endocannabinoid system are ...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Pryce, G., Baker, D. Tags: Clinical trials (epidemiology), Editor's choice, Immunology (including allergy), Drugs: CNS (not psychiatric), Stroke, Dentistry and oral medicine Therapeutics/Prevention Source Type: research
Long-term ticagrelor therapy in patients with prior myocardial infarction significantly reduces ischaemic events, albeit with increased bleeding
Commentary on: Bonaca MP, Bhatt DL, Cohen M, et al., PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015;372:1791–800. Context Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist constitute the cornerstone of treatment in patients with acute coronary syndrome (ACS) with a recommended duration of 1 year.1 Nevertheless, high rates of atherothrombotic events, for which platelet activation is heavily implicated, still occur at later stages.2 Therefore, a longer duration of DAPT appears intuitive, a...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Alexopoulos, D. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics/Prevention Source Type: research
Type 2 diabetes mellitus screening has no effect on mortality
Commentary on: Selph S, Dana T, Blazina I, et al. Screening for type 2 diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 162:765–6. Context Screening for type 2 diabetes mellitus in asymptomatic persons could lead to early identification and treatment, and potentially result in improved outcomes. In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended diabetes screening in asymptomatic adults with sustained blood pressure (BP) greater than 135/80 mm Hg. Unfortunately, the USPSTF found insufficient evidence to assess the balance of benefits...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Yoon, U. Tags: Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Hypertension, Diet, Obesity (nutrition), Screening (epidemiology), Diabetes, Health education, Screening (public health) Therapeutics/Prevention Source Type: research
Cranberry capsules (2 taken twice daily for an average 38 days) reduce the risk of postoperative urinary tract infection in women undergoing benign gynaecological surgery involving intraoperative catheterisation
This study investigates the use of cranberry capsules to prevent postoperative UTI following benign gynaecological surgery. Methods This randomised double-blind, placebo-controlled trial investigates whether cranberry (2 capsules two times per day, equivalent to two 8 oz servings of cranberry juice) taken for approximately 6 weeks after gynaecological surgery reduces postoperative UTI. Participants...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Dieter, A. A. Tags: Epidemiologic studies, Immunology (including allergy), Urinary tract infections, Drugs: CNS (not psychiatric), Stroke, Vulvovaginal disorders, Urinary tract infections Therapeutics/Prevention Source Type: research
Lowering diastolic blood pressure in non-proteinuric hypertension in pregnancy is not harmful to the fetus and is associated with reduced frequency of severe maternal hypertension
Commentary on: Magee LA, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med 2015;372:407–17. Context Guidelines recommend lowering blood pressure (BP) below 140/90 mm Hg in adults <60 years to prevent cardiovascular complications.1 During pregnancy, lowering BP below 160/110 mm Hg is universally endorsed; however, maternal and fetal benefits of targets below 140/90 mm Hg are not clear. Some meta-analyses suggest a possible reduction in fetal birth weight associated with lowering mildly elevated BP.2 However, other analyses fo...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: August, P. Tags: Drugs: cardiovascular system, Stroke, Hypertension, Pregnancy, Renal medicine Therapeutics/Prevention Source Type: research
