Bottom line: Increasing levels of nonfasting triglycerides are associated with an increased risk of ischemic stroke.
Citation: Freiberg J, Tybjaerg-Hansen A, Jensen JS, Nordestgaard BG. Nonfasting triglycerides and risk of ischemic stroke in the general population. JAMA. 2008;300(18):2142-2152.
Short Takes
TUMOR SEEDING AFTER NEEDLE BIOPSY FOR HEPATOCELLULAR CARCINOMA
Dissemination of hepatocellular carcinoma outside the liver following a biopsy remains a concern. Systematic review and meta-analysis showed tumor tract seeding to have an incidence of 2.7% overall, or 0.9% per year, although it did not show an effect on long-term survival.
Citation: Silva MA, Hegab B, Hyde C, Guo B, Buckles JAC, Mirza DF. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut. 2008;57:1592-1596.
PLACEBOS ARE COMMONLY USED BY AMERICAN INTERNISTS
Approximately half of surveyed internists prescribed treatment intended as a placebo, including vitamins and over-the-counter analgesics, and more than half felt the practice was ethically acceptable.
Citation: Tilburt JC, Emanuel EJ, Kaptchuk TJ, Curlin FA, Miller FG. Prescribing “placebo treatments”: results of national survey of U.S. internists and rheumatologists. BMJ. 2008;337:a1938.
OUTCOMES RELATED TO AORTIC STENOSIS ARE NOT IMPROVED BY LIPID-LOWERING THERAPY
Rates of major cardiovascular events in patients with mild to moderate aortic stenosis were not improved by lipid-lowering therapy in this randomized double trial.
Citation: Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343-1356.
RESPIRATORY MEDICATIONS INCREASE DEATH RATES IN PATIENTS RECENTLY DIAGNOSED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
A nested-case control trial evaluated the risks of COPD medications in veterans who were recently diagnosed with COPD. The authors found an increased risk of cardiovascular deaths in those using ipratropium and an increased risk in pulmonary deaths with the use of theophylline.
Citation: Lee TA, Pickard AS, Au DH, Bartle B, Weiss KB. Risk for death with medications for recently diagnosed chronic obstructive pulmonary disease. Ann Intern Med. 2008;149:380-390.
DECREASED PNEUMONIA LENGTH OF STAY IS NOT ASSOCIATED WITH INCREASED MORTALITY OR READMISSION
Prospective, observational cohort study showed that shorter length of hospitalization for community-acquired pneumonia was not associated with an increase in short-term, post-discharge mortality or hospital readmission.
Citation: Capelastegui A, Espana PP, Quintana JM, et al. Declining length of hospital stay for pneumonia and postdischarge outcomes. Am J Med. 2008;121(10):845-852.
RISK OF SUDDEN DEATH AFTER MYOCARDIAL INFARCTION (MI) HAS DECREASED; RISK OF HEART FAILURE HAS INCREASED
This population-based surveillance study showed the risk of sudden cardiac death (SCD) following MI was not associated with recurrent ischemia. However, heart failure independently increased the risk of SCD, indicating the need for close follow-up in these patients.
Citation: Adabag AS, Therneau TM, Gersh BJ, Weston SA, Roger VL. Sudden death after myocardial infarction. JAMA. 2008;300(17):2022-2027.
INHALED ANTICHOLINERGICS INCREASE RISK OF CARDIOVASCULAR EVENTS
Meta-analysis of randomized-controlled trials suggests increased risk of cardiovascular death, MI, or stroke among patients with COPD who take ipratropium bromide or tiotropium bromide for more than 30 days.
Citation: Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA. 2008;300(12):1439-1451.
CONFLICTING MORTALITY OUTCOMES IN PATIENTS WITH INFECTIVE ENDOCARDITIS TREATED SURGICALLY
A systematic review of six cohort studies, aimed at eliminating selection bias, showed conflicting mortality benefits in patients with prosthetic and native valve infective endocarditis treated surgically.
Citation: Tleyjeh IM, Kashour T, Zimmerman V, Steckelberg JM, Wilson WR, Baddour LM. The role of valve surgery in infective endocarditis management: a systematic review of observational studies that included propensity score analysis. Am Heart J. 2008;156:901-909.
Proton-Pump Inhibitor (PPI) Use Increases the Risk of Community-Acquired Pneumonia (CAP)
Clinical question: Is there an association between PPI use and CAP?