In episode 235, Mike and James welcome Adrienne Lindblad who helps us sort out the issue of how many antiplatelets do you need after a stroke. We come to the conclusion that the evidence is really difficult to unclog, the answering is as clear as a plugged drain and if you get the title of this podcast you are very old.

Show notes

1) Tools For Practice

Anti-platelets after stroke: Are two better than one? 

2) Surgery 101 – very clever audio/video podcast from a surgery gang from Edmonton, Alberta

In episode 234, Mike and James go PREMIUM all over again and discuss three new studies that were recently in the news. These studies looked at the link between fatty acids and coronary heart disease and acetaminophen use in pregnancy and ADHD. At the end of the podcast we decide to go out and eat a delicious meal and we forgot that we talked about an acetaminophen study.

Show notes

1) The Health Food Delusion 

Vancouver Sun Podcast

2) Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk

Ann Intern Med 2014;160:398-406

3) Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis

BMJ 2013 Feb 4;346:e8707

4) Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders

JAMA Pediatr. doi:10.1001/jamapediatrics.2013.4914

In episode 233, Mike and James continue on with how to deal with a failing heart. We talk about nitrates, digoxin and the aldosterone antagonists. We then talk about the approach to using these medications and how we don’t need to get to everybody to high doses of every drug and in fact that this causes considerable harm unless it is done carefully.

Show notes

1) Nitrates

NEJM 2004;351:2049-57

2) DIG trial

NEJM 1997; 336:525-33

3) Aldosterone antagonists

Tools For Practice

Aldosterone antagonists in systolic heart failure – no longer an afterthought

4) Target dose evidence

Network – ACE doses

Eur Heart J 1998;19:481-9

ATLAS – ACE doses

Circ 1999;100:2312-8

Carvedilol doses

Circulation 1996;94:2807-16

Beta-blocker doses

Ann Intern Med 2009;150:784-94

Getting to carvedilol doses

QJM 2004;97:133-9

HEAAL – losartan

Lancet 2009;374;1840-8

In episode 232, Mike and James get to all the evidence around drugs for heart failure. We talk about furosemide, ACE inhibitors, beta-blockers and ARBs. The bottom line is that we have good evidence for reduction in mortality and heart failure admissions however the evidence for symptomatic control is surprisingly absent and both our hearts fail a little bit because of that news. 

Show notes

1) Diuretics

Cochrane CD003838

2) ACE inhibitors

Lancet 2000;355:1575-81

3) Aldosterone antagonists in systolic heart failure – no longer an afterthought  

Tools For Practice 

4) Beta-blockers

Ann Intern Med 2001;134:550-60

5) ARBs

PLOS 1 2010

6) Carvedilol vs metoprolol

Lancet 2003;362:7-13