In the continuing effort to demonstrate carvedilol’s superiority over metoprolol, comes a study in this week’s JAMA looking at metabolic side-effects of these two beta-blockers in diabetic hypertensives. Patients with diabetes and hypertension, but without major cardiac disease, who were receiving ACE inhibitors or ARB’s, were first taken off their other anti-hypertensives (if any), but …
Author Archives: journalclub_erjrob
PEACE and CAMELOT
In the November 11 New York Times, Gina Kolata, referring to the CAMELOT study (just published in JAMA), states: “A new study of heart disease patients finds that “normal” blood pressure may not be low enough. By reducing their pressure well below the levels suggested by national guidelines, patients had fewer heart attacks, strokes, cardiac …
A new patent for an old drug in a new population
In a much discussed (see Kevin MD and Medical rants) study presented at the AHA meetings in New Orleans and just being published in this week’s NEJM, a fixed dose combination of hydralazine and isosorbide dinitrate, BiDil, was found to significantly reduce morbidity and mortality in African American patients with congestive heart failure. BiDil (vs …
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Vioxx, the FDA and the Lancet
On November 2, the FDA published the text of a study looking at the cardiovascular risk of Vioxx compared to Celebrex and other NSAIDS. It found a 3.7-fold increase in cardiovascular risk when high dose Vioxx (>25 mg/day) was compared to Celebrex, and a 1.5-fold increase when the standard dose of Vioxx was compared with …
Drug eluting stents and late thrombosis
Unlike restenosis, which is fairly common, stent thrombosis is a rare but much more dangerous complication after coronary stent placement. It usually occurs before endothelialisation has been completed. For bare-metal stents, this process takes a few weeks; the newer, drug-eluting stents inhibit restenosis by inhibiting fibroblast proliferation, but they also tend to delay the endothelialisation …
EBM and industry
This week’s BMJ is a theme-based issue on Evidence-Based Medicine. It contains the expected articles on how to judge whether or not EBM is living up to its promise, how best to implement it, and so on. There is one aspect of EBM, however, that is not addressed: its effect on the drug and device …
Another case-control study ?
This week’s JAMA has a cohort study from the Netherlands looking at the risk of community-acquired pneumonia and use of gastric acid–suppressive drugs. The authors used a large, private practice clinical database to investigate a hypothesized linkage between the prescription of proton pump inhibitors or H2 receptor blockers and community acquired pneumonia. In order to …
Vestibular rehabilitation for dizziness
In the October 19 issue of Annals of Internal Medicine is a study from the UK of the effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Primary care patients with a history of labyrinthine dizziness that had lasted at least two months were randomized in a single blind fashion to receive nurse-taught vestibular rehabilitation …
Review of antiplatelet therapy
In this week’s JAMA are several articles dealing with stroke, stroke prevention and antiplatelet therapy. Tran and Anand review oral antiplatelet therapy in cerebrovascular disease, coronary artery disease and peripheral arterial disease. They looked at trials involving antiplatelet therapy in patients with documented vascular disease (stroke, TIA, coronary disease, peripheral arterial disease). Some of the …
Traffic as a trigger for MI
In today’s NEJM is an article from Augsburg, Germany looking at exposure to automobile traffic as a trigger for myocardial infarction. The statistical methods employed were almost completely incomprehensible to me � I would ask anyone who understands the “statistical analysis” paragraph to email me an explanation. But the bottom line is that, during the …