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NEWS - Cardiology

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.


Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis – JAMA Internal Medicine (free for a limited period)

Invited Commentary: Mineralocorticoid Receptor Antagonists in ST-Segment Elevation Myocardial Infarction – JAMA Internal Medicine (free for a limited period)

Aldosterone antagonists are beneficial for patients with STEMI and reduced ejection fraction. This meta-analysis suggests that patients with STEMI and LVEF greater than 40% or without heart failure also have improved outcomes with aldosterone antagonists.


Perspective by Dr. Eugene Braunwald: Aortic Stenosis: Then and Now – Circulation (free for a limited period)


High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial – Circulation (free)

With a median follow-up of 3.9 years, high-dose as compared with low-dose pitavastatin significantly reduced the risk of the primary end point (4.3% vs 5.4%; NNT = 90), a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization.


Propranolol Versus Metoprolol for Treatment of Electrical Storm in Patients with Implantable Cardioverter-Defibrillator – Journal of the American College of Cardiology (link to abstract – $ for full-text)

“The combination of IV amiodarone and oral propranolol is safe, effective, and superior to the combination of IV amiodarone and oral metoprolol in the management of ES in ICD patients”.


Effect of Ticagrelor Plus Aspirin, Ticagrelor Alone, or Aspirin Alone on Saphenous Vein Graft Patency 1 Year After Coronary Artery Bypass Grafting: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary: Ticagrelor + Aspirin, Ticagrelor Alone, or Aspirin Alone on SVG Patency – American College of Cardiology, Latest in Cardiology (free)

““The major limitation of the DACAB trial is the selection of vein graft patency as the primary outcome”. Agree:we’re starting to understand CAD is a bit more complicated than an open duct (also for this reason, medical practice requires clinical outcomes)” (via @camialderighi see Tweet)


Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials – European Heart Journal (free)

Compared with triple antithrombotic therapy, dual antithrombotic therapy shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of major adverse cardiac events.


First-line drugs for hypertension – Cochrane Library (free)

Summary: Thiazides best first choice for hypertension – Cochrane Library (free)

“First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality”.


Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease – Cochrane Library (link to abstract – $ for full-text)

Summary: Radial artery versus femoral artery approach for performing coronary catheter procedures in people with coronary artery disease – Cochrane Library (free)

“Transradial approach for diagnostic coronary angiography or PCI (or both) in CAD may reduce short-term net adverse clinical events, cardiac death, all-cause mortality, bleeding, and access site complications”.


Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis – JAMA (link to abstract – $ for full-text)

Commentaries: Patients With Highest LDL Levels Benefit Most From Lipid-Lowering Drugs – MedicalResearch.com (free) AND New Study Finds that Statins Prevent Cardiovascular Deaths – Science Based Medicine (free) AND Meta-Analysis: ‘Floor’ for Lipid-Lowering Mortality Benefits May Be Real – MedPage Today (free registration required)

“In meta-analyses of LDL-C lowering drug trials, we found that total and cardiovascular mortality were reduced only when the mean baseline LDL-C in the trial was >100 mg/dl” (from MedicalResearch.com)


Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials – Heart (link to abstract – $ for full-text)

See commentary in: Articles of the month (March 2018) – First10EM (free)

Se related meta-analysis published recently with similar results: Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials – The BMJ (free)

“Bottom line: In the RCTs we have to date, CCTA demonstrate no benefit, but leads to an increase in unnecessary invasive procedures” (from First10EM).


Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials – Heart (link to abstract – $ for full-text)

Related guideline: BTS Guideline for oxygen use in healthcare and emergency settings – British Thoracic Society (free)

“These findings from eight RCTs support departing from the usual practice of administering oxygen in normoxaemic patients”.


Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials – European Journal of Preventive Cardiology (link to abstract – $ for full-text)

“The findings of this meta-analysis suggested that the early discharge strategy after successful primary angioplasty is safe among selected low-risk STEMI patients. A shorter hospital stay could benefit both the patients and the healthcare systems”.


Increased coronary heart disease and stroke hospitalisations from ambient temperatures in Ontario – Heart (free)

Related study: Big Swings in Daily Temperatures Linked to Spikes in MI Rates – TCTMD (free)

“Cold and hot weather associated with risk of cardiovascular disease hospitalization” (via @kamleshkhunti see Tweet)


Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials – European Heart Journal (free)

“5-study EHJ meta analysis confirms value of PFO closure after cryptogenic stroke. “Number Needed to Close”: 178 pts to prevent one stroke over 1 year. Size matters (no effect for small shunts, “NNC” 96 for large shunts)” (via @Steph_Achenbach see Tweet)


The Effect of Door-to-Diuretic Time on Clinical Outcomes in Patients With Acute Heart Failure – JACC Heart Failure (free)

Commentaries: Quicker Diuretics Not Associated With Better Outcomes in Acute Heart Failure – TCTMD (free) AND Door-to-Diuretic Time in Acute Heart Failure – American College of Cardiology, Latest in Cardiology (free) AND Door-to-diuretic time didn’t affect mortality from heart failure in Korean registry – ACP Hospitalist (free)

“Overall, there isn’t strong evidence of benefit from early use of diuretics and “the overriding consideration should remain ‘get it right’ rather than ‘do it fast,’” the editorial concluded”. (from ACP)


Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial – Journal of the American Heart Association (free for a limited period)

“DBP values ≥90 and <60 mm Hg are associated with a significant risk of adverse outcomes in patients with heart failure with preserved ejection fraction who are treated for hypertension”.


Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data – PLOS Medicine (free)

Related study with similar conclusions: Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension – Journal of the American College of Cardiology (link to abstract – $ for full-text)

“An intelligent approach towards blood pressure management: by the individual’s risk instead of just their measurements” (via @EricTopol see Tweet)


#ACC18 – Carvedilol for Prevention of Chemotherapy Related Cardiotoxicity – Journal of the American College of Cardiology (link to abstract – $ for full-text)

Commentaries: Beta Blocker Shows Mixed Results in Protecting Against Chemo-Induced Heart Damage – American College of Cardiology (free) AND Carvedilol Effect in Preventing Chemotherapy Induced CardiotoxicitY – CECCY – American College of Cardiology (free)

Related study from #ACC18: Heart Drugs Prevented Cardiotoxicity in Breast Cancer Treated With Anthracycline and Trastuzumab – American College of Cardiology (free)

“According to the CECCY trial, carvedilol had no effect on left ventricular function in breast cancer patients treated w/ doxorubicin, but did result in a reduction in troponin I levels & diastolic dysfunction”. (via @ACCinTouch see Tweet)


#ACC18 – Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops – New England Journal of Medicine (free for a limited period)

Commentaries: Barbershop-Based Intervention Leads to Blood Pressure Reductions in African-American Men – American College of Cardiology (free) AND Mixing Haircuts and Hypertension Rx a ‘Home Run’ for Blood Pressure Control – TCTMD (free)

“Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists”.


#ACC18 – The ODYSSEY Trial Ends Well— But Will It Be Enough? – Cardiobrief (free) AND Ten Quick Thoughts on ODYSSEY – John Mandrola, via Medscape (free registration required)

“An absolute risk reduction of 1.6% in the primary endpoint translates to a number needed to treat of 64. Using the current price of $14,500 per year, Kaul calculated that preventing one event over the trial period of almost 3 years would cost about $2.6 million” (via John Mandrola). This study was presented at #ACC18 and has not been published yet. Among the many commentaries, these two were selected for a balanced point of view.


N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)

Commentary: NT-proBNP cutpoints validated for diagnosing and ruling out heart failure in the ED – ACP Hospitalist (free)

Related review: BNP in the emergency department: The evidence – First10EM (free)

“In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF”.


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