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The Lancet - recientes

[Editorial] Tobacco control: a Foundation too far?
14/10/2017
The Lancet
ver resumen
Tobacco smoking is the leading cause of preventable mortality worldwide and is responsible for more than 7 million deaths each year. In today's issue of The Lancet, we publish a Viewpoint describing the mission and goals of the recently established Foundation for a Smoke-Free World, funded by tobacco giant Philip Morris International. Led by former WHO executive director Derek Yach, the Foundation, whose aim is “to eliminate cigarette smoking worldwide”, will receive US$1 billion in funding over the next 12 years.

[Editorial] WHO launches new leadership, new priorities
14/10/2017
The Lancet
ver resumen
WHO's Director-General, Dr Tedros, last week launched his new cabinet to widespread acclaim. His mix of deputy and assistant director-generals is made up of nine women (two-thirds of his leadership team) with a geographical spread across 14 countries. India, Brazil, Saudi Arabia, South Africa, and Barbados are all newly represented. The announcement also translated Tedros's verbal promises into structural commitments. New priorities include Universal Health Coverage, climate change, and access to medicines.

[Editorial] The link between cancer and obesity
14/10/2017
The Lancet
ver resumen
The US Centers for Disease Control and Prevention released a new report on cancer and obesity last week, highlighting that cancers associated with overweight and obesity, including thyroid, liver, kidney, and ovarian cancer, constitute 40% of cancers diagnosed in the USA, with over 630 000 diagnoses in 2014 alone. The study looked at data from the United States Cancer Statistics for 2005-2014. Disparities between sexes in the rates of cancers associated with obesity are especially stark, with 55% of all cancers diagnosed in women being associated with overweight and obesity, compared with only 24% of cancers in men.

[Comment] The impact of IMPACT-AF
28/8/2017
Michael D Ezekowitz, Anthony P Kent
ver resumen
We are living in an era when the science of medicine has never been better. Medical textbooks are regularly being updated and rewritten to accommodate advances. However, scientific advances are often not translated into medical practice or medical education. With a global burden in excess of 30 million people, atrial fibrillation could be considered a modern-day epidemic.1 But evidence shows that physicians considering anticoagulation treatments for patients are more influenced by the events they induce (bleeds) than the events potentially prevented, in this case devastating strokes.

[Comment] Dual antiplatelet therapy guided by platelet function testing
27/8/2017
Dominick J Angiolillo
ver resumen
Oral P2Y12 receptor inhibitors are key for secondary prevention of atherothrombotic events in patients with acute coronary syndromes, in particular those undergoing percutaneous coronary intervention (PCI)1. Prasugrel and ticagrelor are more potent than clopidogrel, which is characterised by increased rates of high on-treatment platelet reactivity (HPR), a known marker for recurrent ischaemic events, including stent thrombosis.2 This characteristic could explain the greater reduction in atherothrombotic events, albeit at the expense of more bleeding, associated with prasugrel and ticagrelor therapy among patients with acute coronary syndromes undergoing PCI.

[Comment] A hopeful therapy for Niemann-Pick C diseases
10/8/2017
Robert P Erickson, Maria Teresa Fiorenza
ver resumen
Niemann-Pick C1 disease (NPC1) is a rare autosomal recessive lysosomal storage disease, which was separated from the sphinomyelinase-deficient NPCA and NPCB when cholesterol was found to be stored.1 No drugs for the disease are currently approved in the USA, although miglustat is approved in Europe. In The Lancet, Daniel Ory and colleagues2 report strong evidence that intrathecal delivery of hydroxypropyl-beta-cyclodextrin (HPBCD) slows the progression of NPC1.

[Comment] Towards a smoke-free world? Philip Morris International's new Foundation is not credible
14/10/2017
Mike Daube, Rob Moodie, Martin McKee
ver resumen
Smoking causes more than 7 million deaths each year1 and tobacco companies have known, since at least 1950, that their products are lethal and addictive. Now Philip Morris International (PMI) is committing nearly US$1 billion over 12 years to the Philip Morris Foundation for a Smoke-Free World that will “fund scientific research designed to eliminate the use of smoked tobacco around the globe”.2 In a Lancet Viewpoint in this issue, the Foundation's President Derek Yach argues it will support “an unswerving focus…to improve public health and human wellbeing”.

[Comment] Catastrophic medical insurance in China
14/10/2017
Hongmei Li, Lixin Jiang
ver resumen
China's medical insurance system has changed dramatically in the past two decades. The country's most established programme, the Urban Employee Basic Medical Insurance, dates back to the mid-1990s and initially covered only 109 million employees of state-owned and collective enterprises.1 In the early 2000s, the Chinese Government established two additional insurance programmes, the New Cooperative Medical Scheme (NCMS) for rural residents and the Urban Resident Medical Insurance (URMI) programme for self-employed and unemployed urban residents.

[Comment] Offline: Jim Kim finds his voice
14/10/2017
Richard Horton
ver resumen
Jim Kim was an unexpected choice to lead the World Bank in 2012. He is not an economist (Kim is an anthropologist, physician, and health activist), and many Bank watchers were sceptical that he could lead an organisation full of econometricians. Kim's first term as President was tinged with controversy. Bravely—critics said unwisely—he embarked on a huge internal reform and cost-cutting programme. Soon, unhappiness inside the Bank became public, casting a shadow over his hopes for a fresh start at one of the world's most reviled development institutions.

[World Report] The ACA after the expiry of the budget reconciliation
14/10/2017
Susan Jaffe
ver resumen
After the latest repeal bill was withdrawn and the budget reconciliation has expired, what does the future hold for the ACA? Susan Jaffe, The Lancet's Washington correspondent, reports.

[World Report] Nobel Prize awarded for discoveries in circadian rhythm
14/10/2017
Talha Burki
ver resumen
The 2017 Nobel Prize in Physiology or Medicine was awarded to Jeffrey Hall, Michael Rosbash, and Michael Young. Talha Burki reports.

[World Report] 2017 Roux Prize recipient announced: Samba Sow
14/10/2017
Andrew Green
ver resumen
This year's Roux Prize was awarded to Samba Sow for using health data to save children's lives through a comprehensive vaccination programme. Andrew Green reports.

[Perspectives] Jiang Baoguo: one, two, three against trauma in China
14/10/2017
Geoff Watts
ver resumen
To those who live in nations that count their population in tens rather than hundreds of millions, Chinese health and social statistics can be faintly unnerving. Major trauma, for example, accounts for more than 60 million visits annually to Chinese hospitals, and for 700 000–800 000 deaths. Many of these injuries are due to road traffic accidents—and car ownership in China has soared. One man long familiar with these figures is Professor Jiang Baoguo, President of Peking University People's Hospital and its Chief Physician, who is a co-author of a Review on transport and public health in China in this issue.

[Perspectives] Spatial awareness
14/10/2017
Niall Boyce
ver resumen
How is your Klingon? The first scene of Star Trek: Discovery begins with a heated speech in the alien warriors' language. The Klingons are increasingly concerned about the incursion of Starfleet—the 23rd-century space exploration and defence service of the United Federation of Planets—into deep space. They don't like this human-heavy coalition, and they certainly don't trust it. The only words in English come at the climax of the scene, as the speaker quotes the distrusted “fatal greeting” of the enemy: “We come in peace.”

[Perspectives] Doubt
14/10/2017
Sam Guglani
ver resumen
“You're sure?” she asks me. This is about the nasogastric tube, whether to remove it. Or—someone else, another day—if the biopsy's finally conclusive. Or the operation, to have it now or wait. Or CPR, whether to receive it.

[Obituary] Sir David Todd
14/10/2017
Alison Snyder
ver resumen
Haematologist who transformed medical education and training in Hong Kong. He was born in Guangzhou, China, on Nov 17, 1928, and he died from pneumonia in Hong Kong on Aug 16, 2017, age 88 years.

[Correspondence] Condemning industry attempts to subvert public policy for a tobacco-free world
14/10/2017
David Wood, Jean-Luc Eiselé, Global Coalition for Circulatory Health (appendix)
ver resumen
The World Heart Federation, alongside its partners in the Global Coalition for Circulatory Health, condemns outright the launch of the Foundation for a Smoke-Free World,1 which is a vehicle for the tobacco industry.

[Correspondence] Nuclear war and public health: rebalancing priorities and global health leadership
14/10/2017
John Jungpa Park, Kee B Park, Nagi Shafik
ver resumen
Recently, the North Korean nuclear and missile crisis has gripped international media headlines.1 In the streets of Seoul, the vast majority of civilians remain remarkably calm, confident that this threat will pass like those of the past. Yet, complacency would not serve an excuse in the face of war by either intention or tragic miscalculation. By then, the silence of the global health community will likely be seen as an opportunity missed. Why does it remain silent? Perhaps the community feels out of its depth in an area of competence of the UN Security Council—surely they must know what they are doing?

[Correspondence] Charlie Gard and the limits of medicine
14/10/2017
Brendan D Kelly
ver resumen
The coverage of the Charlie Gard case in The Lancet (Aug 5, p 531)1 was excellent. As Dominic Wilkinson and Julian Savulescu wrote in their Comment,2 “we need a fair, expedient way of resolving disputes between families and clinicians”. But first, we need to acknowledge how rare such disputes are or, rather, how rarely they are not resolved at local level.

[Correspondence] Severity of illness and the weekend effect
14/10/2017
William J Kostis, Abel E Moreyra
ver resumen
In their Article (July 1, p 62),1 A Sarah Walker and colleagues reported that part of the so-called weekend effect can be explained using detailed biochemical, haematological, and other tests, which were absent in previous studies based on administrative databases.



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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