Anti-Inflammatory Therapy May Not Prevent Atherosclerotic Events Low-Dose Methotrexate for the Prevention of Atherosclerotic Events

A randomized double-blinded trial called Cardiovascular Inflammation Reduction Trial (CIRT) recently published in the New England Journal of Medicine by Ridker, M.D. and his colleges at  the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, Boston illustrated that that low-dose methotrexate did not reduce atherosclerotic events or any markers of inflammation such as interleukin-1β, interleukin-6, or C-reactive protein. Continue reading

Statins Shown to Reduce Major Adverse Cardiovascular Events in Patients Older Than Seventy Five Years Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials

HMG-CoA reductase inhibitors or as they are commonly known as statins have been postulated to produce significant reductions in major vascular events irrespective of age, but their efficacy and benefit among patients older than 75 years have not been well documented. In a recent meta-analysis published in The Lancet, by The Cholesterol Treatment Trialists’ Collaboration (CTT collaboration), the influence of advancing age and statin therapy on major vascular episodes in 28 statin trials was analyzed. The collaboration found that statins do reduce the risk of vascular events in older people but have no effect, irrespective of age, on non-vascular mortality and cancer incidence. In the past, 14 meta-analyses have been done each with inconsistent evidence about the use of statins among older people (generally >65 years). This gap in evidence concerning the perception of risk-benefit for the use of statins as the primary prevention in people older than 75 years may be one of the reasons explaining why statin therapy is often discontinued in older patients. Unlike these studies, the present meta-analysis conducted by the CTT collaboration analyzed individual participant data from randomized controlled trials of 186, 854 participants who were older than 75 years with a median follow-up of 4·9 years. Continue reading

Does Aggressive Control of Blood Pressure Decrease the Risk of Cognitive Impairment? Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia- A Randomized Clinical Trial

So far, there has been no definitive treatment for dementia. There are medications that provide symptomatic relief but there has been an advance towards developing disease-modifying medications. Due to the long preclinical period of most neurodegenerative diseases, prevention as a mode of treatment seems to be an important area of exploration. The relation between high blood pressure and cognitive impairment is one important aspect. In a recent randomized controlled trial called Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study published in JAMA NETWORK, researchers from the SPRINT group embarked to ascertain if intensive blood pressure control could decrease the risk of Alzheimer disease and related dementias. This was the first trial ever to demonstrate an effectual strategy for preventing of age-related cognitive impairment as it compared the effectiveness of intensive blood pressure control (targeting a systolic blood pressure of less than 120 mm Hg) to standard blood pressure control (targeting a systolic blood pressure of less than 140 mm Hg) towards the prevention of probable dementia. Continue reading

Debunking Extreme Exercise and Coronary Artery Calcification: Can Those with ‘Hearts of Stone’ Run to Death? A Recent Study Says No Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification

Evidence suggests that men with high physical activity have higher levels of coronary artery calcification (CAC), but very little data is available on whether these men should continue to exercise and whether they have a higher risk of mortality. A recent study published in JAMA Cardiology by Dr. Laura F. DeFina and her colleagues from the Cooper Institute in Dallas, answers the important questions of whether extreme physical activity is injurious to health and if there is an association between increased CAC and clinical events. In short, their answer was no. Continue reading

Long-Term Consequences Post Device Closure of Patent Foramen Ovale in Patients With Cryptogenic Embolism

Recently, Jérôme Wintzer-Wehekind M.D. and his team at Quebec Heart & Lung Institute, Laval University, Quebec, Canada conducted a vast cohort study published in the Journal of American College of Cardiology to look into the long-term outcomes (> 10 years) following PFO closure. Previous randomized trials conducted by various investigators had shown a marvelous reduction in ischemic stroke events for around 2-6 years post PFO closure but not many had gone beyond 10 years. The current study validated that device closure of PFO decreased recurrence of ischemic neurological events and continued to show similar results with the passage of time.  Continue reading

Epidemiological Approach Shows Low LDL Levels Do Not Increase the Risk of Sepsis Association Between Low-Density Lipoprotein Cholesterol Levels and Risk for Sepsis Among Patients Admitted to the Hospital With Infection

A fascinating cohort study published in JAMA Network Open conducted by QiPing Feng, Ph.D., and colleagues from Vanderbilt University Medical Center in Nashville, Tennessee, refuted previous studies that showed a significant relationship between low levels of Low-density lipoprotein cholesterol (LDL-C) level and sepsis. Continue reading