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NEWS - Cardiology

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study – The Lancet (link to abstract – $ for full-text)

Commentaries: The Lancet: Dairy consumption linked to lower rates of cardiovascular disease and mortality – EurekAlert (free) AND Dairy food in moderation ‘may protect the heart’ – The Guardian (free) AND Is Whole-Fat Dairy Good for the Heart? – New York Times (free)

Related: Meta-Analysis: Cheese consumption and risk of cardiovascular disease (link to abstract and commentaries) AND Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality (free study and commentaries)

“It is not the ultimate seal of approval for recommending whole-fat dairy over its low-fat or skimmed counterparts. Readers should be cautious, and treat this study only as yet another piece of the evidence (albeit a large one) in the literature.”

 


Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery – New England Journal of Medicine (free for a limited period)

“In moderate-to-high-risk patients undergoing cardiac surgery, six-month outcomes show that a restrictive red-cell transfusion strategy is noninferior to a liberal strategy” (via @NEJM see Tweet with Visual Abstract)

 


High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial – The Lancet (free)

Commentaries: Diagnosing myocardial infarction: a highly sensitive issue – The Lancet (free) AND Hs-TnI in Suspected ACS: High-STEACS Trial – American College of Cardiology (free) AND Is High Sensitivity Troponin Too Sensitive? – NEJM Journal Watch (free)

“Introduction of a high-sensitivity cardiac troponin I assay reclassified 1 in 6 patients with previously undetected myocardial necrosis, but did not lead to improved clinical outcomes in this large randomised trial” (via @chapdoc1 see Tweet)

“Very important study. What’s weird is that the “better” (more sensitive) troponin assays get, the less helpful the test becomes at the bedside. Look for a coming tsunami of iatrogenesis from overzealous evaluation of troponin bumps.” (via @drjohnm see Tweet)

 


ESC Council on hypertension position document on the management of hypertensive emergencies – European Heart Journal – Cardiovascular Pharmacotherapy (free) (@Abraham_RMI)

“Patients that lack acute hypertension-mediated end organ damage to the heart, retina, brain, kidneys, or large arteries do not have a hypertensive emergency and can be treated with oral BP-lowering agents and usually discharged after a brief period of observation.”

 


Optimal Blood Pressure Target in Diabetic and Nondiabetic Hypertensive Patients – Circulation Research (free)

See counterpoint suggesting lower BP targets: Sprinting Toward the Optimal Blood Pressure Target for Hypertensive Patients – Circulation Research (free)

“We have reviewed the randomized trial evidence in favor of a target blood pressure (BP) around 130/80 mm Hg in hypertensive patients with and without diabetes mellitus”

 


CLARIFY: No Survival Benefit With Beta-Blockers Beyond 1 Year Post-MI in Stable CAD – TCTMD (free)

Related Study: B-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction (free study and commentary)

“The problem, said Sorbets, is that there have never been large randomized trials to test the prognostic effects of beta-blockers in this patient group and instead, recommendations have been drawn from meta-analyses using data extracted from the acute MI setting or from observational studies.”

 


Coronary CT Angiography and 5-Year Risk of Myocardial Infarction – New England Journal of Medicine (free for a limited period)

Commentary: Five Reasons I Don’t Believe an Imaging Test Improves Outcomes – by Dr. John Mandrola, in Medscape (free registration required)

See also an interesting Tweetorial by @AnilMakam, also suggesting caution before adopting this study results in clinical practice.

 


Association Between Electronic Cigarette Use and Myocardial Infarction – American Journal of Preventive Medicine (free for a limited period)

Commentary: Risk of heart attacks is double for daily e-cigarette users – University of California – San Francisco, via ScienceDaily (free)

“New analysis shows five-fold risk for people who use both cigarettes and e-cigarettes daily” (from ScienceDaily)

 


Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement – JAMA (free)

Editorials: Screening for Atrial Fibrillation Comes With Many Snags (free for a limited period) AND Electrocardiography Screening for Atrial Fibrillation: We Can Do Better (free for a limited period)

Author Interview: USPSTF Recommendation: Screening for Atrial Fibrillation With Electrocardiography (free audio)

“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)”

 


Aspirin Plus Clopidogrel vs Aspirin Alone for Preventing Cardiovascular Events Among Patients at High Risk for Cardiovascular Events – JAMA (free for a limited period)

“Clopidogrel+ASA: Reduced risk for MI and ischemic stroke – Increased risk for major bleeding compared with aspirin alone. Combined therapy is NOT associated with lower mortality.” (via @ehlJAMA see Tweet)

 


Blood pressure targets for the treatment of people with hypertension and cardiovascular disease – Cochrane Library (free)

Summary: Blood pressure targets in people with cardiovascular disease – Cochrane Library (free)

“Insufficient evidence to justify lower than standard blood pressure targets in ppl w hypertension + CVD” (via @CochraneHTN see Tweet)

 


Paramedic 2: Epinephrine harms/helps in out of hospital cardiac arrest – First10EM (free)

See Also: Original Article (free study and editorial) AND Expert Reaction (free commentaries)

“Paramedic 2 quick summary:

If 1000 people treated with epinephrine:

– 246 extra ROSC (return of spontaneous circulation)

– 158 extra admissions

– 8 extra survivors (5 with bad neuro outcomes, 3 with good neuro outcomes)

– What those numbers mean is a value question, not a science question.” (via @First10EM see Tweet)

 


To continue taking or to stop taking antiplatelet drugs for a few days before non-cardiac surgery in adults – Cochrane Library (link to abstract – $ for full-text)

Summary: To continue taking or to stop taking antiplatelet drugs for a few days before non-cardiac surgery in adults – Cochrane Library (free)

“We found low-certainty evidence that either continuation or discontinuation of antiplatelet therapy before non-cardiac surgery may make little or no difference to mortality, bleeding requiring surgical intervention, or ischaemic events”.

 


Metformin and Risk of Hypertension in Taiwanese Patients With Type 2 Diabetes Mellitus – Journal of the American Heart Association (free)

“A reduced risk of hypertension is observed in metformin users in a dose‐response pattern”.

 


A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest – New England Journal of Medicine (free)

Editorial: Testing Epinephrine for Out-of-Hospital Cardiac Arrest (free)

Commentary: Using adrenaline in cardiac arrests results in less than 1 percent more people leaving hospital alive – University of Warwick, via EurekAlert (free)

See also: Infographic detailing result findings (free)

“A clinical trial of the use of adrenaline in cardiac arrests has found that its use results in less than 1% more people leaving hospital alive – but almost doubles the risk of severe brain damage for survivors of cardiac arrest” (from University of Warwick).

 


Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials – The Lancet (free)

Commentaries: Weight-adjusted aspirin for cardiovascular prevention – The Lancet (free) AND One dose of aspirin doesn’t fit all – University of Oxford (free)

Practice Changing Article. “Low doses of aspirin (75–100 mg) were only effective in preventing vascular events in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more.”

 


Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement – JAMA (free)

Editorial: USPSTF Recommendations for Assessment of Cardiovascular Risk With Nontraditional Risk Factors: Finding the Right Tests for the Right Patients (free)

“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, or coronary artery calcium (CAC) score to traditional risk assessment for cardiovascular disease (CVD) in asymptomatic adults to prevent CVD events”.

 


Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis – PLOS One (free)

“In addition to established traditional general population cardiovascular risk factors, left ventricular hypertrophy, serum albumin, phosphate, urate and hemoglobin were all found to be statistically significant in their association with future cardiovascular events”.

 


Clinical Presentation and Outcome in a Contemporary Cohort of Patients with Acute Myocarditis: The Multicenter Lombardy Registry – Circulation (link to abstract – $ for full-text)

Commentary: Outcome of Acute Myocarditis Patients – American College of Cardiology (free)

“Retrospective study of 443 patients w/ acute myocarditis from 19 Italian hospitals reports relatively benign overall outcomes” (via @ACCinTouch see Tweet)

 


Performing CPR? Humming the Macarena could help – The Guardian (free)

Related Commentary: La Macarena could be the answer to staying alive, heart study finds – The Telegraph (free)

“Using the song “La Macarena” to keep time improves the quality of chest compressions during cardiopulmonary rescuscitation” (via @kamleshkhunti see Tweet)

 


Estimating the Association of the 2017 and 2014 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults: An Analysis of National Data – JAMA Cardiology (free for a limited period)

Author Interview: Association of the 2014 and 2017 Hypertension Guidelines With Cardiovascular Events and Deaths in US Adults (free)

Commentary: Under 2017 Guideline, More Than 105 Million Americans Have Hypertension – AJMC (free)

The researchers estimated risk reductions of CVD and all-cause mortality, as well as associated harms from therapy, assuming the entire US adult population achieved guideline-recommended systolic BP treatment goals.

 


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