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The Lancet - recientes

[Editorial] 40 years of percutaneous coronary intervention: where next?
19/8/2017
The Lancet
ver resumen
When cardiologists gather in Barcelona, Spain, from Aug 26–31 for the annual European Society of Cardiology meeting, they will celebrate Andreas Grüntzig in a special tribute session. Grüntzig performed the first percutaneous coronary angioplasty on Sept 16, 1977, at the University Hospital Zurich, Switzerland, on a 38-year-old patient with a high-grade discrete stenosis of the proximal left anterior descending coronary artery. He reported the first five patients in The Lancet in 1978. To mark this breakthrough and the birth of interventional cardiology, this year's conference spotlight is on 40 years of percutaneous coronary interventions (PCI).

[Editorial] The rising north–south divide in health in the UK
19/8/2017
The Lancet
ver resumen
The north–south divide in the UK, and in England in particular, is made up of economic and health-related disparities, among other socioeconomic factors. An article by Iain Buchan and colleagues, published on Aug 7 in the Journal of Epidemiology and Community Health, reported that in the past 20 years, age- and sex-adjusted excess mortality has increased by as much as 46 percentage points in people aged 35–44 years in the north of England compared with the south, and by 27 percentage points in people aged 25–34 years.

[Editorial] Nicotine addiction, reduction, and smoking cessation
19/8/2017
The Lancet
ver resumen
Last week, the US Food and Drug Administration (FDA) announced a multiyear roadmap to begin regulating the amount of nicotine allowed in tobacco products. Researchers, including tobacco control advocates, have proposed nicotine reduction as a way of decreasing levels of tobacco use, and the USA may be the first country to seriously discuss using this form of regulation to produce a potentially less addictive form of tobacco. In the wake of the FDA announcement, it was widely reported that other countries, including the UK, Canada, New Zealand, and Finland, have suggested that they would consider nicotine reduction policies for manufacturers.

[Comment] Timing of revascularisation for acute coronary syndrome
1/8/2017
Peter Damman, Robbert J de Winter
ver resumen
Acute coronary syndrome is predominantly caused by a luminal thrombus or a sudden plaque haemorrhage imposed on an atherosclerotic plaque with or without an accompanying vasospasm.1 A luminal thrombus forms as a direct consequence of plaque rupture or erosion (if plaque rupture is not identifiable on intracoronary imaging).2 Initial electrocardiography can be used to distinguish ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

[Comment] Intravenous fibrinolytics in STEMI: a 25-year perspective
19/8/2017
Saurav Chatterjee, Jay Giri
ver resumen
Heart disease remains the number one cause of mortality and morbidity across most of the world.1 Although rates of acute myocardial infarction have fallen in high-income countries, mostly as a consequence of improved lifestyle modifications and continued evolution of risk factor modification,2 acute myocardial infarction remains the most important driver of cardiac mortality. The cornerstones of therapy for acute myocardial infarction have been based on the open-artery hypothesis.3 Previous experimental animal models have shown the initiation of myocardial cell death early after ligation of an epicardial coronary artery.

[Comment] Bioresorbable scaffolds: in search of event-free dissolution
18/7/2017
Raffaele Piccolo, Peter Jüni, Stephan Windecker
ver resumen
Celebrating its 40th anniversary, percutaneous coronary intervention has evolved from balloon angioplasty over bare metal stents to the routine use of drug-eluting stents. Coronary artery stents introduced in the late 1980s marked an important milestone in the development of percutaneous coronary intervention by scaffolding the treated arterial segment and thereby eliminating the risk of abrupt vessel closure due to dissections following balloon angioplasty as well as negative remodelling due to elastic recoil.

[Comment] Expansion of the treatment toolbox for mitral regurgitation
19/8/2017
Ottavio Alfieri, Nicola Buzzatti
ver resumen
In The Lancet, Fabien Praz and colleagues1 report their preliminary experience with the PASCAL mitral repair device and its success among 23 patients, most of whom were not considered anatomically suitable for conventional percutaneous mitral repair.2 The authors did a multicentre, prospective, observational, first-in-man study, collecting data from seven tertiary care hospitals in five countries. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation who were denied other surgical or transcatheter options.

[Comment] Hunting hidden parasites: Trypanosoma cruzi
19/8/2017
Miriam Navarro, Begoña Monge-Maíllo, María D Flores-Chavez, Rogelio López-Vélez
ver resumen
Pathogens are not aware of international borders, including pathogens that cause emerging and neglected tropical diseases. Although Chagas disease is endemic to Latin America, where it affects around 5·7 million people,1,2 it is now a disease of global concern mainly because of the movement of human populations. After the USA, Spain hosts the highest number (more than 50 000) of migrants infected with Trypanosoma cruzi, the parasite that causes this life-threatening disease.3,4 European countries should therefore adapt their legislation to control the main non-vector modes of T cruzi transmission (blood transfusions and haemoderivatives, and organ transplantation).

[World Report] The cost of complacency—black lung in Australia
19/8/2017
Chris McCall
ver resumen
Black lung's resurgence in Australia is a wake-up call for the international community.

[Perspectives] Jeroen Bax: inspiring the next generation of cardiologists
19/8/2017
Rachael Davies
ver resumen
A conversation with the eminent cardiologist Eugene Braunwald fuelled Jeroen Bax's interest in nurturing aspiring cardiologists. “Braunwald told me that what really matters is developing the next generation of researchers and clinicians”, he recalls. By 2018, Bax will have mentored 60 international PhD students in his cardiac imaging research centre at Leiden University Medical Center (LUMC) in the Netherlands. “Jeroen's students have achieved prominent positions at medical institutions throughout the world”, says Anthony DeMaria, Professor of Medicine at the University of California, San Diego.

[Perspectives] Fat and heart disease: challenging the dogma
19/8/2017
Stuart Spencer
ver resumen
Many readers will be incensed by this book. If you think saturated fats and cholesterol are bad for you, you'll be incensed. If you think the fat story is exaggerated, you'll be incensed. If you trust in the objectivity of science to inform health policy, you'll be incensed. Stories of shocking scientific corruption and culpability by government agencies are all to be found in Nina Teicholz's bestseller The Big Fat Surprise. This is a disquieting book about scientific incompetence, evangelical ambition, and ruthless silencing of dissent that has shaped our lives for decades.

[Obituary] Prudence Mabele
19/8/2017
Andrew Green
ver resumen
South African HIV and gender rights activist. Born in Wattville, South Africa, on July 21, 1971, she died from pneumonia in Johannesburg, South Africa, on July 10, 2017, aged 45 years.

[Correspondence] Global health: generation men
19/8/2017
Nina Schwalbe
ver resumen
The Fearless Girl statue that faces down Wall Street's charging bull grabbed international headlines and triggered a debate about the glass ceiling that continues to obstruct women from reaching the higher echelons of the financial sector.

[Correspondence] China, Africa, and US academia join hands to advance global health
19/8/2017
Liu Peilong, Yemane Berhane, Wafaie Fawzi, China Harvard Africa Network (CHAN) team
ver resumen
In 2016, Chinese President Xi Jinping announced the Healthy China 2030 plan—an ambitious agenda to promote health across China and to strengthen South–South cooperation, including the China–Africa Public Health cooperation plan.1 In 2005, African heads of state championed the Agenda Africa 2063, which had a similar emphasis on population health.2 Ongoing health reforms across both Africa and China offer immense potential for mutual learning.3,4 China's success in the provision of preventive and primary care has the potential to inform health care in Africa, which faces similar challenges today as China did more than three decades ago; however, Chinese academic health experts have been unable to translate Chinese experiences to the African context, and suggest academic institutions in both countries need more capacity building to foster sustainable changes to the local health systems.

[Correspondence] PubMed should raise the bar for journal inclusion
19/8/2017
Andrea Manca, Lucia Cugusi, Zeevi Dvir, Franca Deriu
ver resumen
A survey by Manca and colleagues1,2 found that predatory journals active in neuroscience and neurology outnumber those regularly indexed in the main biomedical databases. Furthermore, this analysis of predatory publishing (as of October, 2016) showed that over 10% of predatory journals in three important subdisciplines are indexed in PubMed (12% for rehabilitation, 11·4% for neurosciences, and 20·2% for neurology).1,2

[Correspondence] The BLISTER study: possible overestimation of tetracycline efficacy
19/8/2017
Michael J Sladden, Peter E Hutchinson
ver resumen
The BLISTER study, by Hywell C Williams and colleagues (March 6, p 1630),1 indicated that a 25% decrease in the efficacy of tetracycline in the early control of blisters would be acceptable to most UK dermatologists, if accompanied by a reduction of at least 20% in long-term serious side-effects compared with prednisolone. The efficacy of the tetracycline doxycycline was acceptable according to the study's primary effectiveness measure at 6 weeks (upper limit of 90% CI of adjusted difference between treatments [UB], 26·1%, within the 37% predefined acceptable non-inferiority margin [AM]); however, we question the aspects of the study design that appear to favour doxycycline.

[Correspondence] The BLISTER study: possible overestimation of tetracycline efficacy – Authors' reply
19/8/2017
Hywel C Williams, Joanne R Chalmers, Andrew J Nunn, Gudula Kirtschig, Enno Schmidt
ver resumen
We thank Michael J Sladden and Peter E Hutchinson for their comments, but respectfully disagree that our study design1 favoured doxycycline. BLISTER was not an efficacy study of doxycycline versus prednisolone. We investigated whether a doxycycline-initiated pemphigoid treatment strategy could result in improved safety and acceptable effectiveness, when compared with starting with prednisolone. The doxycycline-initiated strategy was expected to be 25% less effective than prednisolone at 6 weeks.

[Correspondence] Forgotten episodes of euthanasia in the 19th century
19/8/2017
Marta Licata, Federico Nicoli, Giuseppe Armocida
ver resumen
Two forgotten episodes of euthanasia occurred in the 19th century. The first was recounted by Giuseppe Bandi,1 an officer of Giuseppe Garibaldi, who was injured during the Battle of Calatafimi in 1860 (Sicily, Italy). Bandi was subsequently admitted to the san Michele Convent (Calatafimi, Italy), where other soldiers who had also been gravely wounded were recovering. Among the soldiers was a young man—the Mantuan—with a broken leg who had gangrene and another—the Maironi from Bergamo—who had been wounded by a bullet to his right arm.

[Articles] Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials
1/8/2017
Alexander Jobs, Shamir R Mehta, Gilles Montalescot, Eric Vicaut, Arnoud W J van't Hof, Erik A Badings, Franz-Josef Neumann, Adnan Kastrati, Alessandro Sciahbasi, Paul-Georges Reuter, Frédéric Lapostolle, Aleksandra Milosevic, Goran Stankovic, Dejan Milasinovic, Reinhard Vonthein, Steffen Desch, Holger Thiele
ver resumen
An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients.

[Articles] Comparative efficacy and safety of reperfusion therapy with fibrinolytic agents in patients with ST-segment elevation myocardial infarction: a systematic review and network meta-analysis
19/8/2017
Peerawat Jinatongthai, Junporn Kongwatcharapong, Chee Yoong Foo, Arintaya Phrommintikul, Surakit Nathisuwan, Ammarin Thakkinstian, Christopher M Reid, Nathorn Chaiyakunapruk
ver resumen
Significant differences exist among various fibrinolytic regimens as reperfusion therapy in STEMI and alteplase (accelerated infusion), tenecteplase, and reteplase should be considered over streptokinase and non-accelerated infusion of alteplase. The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy should be discouraged.



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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