Consider The Evidence: Med/Peds Journal Roundup

September 10, 2006

Din-o-mite: Intensive Lipid Lowering in CHD

Filed under: cardiovascular, CHD, lancet — medblog @ 8:33 pm

Lancet 9/9 – In the latest set of reccomendations from the NCEP ATP, the panel reccomended that patients with CHD or risk equivalent have a goal LDL of 100mg/dL, with an option of less than 70mg/dL in high-risk patients. Several prior studies have shown that further reductions in LDL may decrese mortality, but further study is needed.

In the most recent issue of the Lancet, Deedwania et al. publish results of the TNT study on the outcomes of this new goal of intensive lipid lowering. The design was a double blind RCT involving 10,000 patients with over a median of 5 years. To fit the inclusion criteria, subjects had to be aged 35-75 with history of MI, revascularization, or angina with objective evidence of atherosclerotic disease. Subjects were randomized to recieve either 10mg or 80mg of atorvastatin.

Mean LDL levels were 99mg/dL in the low dose, and 72.6mg/dL in the high dose group. The outcome was a statistically significant decrease in risk for major cardiovascular events in the high dose group. With an absolute risk reduction of 3.5% which is 29% relative. The levels obtained were convenient because they closely reflected the new LDL goals. It seems as if this study does show data to support those reccomendations. The question remains as to whether the results can be generalized to CHD risk equivalents such as diabetes, because the study only included clinically evident coronary disease. (more…)

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July 13, 2006

Dont Re-Invent the Wheel with CRP

Filed under: archives of internal medicine, CHD, CRP — medblog @ 8:08 pm

ArchivesIM 7/10 – Ever since it was shown that CRP levels are strong predictors of CHD, the controversy has been whether it is really any better than the risk predictors we already have. Several articles have concluded that CRP in some way is a “better” method of stratifying CHD risk.

A paper by Fulstrom et al. addressing this issue presents data from the Atherosclerosis Risk in Communities (ARIC) Study. This was a prospective case cohort study. They looked at the reciever-operator curve using traditional risk factors, and then calculated the improvement of this curve once novel risk markers such as CRP, IL-6, pLA2, etc were added. They found that these fancy-schmancy molecules did not add significantly to the accuracy of the old prediction model.

So maybe CRP levels are a solution without a cause… but there is still a camp that believes that using that measure will include a group of higher-risk individuals that is not identified by the traditional risk factors…

February 17, 2006

Statins alter initial presentation of CAD

Filed under: annals of internal medicine, CHD, statins — medblog @ 11:49 am

AnnalsIM 2/21 – Clearly statins reduce the risk of CAD, and act in several ways to prevent the formation of unstable plaques. So theoretically, the initial presentation of cardiac disease in patients on statins would be less likely to be unstable angina/MI vs. stable angina. In this weeks Annals, Go et al. present a study that supports just that conclusion. (more…)

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