Cardiology
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Coronary Stents and Noncardiac Surgery
Contemporary data suggest that approximately one in every five patients will require non-cardiac surgery within two years of coronary stent implantation.
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Spironolactone & the Potential Benefit for HFPEF Patients
No treatment has been shown to improve outcomes in heart failure with preserved ejection fraction.
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Revascularization for Isolated Proximal LAD Disease: PCI is Easiest, but is it Best?
Among patients with obstructive coronary disease requiring revascularization, guidelines would suggest a clear preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) only in certain defined subsets, including those with left main disease and in diabetics with multi-vessel disease. Patients with isolated proximal LAD disease represent a unique high-risk subset of those with single-vessel disease, in that the size of the affected territory and associated ischemic risk makes CABG a viable option. In fact, U.S. guidelines currently assign a slight advantage to CABG with a left internal mammary graft to the left anterior descending (LAD) for such patients, rating this as a IIa indication vs a IIb recommendation for PCI. This is despite a relative paucity of data on this subset of patients, at least using contemporary treatments. In fact, of the nine randomized, controlled trials forming the basis for 17 published studies examining this question, most are quite small, and all but one were performed using bare-metal stents; the single small RCT incorporating drug-eluting stents (DES) used first-generation devices that are no longer part of the treatment landscape.
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Empagliflozin Tablets (Jardiance ®)
A new sodium glucose co-transporter 2 (SGLT2) has been approved by the FDA. Empagliflozin follows canagliflozin (Invokana) and dapagliflozin (Farxiga)as the third entry in this group. These drugs reduce plasma glucose levels by reducing renal absorption of filtered glucose. Empagliflozin is marketed by Boehringer Ingelheim as Jardiance. -
Good Ol’ Vitamin C: Does It Deserve Another Look for Your Heart?
SYNOPSIS: A meta-analysis and systematic review found vitamin C supplementation improved endothelial function in patients with diabetes, atherosclerosis, and heart failure. -
Stopping Colonoscopy at Age 75 ¡ª Even With a History of Colon Cancer
SYNOPSIS: The incidence of colorectal cancer is much less in people > 75 years of age compared with ages 50-74, even in patients with a personal history of colon cancer or adenomatous polyps. Complication rates for colonoscopy are high in the elderly ¡Ý age 75 and in patients with comorbidities. Surveillance colonoscopy may be stopped in the advanced elderly and in comorbid elderly patients. -
Bring on the Butter and the Eggs
SYNOPSIS: People who were randomized to a low-carbohydrate diet lost more weight than those who were randomized to a low-fat diet over a year. They also had greater improvements in risk factors for cardiovascular disease. -
CLINICAL BRIEFS
The highest morbidity and mortality consequences of influenza occur in senior citizens. The efficacy of standard flu vaccine varies depending on the outcome that is examined -
OnabotulinumtoxinA for Treatment of Chronic Migraines
A pooled analysis of four clinical trials concluded that treatment with onabotulinumtoxinA at doses of 75-260 U administered every 12 weeks for up to five treatment cycles was efficacious, safe, and well tolerated for the prophylaxis of headache in adults with chronic migraine. -
Does It Really Make a Difference What Weight-Reduction Diet You Choose?
Since two-thirds of American adults are currently overweight or obese, we would all like to be able to help patients choose the best diet. The list of choices and categories is lengthy, with vocal advocates for the Atkins diet, the Zone diet, South Beach diet, Jenny Craig, Ornish, etc. Of course, were any of these diets sufficiently effective and easily adopted that they could gain widespread advocacy, we wouldnt be faced with such an obesity epidemic in the first place! So, apparently there is no simple answer. Among the choices we have, then, which one might be the best?