Video References
DIABETES
General
ACCORD – glucose lowering
ACCORD – blood pressure lowering
NEJM 2010:10.1056/NEJMoa1001286
Effect of intensive control of glucose on cardiovascular outcomes – meta-analysis
ADVANCE
N Engl J Med 2008 358:2560-2572
VADT trial
Glucose lowering meta-analysis – do the results support the conclusions?
UKPDS data
UKPDS (original trial)
UKPDS (recent results)
STENO
Risks
Lifetime risk of dialysis and blindness
Ann Intern Med 1997;127:788-95
Estimated benefits of glycemic control in microvascular complications in type 2 diabetes
Ann Intern Med 1997;127:788-95
Risk of dialysis in type 2 diabetes
A1c
Impact of glycosylated hemoglobin on functional decline
J Am Geriatr Soc 2012;60:1215–21
Metformin
Metformin meta-analysis – is it good or bad?
PLoS Med 9(4): e1001204. doi:10.1371/journal.pmed.1001204
SPREAD-DIMCAD
Diabetes Care 2012 Dec 10 (Epub ahead of print)
UKPDS 34 metformin
Sulfonylureas
Insulin
N Engl J Med 2012; 367:319-328
Gliptins/DPP4s
SAVOR-TIMI 53 – saxagliptin and cardiovascular outcomes
September 2, 2013DOI: 10.1056/NEJMoa1307684
EXAMINE – alogliptin and cardiovascular outcomes
September 2, 2013DOI: 10.1056/NEJMoa1305889
Sulphonylureas and risk of cardiovascular disease:systematic review and meta-analysis
Glitazones
Rosiglitazone
ACP Journal Club 2007Nov-Dec;147:66
Arch Intern Med 2010;170(14):1191-1201
Food and Drug Administration. Briefing document:July13-14,2010 meeting of the
Endocrinologic and Metabolic Drugs Advisory Committee
BMJ 2010;340:c1344.doi:10.1136/bmj.c1344
Glitazones meta-analyses
Lifestyle
Association of an Intensive Lifestyle Intervention With Remission of Type-2 Diabetes – LookAHEAD
JAMA 2012;308:2489-96. doi:10.1001/jama.2012.67929
Self-monitoring of blood glucose
ESMON
DiGEM
Burden
ASA – no benefit in diabetics
ASA -general
Arch Intern Med 2012;172:209-16
CHOLESTEROL
Statins
Statin meta-analyses
Relative risk reduction with statins in primary prevention
BMJ 2009;338:b2376
ACP J Club 2009;151:14
Lancet 2005;366:1267–78
Diabetes – Lancet 2008;371:117–25
Statin intolerance
RxFiles – Statin intolerance – management considerations
Statins and the elderly
J Am Coll Cardiol 2013;doi:10.1016/j.jacc.2013.07.069
High dose vs low dose
How does high dose statin compare to low dose in people with heart disease?
SEARCH – low dose (20 mg) vs high dose (80 mg) simvastatin in patients after an MI
Statin dose meta-analysis response
Statins in women
J Am Coll Cardiol 2012;59:572–82
Niacin
Niacin
AIM-HIGH
Combined analysis
Niacin Coronary drug project
Eur J Clin Pharmacol 1991;40 [Suppl 1]: S49-S51
Fibrates
ACCORD – fenofibrate
NEJM 2010:10.1056/NEJMoa1001282
FIELD – fenofibrate
Studies, systematic reviews and meta-analyses of fibrates
Am J Med 2009; 122: 962.e1-962.e8
J Am Coll Cardiol 2005;45:185–97
Arch Intern Med. 2005;165:725-730
Int J Cardiol 2009; doi:10.1016/j.ijcard.2008.11.211
ENHANCE
SEAS
Cancer data
Ezetimibe vs niacin – niacin better?
ARBITER 6–HALTS
Other
Dalcetrapib
N Engl J Med 2012 DOI: 10.1056/NEJMoa1206797
Torcetrapib
Lipid Research Clinics Trial
High cholesterol in patients over age 75-80
J Am Geriatr Soc 2004;52:1639-47
J Am Geriatr Soc 2005;53:2159-64
J Am Geriatr Soc 2005;53:219-26
HIGH BLOOD PRESSURE
General
Meta-analysis
Targets for hypertension
CD004349
Mild hypertension
CD006742
Other
J Htn 1993;11(suppl4):S61-73,
Lancet 2004;364:1684–9,
Ann Intern Med 2003;138:587-92
Benefit regardless of level
BMJ 2009;338:b1665doi:10.1136/bmj.b1665.
Specific drugs
Aliskiren
N Engl J Med 2012.DOI: 10.1056/NEJMoa1208799
Atenolol
Elderly
HYVET
Tools for practice
Hypertens Res 2008;31:1595-601
Different numbers
150 SBP vs 140 SBP
Systematic review of intensive BP treatment
Specific studies
ACCORD blood pressure study
CARDIO-Sis
AASK – chronic kidney disease
INVEST – retrospective data
UKPDS 38
HOT Trial
Waste and Harm in the Treatment of Mild Hypertension
JAMA Intern Med. 2013;():1-2. doi:10.1001/jamainternmed.2013.970.
doi:10:1001/jama.2010.920
NUTRITION
Mediterranean
N Engl J Med 2013 DOI:10.1056/NEJMoa1200303
Ann Intern Med 2009;151:306-14
Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors
Vitamins
A & E harmful
Can Fam Physician 2005;51:1471-2
Antioxidants
Multivitamins unnecessary
JAMA 2010;304:1592-1601
Vitamin B increases mortality
Increased mortality for beta-carotene, Vitamin A, Vitamin E, but not for selenium and Vitamin C
Cochrane Database Syst Rev 2008;(2):CD007176
Vitamin B (folic acid) and homocysteine – 1 positive trial, 3 negative trials
J Am Coll Cardiol 2003;41:2105-13
Diet type
Tools for Practice
Is any diet better for weight loss or preventing negative health outcomes?
Low glycaemic index or low glycaemic load diets for overweight and obesity
Low fat, low carb vs Mediterranean
4 different diets (varying concentrations of carbohydrate, protein and fat)
Cohort data – increased mortality with low carb diets especially if protein and fat from animal sources
Eur J Clin Nutr 2007;61:575-81
Ann Intern Med 2010;153:289-98
Very low calorie diets
Little evidence for any one commercial diet over another
No difference if you eat fat or protein or carbs
Arch Intern Med 2006;166:1466-75
Am J Clin Nutr 2005;81:1298-306
Arch Intern Med 2004;164:210-7
Ann Intern Med 2004;140:778-85
Fish oil
Arch Intern Med 2005;165:725-30
Omega-3 fatty acids
ACTIVITY
Quality of life
Arch Intern Med 2009;169:269-278
Exercise Improves: Sleep, osteoarthritis pain, depression, obesity, glucose, lipids, BP
Cochrane 2002;CD003404
J Gerontol A Biol Sci Med Sci 2008;63:997-1004
J Sports Med Phys Fitness 2007;47:462-7
Cochrane 2008:CD004366
Cochrane 2008:CD004376
Inactivity a bigger risk than weight
J Am Geriatr Soc 2010;58:234–241
More activity, better
Br J Sports Med 2008;42:238–243
NEJM 1999;341:650-8
Eur J Epidemiol 2009;24:181–192
Activity vs angioplasty
Circulation 2004;109:1371-8
Morbidity and mortality
Arch Intern Med 2007;167:2453-60
NEJM 2002;347:716-25
Arch Intern Med 2007;167:2453-60
JAMA 2003;289:2379-86
NEJM 2002;347:716-25
JAMA 1995;273:1093-8
Circulation 2008;117: 614-22
PLOS 2008;5: e12.
Impact of exercise on weight
Exercise versus angioplasty
Lifestyle prescription
Am J Public Health 1998;88:288-91
Heart failure
J Am Coll Cardiol 2012;60:1521–8
HF-ACTION
Exercise based rehabilitation for heart failure
Exercise-based cardiac rehabilitation for coronary heart disease
Pedometers
Can Fam Physician 2010;56:887
Other activity benefits
J Gerontol A Biol Sci Med Sci 2008;63:997-1004
J Sports Med Phys Fitness 2007;47:462-7
Calculator numbers
Eur J Cardiovasc Prev Rehabil 2008;15:239-46
Int J Environ Res Public Health 2012;9:391-407z
WEIGHT
Mortality
Being a little bit overweight is OK
J Am Geriatr Soc 2005;53:2112-8
Metabolic syndrome – who cares?