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Specialty: Internal Medicine
Source: Evidence-Based Medicine
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Total 156 results found since Jan 2013.
Fruit and vegetable consumption is associated with reduced all-cause and cardiovascular mortality
Commentary on: Wang X, Ouyang Y, Liu J, et al.. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014;349:g4490 Context Dietary guidelines from around the world recommend the daily consumption of a variety of fruits and vegetables. For example, the ‘5 a day’ public health campaign in the UK encourages people to consume at least five 80 g portions of fruits and vegetables every day. These guidelines are largely based on recommendations from the WHO to consume at least 400&nb...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Crowe, F. L. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Health education, Smoking Therapeutics/Prevention Source Type: research
For patients who underwent elective non-cardiac surgery, a history of stroke is associated with an increased risk of major adverse cardiovascular events and death, particularly if time elapsed between stroke and surgery is less than 9 months
Commentary on: Jørgensen ME, Torp-Pedersen C, Gislason GH, et al.. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014;312:269–77. Context Non-cardiac surgeries (NCS) performed in patients with a recent myocardial infarction or coronary stent implantation have been associated with increased risk of perioperative cardiac events and bleeding compared with patients with more distant myocardial infarction or stent placement.1 2 Whether a similar time-dependent relationship exists for stroke is not known, and recommendations on ...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Biteker, M. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ophthalmology, Ischaemic heart disease, Radiology, Clinical diagnostic tests Source Type: research
Aiming too high or too low? Searching for the appropriate therapeutic thresholds in hypertension is not over yet
Commentary on: Rodriguez CJ, Swett K, Agarwal SK, et al.. Systolic blood pressure levels among adults with hypertension and incident cardiovascular events: the Atherosclerosis Risk in Communities Study. JAMA Intern Med 2014;174:1252–61. Context Increased arterial blood pressure (BP) is an established and modifiable cardiovascular (CV) risk factor. Consequently, the decision on antihypertensive treatment has been in the focus of changing recommendations over the past decades, initially with higher accepted BP thresholds than those recommended by modern guidelines. However, recently published consensus statements have ...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Fedorowski, A. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease Source Type: research
Risk of warfarin-associated intracerebral haemorrhage after ischaemic stroke is low and unchanged during the 2000s
Commentary on: Asberg A, Erisksson M, Henriksson KM, et al.. Warfarin-associated intracerebral hemorrhage after ischemic stroke. Stroke 2014;45:2118–20. Context Since its isolation during the early half of the 20th century from the mouldy hay responsible for ‘sweet clover disease’ in cattle, warfarin has become the most widely used oral anticoagulant.1 Indications include atrial fibrillation (AF), mechanical prosthetic valves and venous thromboembolism treatment.2 Warfarin reduces stroke risk in patients with AF by nearly two-thirds; AF accounts for 20% of ischaemic strokes, which tend to be more severe t...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Ruland, S., Biller, J. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Alcohol-related disorders, Drugs misuse (including addiction), Arrhythmias, Alcohol, Health education Aetiology/Harm Source Type: research
Mendelian randomisation meta-analysis sheds doubt on protective associations between 'moderate' alcohol consumption and coronary heart disease
Commentary on: Holmes M, Dale C, Zuccolo L, et al.. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ 2014;349:g4164. Context A protective association between low-dose alcohol and risk of coronary heart disease (CHD) has been suggested by meta-analyses of observational studies and experimental studies. Observational studies are, however, vulnerable to residual confounding and selection bias. Compared with observational studies, the Mendelian randomisation (MR) approach can mitigate confounding, is immune to reverse causation, and is consistent...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Chikritzhs, T. N., Naimi, T. S., Stockwell, T. R., Liang, W. Tags: Genetics, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Alcohol, Health education Aetiology/Harm Source Type: research
Intensive glucose-lowering results in increased cardiovascular mortality in younger but not older individuals with type 2 diabetes
Commentary on: Miller ME, Williamson JD, Gerstein HC, et al..; ACCORD Investigators. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD Trial. Diabetes Care 2014;37:634–43. Context The glycaemic portion of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial showed that an intensive glucose-lowering strategy may increase overall and cardiovascular (CV) mortality, as compared with a standard management.1 However, it is unclear whether age may influence the effects of intensive glycaemic control. Ans...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Giorgino, F. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics Source Type: research
Study concludes L. reuteri not effective for infant colic, but findings may be limited by participants' heterogeneity
Commentary on: Sung V, Hiscock H, Tang ML, et al.. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial. BMJ 2014;348:g2107. Context Colic is a common problem in healthy, thriving infants that is associated with excessive crying over a regular period during the day and is sustained for the first few months of life.1 Colic affects between 5% and 19% of young infants, remains difficult to treat and may result in significant psychosocial consequences. Despite 40 years of research, the aetiology of infantile colic remains elusive. Recently, the composition of in...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Indrio, F. Tags: Clinical trials (epidemiology), Immunology (including allergy), Pain (neurology), Stroke, Childhood nutrition, Pregnancy, Child and adolescent psychiatry, Mood disorders (including depression) Therapeutics Source Type: research
ACE inhibitors are associated with a reduction in all-cause mortality versus angiotensin II receptor blockers in patients with diabetes mellitus
Commentary on: Cheng J, Zhang W, Zhang X, et al.. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Intern Med 2014;174:773–85. Context Renin-angiotensin system blockade has been proven to reduce mortality and morbidity in populations at high risk for cardiovascular events. This extends to the patients with diabetes mellitus, where evidence-based guidelines recommend first -line treatment with ACE inhibitors (ACEIs) or angiotensin II receptor blockers...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Harel, Z., Silver, S. A. Tags: Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Drugs: CNS (not psychiatric), Stroke, Hypertension, Ischaemic heart disease, Diabetes, Guidelines Therapeutics Source Type: research
Psychological therapies help reduce headache and non-headache pain in children and adolescents
Commentary on: Eccleston C, Palermo TM, Williams AC, et al.. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014;5:CD003968. Context Chronic and recurrent pain, especially in the head, abdomen and limbs affects up to 30% of children and adolescents.1 Pain can be severely disabling, disrupting school and social activities and if left untreated, may extend towards adulthood. Increasing evidence shows that psychological factors are pivotal in the transition from acute to chronic disabling pain. As a result, psychological interventions have been ...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Vlaeyen, J. W. S., Gatzounis, R. Tags: Palliative care, Clinical trials (epidemiology), Headache (including migraine), Pain (neurology), Stroke, Child and adolescent psychiatry, Complementary medicine 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
Questions linger over POISE-2 and perioperative aspirin management
Commentary on: Devereaux PJ, Mrkobrada M, Sessler DI, et al.. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014;370:1494–503. Context Aspirin therapy for secondary prevention in patients with cardiovascular (CV) disease was catalysed by the Antithrombotic Trialists’ Collaboration meta-analysis in which antiplatelet therapy (primarily aspirin) demonstrated a 22% reduction in mortality from any vascular cause.1 Based on this meta-analysis and American Heart Association (AHA) guidelines, high-risk patients (those with coronary artery, cerebrovascular or peripheral vascular disease) should be pre...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Gerstein, N. S., Charlton, G. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease Therapeutics Source Type: research
Prolonged cardiac monitoring after cryptogenic stroke superior to 24 h ECG in detection of occult paroxysmal atrial fibrillation
Commentary on: Gladstone DJ, Spring M, Dorian P, et al.. Atrial fibrillation in patients with cryptogenic stroke. N Eng J Med 2014;370:2467–77. Context Stroke remains a prevalent and devastating condition for many people across the world, it is a leading cause of disability and is associated with significant monetary and social losses, yet is considered to be a largely preventable disease. One-third of all strokes are considered cryptogenic after initial diagnostic evaluations. Cryptogenic stroke has been identified, only recently, as an important area of additional investigation. Part of the EMBRACE trial, Gladstone...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Miller, D. J. Tags: EBM Diagnosis, Drugs: cardiovascular system, Stroke, Arrhythmias 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
Similar 5-year clinical outcomes in patients with stable coronary artery disease and myocardial ischaemia managed with an initial approach of medical therapy compared with medical therapy plus percutaneous coronary intervention
Commentary on: Stergiopoulos K, Boden WE, Hartigan P, et al.. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischaemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med 2014;174:232–40. Context In patients with stable coronary artery disease (CAD), the presence of myocardial ischaemia is associated with increased cardiac event rates. Percutaneous coronary intervention (PCI) achieves greater short-term reductions in myocardial ischaemia and angina than medical therapy. In contrast to patients with acute cor...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Archbold, R. A. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics Source Type: research
Trial suggests yoga and exercise lead to modest improvements in menopause-related quality of life: longer term studies are needed
Commentary on: Reed SD, Guthrie KA, Newton KM, et al.. Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements. Am J Obstet Gynecol 2014;210:244.e1–11. Context Since publication of the Women's Health Initiative Study, the potential benefits of non-pharmacological therapies for menopause-related symptoms have gained increased interest among midlife women, clinicians and researchers.1 Interventions requiring behavioural change have yielded mixed outcomes, owing to small sample sizes, a variety of outcome measures, lack of control groups and limited follow-up.2–4 Methods To assess the effects of...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Woods, N. F. Tags: Pain (neurology), Sleep disorders (neurology), Stroke, Menopause (including HRT), Anxiety disorders (including OCD and PTSD), Mood disorders (including depression), Sleep disorders, Sleep disorders (respiratory medicine) Therapeutics Source Type: research
