Descripción del proyecto

Annals of Internal Medicine - recientes

Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes A Cohort Study
15/8/2017
Zhang H, Plutzky J, Shubina M, et al.
ver resumen
Background:
Many patients discontinue statin treatment, often after having a possible adverse reaction. The risks and benefits of continued statin therapy after an adverse reaction are not known.
Objective:
To examine the relationship between continuation of statin therapy (any prescription within 12 months after an adverse reaction) and clinical outcomes.
Design:
Retrospective cohort study.
Setting:
Primary care practices affiliated with 2 academic medical centers.
Participants:
Patients with a presumed adverse reaction to a statin between 2000 and 2011.
Measurements:
Information on adverse reactions to statins was obtained from structured electronic medical record data or natural-language processing of narrative provider notes. The primary composite outcome was time to a cardiovascular event (myocardial infarction or stroke) or death.
Results:
Most (81%) of the adverse reactions to statins were identified from the text of electronic provider notes. Among 28 266 study patients, 19 989 (70.7%) continued receiving statin prescriptions after the adverse reaction. Four years after the presumed adverse event, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions, compared with 13.9% for those without them (difference, 1.7% [95% CI, 0.8% to 2.7%]; P < 0.001). In a secondary analysis of 7604 patients for whom a different statin was prescribed after the adverse reaction, 2014 (26.5%) had a documented adverse reaction to the second statin, but 1696 (84.2%) of those patients continued receiving statin prescriptions.
Limitations:
The risk for recurrent adverse reactions to statins could not be established for the entire sample. It was also not possible to determine whether patients actually took the statins.
Conclusion:
Continued statin prescriptions after an adverse reaction were associated with a lower incidence of death and cardiovascular events.
Primary Funding Source:
Chinese National Key Program of Clinical Science, National Natural Science Foundation of China, and Young Scientific Research Fund of Peking Union Medical College Hospital.

Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations
15/8/2017
Park S, Freedman ND, Haiman CA, et al.
ver resumen
Background:
Coffee consumption has been associated with reduced risk for death in prospective cohort studies; however, data in nonwhites are sparse.
Objective:
To examine the association of coffee consumption with risk for total and cause-specific death.
Design:
The MEC (Multiethnic Cohort), a prospective population-based cohort study established between 1993 and 1996.
Setting:
Hawaii and Los Angeles, California.
Participants:
185 855 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites aged 45 to 75 years at recruitment.
Measurements:
Outcomes were total and cause-specific mortality between 1993 and 2012. Coffee intake was assessed at baseline by means of a validated food-frequency questionnaire.
Results:
58 397 participants died during 3 195 484 person-years of follow-up (average follow-up, 16.2 years). Compared with drinking no coffee, coffee consumption was associated with lower total mortality after adjustment for smoking and other potential confounders (1 cup per day: hazard ratio [HR], 0.88 [95% CI, 0.85 to 0.91]; 2 to 3 cups per day: HR, 0.82 [CI, 0.79 to 0.86]; ≥4 cups per day: HR, 0.82 [CI, 0.78 to 0.87]; P for trend < 0.001). Trends were similar between caffeinated and decaffeinated coffee. Significant inverse associations were observed in 4 ethnic groups; the association in Native Hawaiians did not reach statistical significance. Inverse associations were also seen in never-smokers, younger participants (<55 years), and those who had not previously reported a chronic disease. Among examined end points, inverse associations were observed for deaths due to heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease.
Limitation:
Unmeasured confounding and measurement error, although sensitivity analysis suggested that neither was likely to affect results.
Conclusion:
Higher consumption of coffee was associated with lower risk for death in African Americans, Japanese Americans, Latinos, and whites.
Primary Funding Source:
National Cancer Institute.

Coffee Drinking and Mortality in 10 European Countries A Multinational Cohort Study
15/8/2017
Gunter MJ, Murphy N, Cross AJ, et al.
ver resumen
Background:
The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear.
Objective:
To examine whether coffee consumption is associated with all-cause and cause-specific mortality.
Design:
Prospective cohort study.
Setting:
10 European countries.
Participants:
521 330 persons enrolled in EPIC (European Prospective Investigation into Cancer and Nutrition).
Measurements:
Hazard ratios (HRs) and 95% CIs estimated using multivariable Cox proportional hazards models. The association of coffee consumption with serum biomarkers of liver function, inflammation, and metabolic health was evaluated in the EPIC Biomarkers subcohort (n = 14 800).
Results:
During a mean follow-up of 16.4 years, 41 693 deaths occurred. Compared with nonconsumers, participants in the highest quartile of coffee consumption had statistically significantly lower all-cause mortality (men: HR, 0.88 [95% CI, 0.82 to 0.95]; P for trend < 0.001; women: HR, 0.93 [CI, 0.87 to 0.98]; P for trend = 0.009). Inverse associations were also observed for digestive disease mortality for men (HR, 0.41 [CI, 0.32 to 0.54]; P for trend < 0.001) and women (HR, 0.60 [CI, 0.46 to 0.78]; P for trend < 0.001). Among women, there was a statistically significant inverse association of coffee drinking with circulatory disease mortality (HR, 0.78 [CI, 0.68 to 0.90]; P for trend < 0.001) and cerebrovascular disease mortality (HR, 0.70 [CI, 0.55 to 0.90]; P for trend = 0.002) and a positive association with ovarian cancer mortality (HR, 1.31 [CI, 1.07 to 1.61]; P for trend = 0.015). In the EPIC Biomarkers subcohort, higher coffee consumption was associated with lower serum alkaline phosphatase; alanine aminotransferase; aspartate aminotransferase; γ-glutamyltransferase; and, in women, C-reactive protein, lipoprotein(a), and glycated hemoglobin levels.
Limitations:
Reverse causality may have biased the findings; however, results did not differ after exclusion of participants who died within 8 years of baseline. Coffee-drinking habits were assessed only once.
Conclusion:
Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country.
Primary Funding Source:
European Commission Directorate-General for Health and Consumers and International Agency for Research on Cancer.

Treatment of Latent Tuberculosis Infection An Updated Network Meta-analysis
15/8/2017
Zenner D, Beer N, Harris RJ, et al.
ver resumen
Background:
Treatment of latent tuberculosis infection (LTBI) is an important component of tuberculosis (TB) control, and this study updates a previous network meta-analysis of the best LTBI treatment options to inform public health action and programmatic management of LTBI.
Purpose:
To evaluate the comparative efficacy and harms of LTBI treatment regimens aimed at preventing active TB among adults and children.
Data Sources:
PubMed, Embase, and Web of Science from indexing to 8 May 2017; clinical trial registries; and conference abstracts. No language restrictions were applied.
Study Selection:
Randomized controlled trials that evaluated human LTBI treatments and recorded at least 1 of 2 prespecified end points (hepatotoxicity and prevention of active TB).
Data Extraction:
2 investigators independently extracted data from eligible studies and assessed study quality according to a standard protocol.
Data Synthesis:
The network meta-analysis of 8 new and 53 previously included studies showed that isoniazid regimens of 6 months (odds ratio [OR], 0.65 [95% credible interval {CrI}, 0.50 to 0.83]) or 12 to 72 months (OR, 0.50 [CrI, 0.41 to 0.62]), rifampicin-only regimens (OR, 0.41 [CrI, 0.19 to 0.85]), rifampicin-isoniazid regimens of 3 to 4 months (OR, 0.53 [CrI, 0.36 to 0.78]), rifampicin-isoniazid-pyrazinamide regimens (OR, 0.35 [CrI, 0.19 to 0.61]), and rifampicin-pyrazinamide regimens (OR, 0.53 [CrI, 0.33 to 0.84]) were efficacious compared with placebo. Evidence existed for efficacy of weekly rifapentine-isoniazid regimens compared with no treatment (OR, 0.36 [CrI, 0.18 to 0.73]). No conclusive evidence showed that HIV status altered treatment efficacy.
Limitation:
Evidence was sparse for many comparisons and hepatotoxicity outcomes, and risk of bias was high or unknown for many studies.
Conclusion:
Evidence exists for the efficacy and safety of 6-month isoniazid monotherapy, rifampicin monotherapy, and combination therapies with 3 to 4 months of isoniazid and rifampicin.
Primary Funding Source:
U.K. National Institute for Health Research. (PROSPERO: CRD42016037871)

Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy A Narrative Review
15/8/2017
Streed CG, Jr., Harfouch O, Marvel F, et al.
ver resumen
Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT. Currently, systemic hormone replacement for cisgender adults requires a nuanced discussion based on baseline risk factors and age of administration of exogenous hormones because of concern regarding an increased risk for myocardial infarction and stroke. For transgender adults, CSHT has been associated with the potential for worsening CVD risk factors (such as blood pressure elevation, insulin resistance, and lipid derangements), although these changes have not been associated with increases in morbidity or mortality in transgender men receiving CSHT. For transgender women, CSHT has known thromboembolic risk, and lower-dose transdermal estrogen formulations are preferred over high-dose oral formulations. In addition, many studies of transgender adults focus predominantly on younger persons, limiting the generalizability of CSHT in older transgender adults. The lack of randomized controlled trials comparing various routes and formulations of CSHT, as well as the paucity of prospective cohort studies, limits knowledge of any associations between CSHT and CVD.

Sensitivity Analysis in Observational Research: Introducing the E-Value
15/8/2017
VanderWeele TJ, Ding P.
ver resumen
Sensitivity analysis is useful in assessing how robust an association is to potential unmeasured or uncontrolled confounding. This article introduces a new measure called the “E-value,” which is related to the evidence for causality in observational studies that are potentially subject to confounding. The E-value is defined as the minimum strength of association, on the risk ratio scale, that an unmeasured confounder would need to have with both the treatment and the outcome to fully explain away a specific treatment–outcome association, conditional on the measured covariates. A large E-value implies that considerable unmeasured confounding would be needed to explain away an effect estimate. A small E-value implies little unmeasured confounding would be needed to explain away an effect estimate. The authors propose that in all observational studies intended to produce evidence for causality, the E-value be reported or some other sensitivity analysis be used. They suggest calculating the E-value for both the observed association estimate (after adjustments for measured confounders) and the limit of the confidence interval closest to the null. If this were to become standard practice, the ability of the scientific community to assess evidence from observational studies would improve considerably, and ultimately, science would be strengthened.

The Pharmaceuticalization of the Tobacco Industry
15/8/2017
Hendlin Y, Elias J, Ling PM.
ver resumen
The use and acceptance of e-cigarettes and other noncombustible tobacco products have been growing. The authors point to a concerted effort by tobacco companies to rehabilitate their image as providers of health-related products and argue that such “pharmaceuticalization” of this industry has important consequences for public health.

Annals Understanding Clinical Research: Evaluating the Meaning of a Summary Estimate in a Meta-analysis
15/8/2017
Cornell JE, Liao JM, Stack CB, et al.
ver resumen
In meta-analyses, researchers combine data from individual studies into a summary measure to describe the benefits or harms of an intervention. This installment of the “Understanding Clinical Research” series addresses issues that readers should consider when evaluating the meaning of a summary estimate and understanding to whom and under what circumstances it applies.

Statin Denial: An Internet-Driven Cult With Deadly Consequences
15/8/2017
Nissen SE.
ver resumen
Zhang and colleagues report that among patients who reported an adverse reaction to statins, those who continued to receive statins had a lower cardiovascular event rate at 4 years than those who stopped therapy. The editorialist discusses the potential contribution of unscientific but seemingly persuasive criticism of statins via the Internet to poor statin adherence and the consequent societal costs.

Moderate Coffee Intake Can Be Part of a Healthy Diet
15/8/2017
Guallar E, Blasco-Colmenares E, Arking DE, et al.
ver resumen
Two large studies provide new evidence on the association of coffee intake with mortality. The editorialists discuss these findings in light of previous evidence and conclude that coffee intake can be part of a healthy diet.

Sensitivity Analysis for Unmeasured Confounding: E-Values for Observational Studies
15/8/2017
Localio A, Stack CB, Griswold ME.
ver resumen
VanderWeele and Ding introduce the “E-value” as a simple measure of the potential for bias arising from unmeasured confounders in observational studies. Using an example of an observational study of coffee intake and mortality, the editorialists discuss how the E-value can help researchers explore the possible influence of bias from unobserved factors.

Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older
15/8/2017
Bahat G, İlhan B, Tufan A, et al.
ver resumen

Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older
15/8/2017
Weiss J, Kansagara D.
ver resumen

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older
15/8/2017
Rabi DM, Daskalopoulou SS, Leung AA, et al.
ver resumen

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older
15/8/2017
Cushman WC, Johnson KC, Applegate WB, et al.
ver resumen

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older
15/8/2017
Kansagara D, Wilt TJ, Frost J, et al.
ver resumen

Correction: Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals
15/8/2017
ver resumen

Correction: The Relationship of Obesity to Hospice Use and Expenditures
15/8/2017
ver resumen

In older adults with subclinical hypothyroidism, levothyroxine did not improve symptoms or tiredness
15/8/2017
Shah R.
ver resumen

In type 1 diabetes, education with either insulin pumps or daily injections did not differ for HbA 1c at 2 y
15/8/2017
Lipscombe LL.
ver resumen







Feed aggregation powered by Syndicate Press.
Processed request in 0.37944 seconds.