Statins (HMG CoA reductase inhibitors) have traditionally been prescribed for the treatment of hypercholesterolemia, but the landmark JUPITER trial revealed other cardiovascular benefits of their use even in patients with low LDL. I also recently wrote an blog article about a published sub-analysis of the JUPITER data demonstrating that rosuvastatin decreases the risk of symptomatic venous thromboembolism.
The JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial evaluated the effects of rosuvastatin use on major cardiovascular events. A recent sub-analysis of the data that was published in the New England Journal of Medicine evaluated for the incidence of venous thromboembolism while on rosuvastatin, compared to placebo.
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The 85-center SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) trial compared percutaneous coronary intervention (PCI) with coronary-artery bypass grafting (CABG) for treating patients with previously untreated three-vessel or left main artery disease. The primary endpoints for the study included the following: death from any cause, stroke, myocardial infarction, and repeat revascularization. These variables were measured up to 12 months after treatment. Between the two interventions, the study found no difference in rates of death
or myocardial infarction. The incidence of stroke was higher in the
CABG group (2.7% vs. 0.3% with PCI; p=0.01). The rates for combined major adverse cardiac or cerebrovascular events were however higher in the PCI group (17.8% vs. 12.4% with CABG; p=0.002). This difference was largely attributed to a significant difference in the rate of repeat revascularization (13.5% vs. 5.9% with CABG; p<0.001).
The authors conclude that “CABG, as compared with PCI, is associated with a lower rate of major adverse cardiac or cerebrovascular events at 1 year among patients with three-vessel or left main coronary artery disease (or both) and should therefore remain the standard of care for such patients.”
- Source
- Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; the SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009
A German group recently evaluated the use of antidepressants for
fibromyalgia syndrome (FMS), a chronic pain disorder affecting
multiple points of tenderness. They performed a meta-analysis of
randomized controlled trials published through August 2008. The
studies included randomized placebo-controlled trials involving
tricyclic/tetracyclic antidepressants (TCAs), selective serotonin
reuptake inhibitors (SSRIs), combined serotonin and noradrenaline
reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs).
The study noted a strong association between the use of antidepressants and reduction in pain, fatigue, depression, and sleep disturbances. There was also an improved health-related quality of life. The effects were most notable with TCAs, less with MAOIs, and least with SSRIs or SNRIs.
Source: Hauser W, Bernardy K, Uceyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants. JAMA 2009;301:198-209.
Researchers from the Mayo Clinic department of emergency medicine investigated the incidence of anaphylaxis in Rochester, Minnesota, over a 10-year period spanning 1990 through 2000. Anaphylaxis was identified based on signs and symptoms of mast cell and/or basophil-mediated cytokine release, accompanied by organ involvement (i.e., mucocutaneous walls, gastrointestinal tract, respiratory tract, or cardiovascular system).
There were 211 cases identified within the 10-year period, which resulted in an age- and sex-adjusted incidence rate of 49.8 cases per 100,000 person-years. Leading causes for anaphylaxis were food (70 cases), insect stings (39 cases), medication effect (29 cases), and radiologic contrast (1 case). There were 19 cases attributed to “other” causes, such as cats, latex, cleaning agents, environmental triggers, and exercise. There were also 53 cases of anaphylaxis from “unknown” causes.
Source: Decker WW, Campbell RL, Manivannan V, Luke A, St Sauver JL, Weaver A, Bellolio MF, Bergstralh EJ, Stead LG, Li JT. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol 2008;122:1161-5.
