Descripción del proyecto

The Lancet - recientes

[Comment] Statin-associated muscle symptoms: beware of the nocebo effect
2/5/2017
Juan Pedro-Botet, Juan Rubiés-Prat
ver resumen
Patient-reported statin intolerance, predominantly due to statin-associated muscle symptoms (SAMS), is a common and difficult-to-manage condition affecting millions of patients worldwide.1 Different expert panels have proposed various definitions and classifications for statin intolerance.2,3 However, the development of SAMS does not necessarily signify statin intolerance since statin therapy might not always be pharmacologically involved. Moreover, some patients with SAMS might be able to tolerate a lower dose than the dose that leads to SAMS, longer dose intervals, or an alternative statin.

[Comment] Thresholds in women with abdominal aortic aneurysm
25/4/2017
Minna Johansson, Russell P Harris
ver resumen
Past studies have found that women have a lower prevalence of abdominal aortic aneurysm,1 develop abdominal aortic aneurysm at later ages,2 have higher rates of rupture,3 and have higher 30-day mortality and more complications from either open abdominal aortic aneurysm repair or endovascular repair (EVAR) than do men.4 These sex differences have raised questions about thresholds in women: what aortic diameter should be labelled an abdominal aortic aneurysm, and at what diameter should surgical intervention be considered? These were among the questions addressed for men by the UKSAT5 and ADAM6 trials, but these trials included only 198 women in total.

[Comment] Immune oncology in hepatocellular carcinoma—hype and hope
20/4/2017
Marcus-Alexander Wörns, Peter R Galle
ver resumen
The multikinase inhibitor sorafenib was the first systemic agent to show a significant improvement in overall survival for patients with advanced hepatocellular carcinoma, thereby introducing molecularly targeted therapy into this therapeutic field of unmet needs.1 Overall survival benefits are modest, however, and all subsequent agents tested in phase 3 randomised controlled trials (RCTs), both in first-line and second-line settings, have been unable to reach or improve on the magnitude of benefit obtained with sorafenib.

[Comment] A personal perspective on health in Israel
8/5/2017
Tamara Lucas
ver resumen
My earliest memories of my father, Noah Lucas (1927–2008), seat him perpetually at a typewriter, pipe in mouth, radio on; and hanging behind him on the wall, a framed picture of the enchanting Chagall stained glass windows—a dove carrying an olive branch of peace.

[Comment] Digital health nation: Israel's global big data innovation hub
8/5/2017
Ran D Balicer, Arnon Afek
ver resumen
Traditional care models are unlikely to sustain the escalating growth in patient needs and health-care costs in high-income economies. Digital medicine innovation holds promise to help reduce inefficiencies in health-care delivery, improve access, increase quality, and make medicine more personalised and precise in an era of increasing budget constraints.1,2 With increasing global investments in digital health3 there is much anticipation to see whether these promises will be realised. With its many start-up enterprises Israel encourages digital innovation and this culture will help tackle some of the key challenges facing the country's health systems, as Rafael Beyar and colleagues4 highlight in their Viewpoint for the Lancet Series on health in Israel.

[Comment] Medical genetics in Israel's diverse population
8/5/2017
Satvit A Shalev, Joel Zlotogora, Adel Shalata, Ephrat Levy-Lahad
ver resumen
Medical genetics in Israel reflects its ethnically diverse population. The Israeli population of 8·46 million is comprised of 75% Jews and 21% Arabs, including 4% Bedouins (a historically nomadic group).1 Israeli Arabs are largely Muslim (83%), with Christian Arab (9%) and Druze (8%) minorities.1 The genetic landscape of these different ethnic groups has been shaped by their history and cultural practices. Israeli Jews, who are mainly urban, can usually trace their ancestry to specific Jewish communities, broadly classified as Ashkenazi (European) and Mizrahi or non-Ashkenazi (according to country of origin).

[Perspectives] Rafael Beyar: a meeting of medicine, science, and technology
8/5/2017
Tamara Lucas
ver resumen
Rafael Beyar is a medic who embodies the entrepreneurial spirit of Israel. As an author in the Lancet Israel Series, Beyar writes about Israel's start-up culture. His outlook is shaped by his vision of “the whole circle of building the concept of medicine, engineering, science, and humanity, intertwined around the patient”, he says. “For the past 11 years I have been director of Rambam Health Care Campus. My goal from the beginning was to take the great clinical infrastructure that we have at the hospital, and the great science, and the great engineering abilities at the Technion, and to combine them in a unique institution that brings together medicine, engineering, and science, through education,” Beyar explains.

[Perspectives] Orly Manor: public health leader in Israel's health system
8/5/2017
Richard Lane
ver resumen
“Tikkun olam” translated from Hebrew means “to mend the world”, a maxim that has been at the heart of Orly Manor's career. She is Professor of the Braun School of Public Health and Community Medicine at the Hebrew University of Jerusalem, and has been a leading figure behind the Lancet Series about health in Israel. Her current research activities are divided between two main projects: one evaluating the quality of treatment of Israeli health care, the other being a long-term project investigating the developmental origin of adult diseases.

[Correspondence] Christiana Figueres joins The Lancet Countdown—delivering on the promise of Paris
24/6/2017
Anthony Costello, Peng Gong, Hugh Montgomery, Nick Watts, Nicola Wheeler
ver resumen
The 2015 Paris Agreement on climate change marked historic progress for the planet and human health. Signatories agreed to limit global temperature rise to “well below 2°C above pre-industrial levels”; redouble a global commitment of financial flows to developing countries of US$100 billion annually by 2020; and created a mechanism to increase ambitious action.1 Although inaction threatens to undermine 50 years of progress in public health, meeting the Paris Agreement's ambitions presents the greatest global health opportunity of this century.

[Articles] Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase
2/5/2017
Ajay Gupta, David Thompson, Andrew Whitehouse, Tim Collier, Bjorn Dahlof, Neil Poulter, Rory Collins, Peter Sever, ASCOT Investigators
ver resumen
These analyses illustrate the so-called nocebo effect, with an excess rate of muscle-related AE reports only when patients and their doctors were aware that statin therapy was being used and not when its use was blinded. these results will help assure both physicians and patients that most AEs associated with statins are not causally related to use of the drug and should help counter the adverse effect on public health of exaggerated claims about statin-related side-effects.

[Articles] Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis
25/4/2017
Pinar Ulug, Michael J Sweeting, Regula S von Allmen, Simon G Thompson, Janet T Powell, SWAN collaborators
ver resumen
Compared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative mortality is much higher in women for both EVAR and open repair. The management of abdominal aortic aneurysm in women needs improvement.

[Articles] Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial
20/4/2017
Anthony B El-Khoueiry, Bruno Sangro, Thomas Yau, Todd S Crocenzi, Masatoshi Kudo, Chiun Hsu, Tae-You Kim, Su-Pin Choo, Jörg Trojan, Theodore H Welling, Tim Meyer, Yoon-Koo Kang, Winnie Yeo, Akhil Chopra, Jeffrey Anderson, Christine dela Cruz, Lixin Lang, Jaclyn Neely, Hao Tang, Homa B Dastani, Ignacio Melero
ver resumen
Nivolumab had a manageable safety profile and no new signals were observed in patients with advanced hepatocellular carcinoma. Durable objective responses show the potential of nivolumab for treatment of advanced hepatocellular carcinoma.

[Series] Health and health care in Israel: an introduction
8/5/2017
A Mark Clarfield, Orly Manor, Gabi Bin Nun, Shifra Shvarts, Zaher S Azzam, Arnon Afek, Fuad Basis, Avi Israeli
ver resumen
Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922–48), the development of many of today's health services predated the state's establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law.

[Series] Maternal and child health in Israel: building lives
8/5/2017
Lisa Rubin, Ilana Belmaker, Eli Somekh, Jacob Urkin, Mary Rudolf, Mira Honovich, Natalya Bilenko, Zachi Grossman
ver resumen
Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development.

[Series] Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges
8/5/2017
Khitam Muhsen, Manfred S Green, Varda Soskolne, Yehuda Neumark
ver resumen
Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries.

[Series] Coming of age: health-care challenges of an ageing population in Israel
8/5/2017
Tzvi Dwolatzky, Jenny Brodsky, Faisal Azaiza, A Mark Clarfield, Jeremy M Jacobs, Howard Litwin
ver resumen
Although Israel is still young in years, with relatively high birth rates and older people (individuals aged 65 years or older) constituting only about 11% of its population, the absolute number of older people is growing rapidly. Life expectancy is high, and increasing numbers of people are living to advanced old age (older than 85 years). A wide spectrum of geriatric care is provided within a universal system providing health services to all citizens. Community and institutional care is available, and many innovative programmes are being developed.

[Series] Israel: health and beyond
8/5/2017
Karl Skorecki, Richard Horton
ver resumen
The principle that global human identity and dignity supersede other values is a broadly accepted conviction that guides practice and policies in the realm of human health in most of the world. An assessment of the level of success that Israel has achieved in health, in the face of formidable challenges, including rapid population growth, diverse and often divided ethnic affiliations, and existential security threats, leads us to propose that extension of this principle of global human identity and dignity, together with the objective of a decent society, as overriding values beyond health to other domains of human endeavour within Israel and in its relations with neighbouring peoples, represents an entirely achievable imperative.

[Viewpoint] Israel: a start-up life science nation
8/5/2017
Rafael Beyar, Benny Zeevi, Gideon Rechavi
ver resumen
Advances in biomedicine are the product of a combination of research, technological progress, and innovation. The environment needed to promote such progress includes strong academic education and research, vibrant health and hospital systems, an entrepreneurial culture, and the appropriate industrial infrastructure. Senor and Singer1 provide a detailed analysis of the reasons for the surge of technology-based companies in Israel—what they call a start-up nation. In this Viewpoint, we examine the development of Israeli life science research and associated industry and analyse the reasons Israel has become a life science start-up nation.

[Viewpoint] The medical education system in Israel
8/5/2017
Shmuel Reis, Shimon M Glick, Jacob Urkin, Peter Gilbey
ver resumen
During the British administration of the Palestine Mandate, before the foundation of Israel in 1948, the Jewish community built hospitals, developed a network of clinics, and established a fairly extensive coverage of health care.1 Yet not until 1949 was the first medical school founded at the Jerusalem-based Hebrew University of Jerusalem. Although much of the funding came from the Hadassah, the Women's Zionist Organization of America, most of the teaching staff were, at first, refugees who had received their medical training in Germany before migrating to Palestine.

[Viewpoint] Women and health in Israel
8/5/2017
Leeat Granek, Ora Nakash, Rivka Carmi
ver resumen
WHO defines health as “a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity”.1 This broad definition includes physical and mental health, but also socioeconomic standing and access to resources such as health care and safety. In this Viewpoint, we present a holistic picture of women's health within the Israeli societal and cultural context, taking these factors into account.



The Lancet - cardiopatía isquémica

[Articles] Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase
2/5/2017
ver resumen
These analyses illustrate the so-called nocebo effect, with an excess rate of muscle-related AE reports only when patients and their doctors were aware that statin therapy was being used and not when its use was blinded. These results will help assure both physicians and patients that most AEs associated with statins are not causally related to use of the drug and should help counter the adverse effect on public health of exaggerated claims about statin-related side-effects.

[Articles] Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial
31/10/2016
ver resumen
The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease.

[Articles] Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB II): a 3 year, randomised, controlled, single-blind, multicentre clinical trial
30/10/2016
ver resumen
The trial did not meet its co-primary endpoints of superior vasomotor reactivity and non-inferior late luminal loss for the Absorb bioresorbable scaffold with respect to the metallic stent, which was found to have significantly lower late luminal loss than the Absorb scaffold. A higher rate of device-oriented composite endpoint due to target vessel myocardial infarction, including peri-procedural myocardial infarction, was observed in the Absorb group. The patient-oriented composite endpoint, anginal status, and exercise testing, were not statistically different between both devices at 3 years.

[Articles] Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial
30/10/2016
ver resumen
OCT-guided PCI using a specific reference segment external elastic lamina-based stent optimisation strategy was safe and resulted in similar minimum stent area to that of IVUS-guided PCI. These data warrant a large-scale randomised trial to establish whether or not OCT guidance results in superior clinical outcomes to angiography guidance.

[Articles] Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): a three-arm, randomised, non-inferiority trial
30/10/2016
ver resumen
At 12 month follow-up, both very thin strut drug-eluting stents with dissimilar biodegradable polymer coatings (eluting either everolimus or sirolimus) were non-inferior to the durable polymer stent (eluting zotarolimus) in treating allcomers with a high proportion of patients with acute coronary syndromes. The absence of a loss of 1 year safety and efficacy with the use of these two biodegradable polymer-coated stents is a prerequisite before assessing their potential longer-term benefits.

[Review] Interpretation of the evidence for the efficacy and safety of statin therapy
8/9/2016
ver resumen
This Review is intended to help clinicians, patients, and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomised controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.

[Articles] Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study
29/8/2016
ver resumen
During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.

[Articles] Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial
28/8/2016
ver resumen
Platelet function monitoring with treatment adjustment did not improve the clinical outcome of elderly patients treated with coronary stenting for an acute coronary syndrome. Platelet function testing is still being used in many centres and international guidelines still recommend platelet function testing in high-risk situations. Our study does not support this practice or these recommendations.

[Seminar] Acute myocardial infarction
5/8/2016
ver resumen
Acute myocardial infarction has traditionally been divided into ST elevation or non-ST elevation myocardial infarction; however, therapies are similar between the two, and the overall management of acute myocardial infarction can be reviewed for simplicity. Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide, despite substantial improvements in prognosis over the past decade. The progress is a result of several major trends, including improvements in risk stratification, more widespread use of an invasive strategy, implementation of care delivery systems prioritising immediate revascularisation through percutaneous coronary intervention (or fibrinolysis), advances in antiplatelet agents and anticoagulants, and greater use of secondary prevention strategies such as statins.

[Review] Pathophysiology and management of cardiovascular disease in patients with HIV
9/2/2016
ver resumen
Results from several studies have suggested that people with HIV have an increased risk of cardiovascular disease, especially coronary heart disease, compared with people not infected with HIV. People living with HIV have an increased prevalence of traditional cardiovascular disease risk factors, and HIV-specific mechanisms such as immune activation. Although older, more metabolically harmful antiretroviral regimens probably contributed to the risk of cardiovascular disease, new data suggest that early and continuous use of modern regimens, which might have fewer metabolic effects, minimises the risk of myocardial infarction by maintaining viral suppression and decreasing immune activation.

[Articles] Plasma urate concentration and risk of coronary heart disease: a Mendelian randomisation analysis
15/1/2016
ver resumen
Conventional and multivariate Mendelian randomisation analysis implicates a causal role for urate in the development of coronary heart disease, but these estimates might be inflated by hidden pleiotropy. Egger Mendelian randomisation analysis, which accounts for pleiotropy but has less statistical power, suggests there might be no causal effect. These results might help investigators to determine the priority of trials of urate lowering for the prevention of coronary heart disease compared with other potential interventions.

[Articles] Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study
15/12/2015
ver resumen
Chinese patients with early-onset type 2 diabetes are at increased risk of non-fatal cardiovascular disease, mostly attributable to longer duration of diabetes.

[Articles] Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study
20/10/2015
ver resumen
No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease.

[Comment] Prevention of malaria in pregnancy: a fork in the road?
28/9/2015
ver resumen
In efforts to improve protection against the adverse consequences of malaria in pregnancy, several trials1–3 have investigated alternative drug regimens and strategies to replace sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria in pregnancy. Even before WHO first recommended inclusion of intermittent preventive treatment with sulfadoxine–pyrimethamine in the focused antenatal care package in 2004,4 malaria parasites expressed mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) genes,5 compromising the protective effect of the intervention.

[Articles] Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin–piperaquine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial
28/9/2015
ver resumen
At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine–pyrimethamine in the context of high sulfadoxine–pyrimethamine resistance and malaria transmission. However, dihydroartemisinin–piperaquine is a promising alternative drug to replace sulfadoxine–pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin–piperaquine.

[Articles] Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
19/8/2015
ver resumen
Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

[Articles] Cardiovascular safety of albiglutide in the Harmony programme: a meta-analysis
11/8/2015
ver resumen
Cardiovascular events were not significantly more likely to occur with albiglutide than with all comparators. Because the upper bound of the 95% CI for major adverse cardiovascular event plus hospital admission for unstable angina was greater than 1·3, a dedicated study with a cardiovascular endpoint is underway to confirm the safety of albiglutide.

[Articles] Antisense therapy targeting apolipoprotein(a): a randomised, double-blind, placebo-controlled phase 1 study
22/7/2015
ver resumen
ISIS-APO(a)Rx results in potent, dose-dependent, selective reductions of plasma Lp(a). The safety and tolerability support continued clinical development of ISIS-APO(a)Rx as a potential therapeutic drug to reduce the risk of cardiovascular disease and calcific aortic valve stenosis in patients with elevated Lp(a) concentration.

[Articles] An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study
14/7/2015
ver resumen
Health workers without formal professional training can be adequately trained to effectively screen for, and identify, people at high risk of cardiovascular disease. Using community health workers for this screening would free up trained health professionals in low-resource settings to do tasks that need high levels of formal, professional training.

[Articles] Association of HDL cholesterol efflux capacity with incident coronary heart disease events: a prospective case-control study
26/5/2015
ver resumen
HDL cholesterol efflux capacity might provide an alternative mechanism for therapeutic modulation of the HDL pathway beyond HDL cholesterol concentration to help reduce risk of coronary heart disease.



The Lancet - hipertensión

[Articles] Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
5/4/2017
ver resumen
Mean achieved SBP less than 120 mm Hg during treatment was associated with increased risk of cardiovascular outcomes except for myocardial infarction and stroke. Similar patterns were observed for DBP less than 70 mm Hg, plus increased risk for myocardial infarction and hospital admission for heart failure. Very low blood pressure achieved on treatment was associated with increased risks of several cardiovascular disease events. These data suggest that the lowest blood pressure possible is not necessarily the optimal target for high-risk patients, although it is not possible to rule out some effect of reverse causality.

[Articles] Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review
9/2/2017
ver resumen
The findings of our small trial in the context of previous randomised evidence suggest that the benefits of quarter-dose therapy could be additive across classes and might confer a clinically important reduction in blood pressure. Further examination of the quadpill concept is needed to investigate effectiveness against usual treatment options and longer term tolerability.

[Articles] Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study
30/8/2016
ver resumen
In patients with hypertension and coronary artery disease from routine clinical practice, systolic blood pressure of less than 120 mm Hg and diastolic blood pressure of less than 70 mm Hg were each associated with adverse cardiovascular outcomes, including mortality, supporting the existence of a J-curve phenomenon. This finding suggests that caution should be taken in the use of blood pressure-lowering treatment in patients with coronary artery disease.

[Articles] Ramipril versus placebo in kidney transplant patients with proteinuria: a multicentre, double-blind, randomised controlled trial
22/10/2015
ver resumen
Treatment with ramipril compared with placebo did not lead to a significant reduction in doubling of serum creatinine, end-stage renal disease, or death in kidney transplant recipients with proteinuria. These results do not support the use of angiotensin-converting enzyme inhibitors with the goal of improving clinical outcomes in this population.

[Articles] Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study
20/10/2015
ver resumen
No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease.

[Comment] Prevention of malaria in pregnancy: a fork in the road?
28/9/2015
ver resumen
In efforts to improve protection against the adverse consequences of malaria in pregnancy, several trials1–3 have investigated alternative drug regimens and strategies to replace sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria in pregnancy. Even before WHO first recommended inclusion of intermittent preventive treatment with sulfadoxine–pyrimethamine in the focused antenatal care package in 2004,4 malaria parasites expressed mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) genes,5 compromising the protective effect of the intervention.

[Articles] Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin–piperaquine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial
28/9/2015
ver resumen
At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine–pyrimethamine in the context of high sulfadoxine–pyrimethamine resistance and malaria transmission. However, dihydroartemisinin–piperaquine is a promising alternative drug to replace sulfadoxine–pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin–piperaquine.

[Articles] Cardiovascular safety of albiglutide in the Harmony programme: a meta-analysis
11/8/2015
ver resumen
Cardiovascular events were not significantly more likely to occur with albiglutide than with all comparators. Because the upper bound of the 95% CI for major adverse cardiovascular event plus hospital admission for unstable angina was greater than 1·3, a dedicated study with a cardiovascular endpoint is underway to confirm the safety of albiglutide.

[Review] Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions
13/7/2015
ver resumen
Almost two decades have elapsed since posterior reversible encephalopathy syndrome (PRES) was described in an influential case series. This usually reversible clinical syndrome is becoming increasingly recognised, in large part because of improved and more readily available brain imaging. Although the pathophysiological changes underlying PRES are not fully understood, endothelial dysfunction is a key factor. A diagnosis of PRES should be considered in the setting of acute neurological symptoms in patients with renal failure, blood pressure fluctuations, use of cytotoxic drugs, autoimmune disorders, or eclampsia.

[Articles] Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data
28/5/2015
ver resumen
Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when these measures are already assessed for clinical purpose or if cardiovascular mortality and heart failure are outcomes of interest. ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved classification of cardiovascular risk, supporting current guidelines for chronic kidney disease.

[Articles] Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration)
18/5/2015
ver resumen
Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed offspring glucose metabolism.

[Articles] Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)
6/3/2015
ver resumen
Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.

[Articles] Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial
9/1/2015
ver resumen
No significant effects of statin therapy on arterial inflammation of the aorta were seen as measured by FDG-PET. However, statin therapy reduced non-calcified plaque volume and high-risk coronary plaque features in HIV-infected patients. Further studies should assess whether reduction in high-risk coronary artery disease translates into effective prevention of cardiovascular events in this at-risk population.

[Comment] Optimum antihypertensive therapy: does adiposity matter?
4/11/2014
ver resumen
Given that at least 75% of patients with hypertension are obese, it is no coincidence that the continuing obesity epidemic is driving the increasing incidence of hypertension.1 Physicians have questioned whether the benefits of blood pressure lowering for cardiovascular disease might depend, in part, on choice of antihypertensive drugs (as shown in ACCOMPLISH2) and that the choice of drugs should vary with the state of adiposity.3

[Articles] Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials
4/11/2014
ver resumen
We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.

[Articles] Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke: a secondary analysis from the SPS3 randomised trial
24/10/2014
ver resumen
Cognitive function is not affected by short-term dual antiplatelet treatment or blood pressure reduction in fairly young patients with recent lacunar stroke. Future studies of cognitive function after stroke should be of longer duration or focus on patients with higher rates of cognitive decline.

[Comment] Blood pressure control after stroke: too little, too late, or too soon to tell?
24/10/2014
ver resumen
Cognitive decline is among the most feared and common changes in late life, and prevention of cognitive decline in any population is a worthy goal. In The Lancet Neurology, Lesly Pearce and colleagues1 report results of a prespecified secondary outcome analysis of cognitive function from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, which compared aspirin plus clopidogrel with aspirin plus placebo, and high goal (130–149 mm Hg) with low goal (<130 mm Hg) blood pressure targets, in a factorial design.

[Comment] Low vitamin D and hypertension: a causal association?
25/6/2014
ver resumen
In The Lancet Diabetes & Endocrinology, Karani Vimaleswaran and colleagues1 report the results of a mendelian randomisation study with data from up to 146 581 individuals, which suggest that low vitamin D concentrations might be causally associated with an increased risk of hypertension. The investigators used variants of genes that affect 25-hydroxyvitamin D (25[OH]D) synthesis or substrate availability (CYP2R1 and DHCR7) and report that each 10% increase in genetically instrumented plasma 25(OH)D concentration was associated with a decrease in diastolic blood pressure (−0·29 mm Hg, 95%CI −0·52 to −0·07; p=0·01) and systolic blood pressure (−0·37 mm Hg, −0·73 to 0·003; p=0·052), and an 8·1% reduced odds of hypertension (odds ratio [OR] 0·92, 95% CI 0·87–0·97; p=0·002).

[Articles] Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study
25/6/2014
ver resumen
Increased plasma concentrations of 25(OH)D might reduce the risk of hypertension. This finding warrants further investigation in an independent, similarly powered study.

[Personal View] Adrenal vein sampling in primary aldosteronism: towards a standardised protocol
12/5/2014
ver resumen
Primary aldosteronism comprises subtypes that need different therapeutic strategies. Adrenal vein sampling is recognised by Endocrine Society guidelines as the only reliable way to correctly diagnose the subtype of primary aldosteronism. Unfortunately, despite being the gold-standard procedure, no standardised procedure exists either in terms of performance or interpretation criteria. In this Personal View, we address several questions that clinicians are presented with when considering adrenal vein sampling.







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