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Trends in Carotid Revascularization Procedures

Mar, 16/01/2018 - 01:00
To the Editor In a study of Medicare beneficiaries during 1999-2014, 30-day ischemic stroke or death rates after carotid endarterectomy improved (from 4.4% in 1999-2000 to 3.1% in 2013-2014), as did all-cause mortality (from 1.6% to 1.1%). In contrast, 30-day ischemic stroke or death rates after carotid artery stenting did not differ between the beginning and the end of the study period (7.0% in 1999-2000 and 7.0% in 2013-2014) and neither did all-cause mortality (4.7% in 1999-2000 and 4.8% in 2013-2014). Importantly, 30-day ischemic stroke or death rates after carotid artery stenting were higher than those recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines (<6% for symptomatic patients and <3% for asymptomatic patients). This finding was not discussed by the authors.

Trends in Carotid Revascularization Procedures—Reply

Mar, 16/01/2018 - 01:00
In Reply Dr Hussain and colleagues point out interesting comparisons in carotid revascularization trends in Ontario, Canada, and in the US Medicare population, including similar 30-day stroke or death outcomes after carotid endarterectomy and stenting. We agree that differing reimbursement policies in the United States and Canada may account for differing patterns of carotid stenting after 2006. A noted difference is the lower receipt of procedures among symptomatic patients in the United States vs Ontario. However, such variation is expected because the approach to asymptomatic treatment has been shown to vary among Western countries.

Risk of Statins for Lower-Risk Individuals

Mar, 16/01/2018 - 01:00
To the Editor In a Viewpoint on cholesterol treatment in 2017, Dr Krumholz argued that prescribing statins for secondary prevention of vascular disease or in individuals at higher disease risk is supported by estimates from clinical trials that the number of preventable vascular events over 5 years far exceeds that of anticipated adverse events. He later asserted, without evidence, that “For lower-risk individuals, treatment with statins provides a smaller benefit, but many will find the benefits to outweigh risks.”

Risks of Statins for Lower-Risk Individuals

Mar, 16/01/2018 - 01:00
In Reply I stand by my statement that “For lower-risk individuals, treatment with statins provides a smaller benefit, but many will find the benefits to outweigh risks.” The lower the absolute risk, the smaller the benefit from statins, but what one person considers a meaningful risk reduction might differ from the view of another. Dr Regenold states that numerous brain disorders are associated with statin use but cites an article that lacks any strong clinical evidence to support that claim. Although it is appropriate to be vigilant in identifying harms of any therapy, physicians must also be careful not to rely on weak evidence and speculation to suggest that there is harm when it has yet to be demonstrated.

Interest in the Ketogenic Diet Grows

Mar, 16/01/2018 - 01:00
This Medical News article discusses clinical use of a very-low-carb, high-fat diet for weight loss and type 2 diabetes treatment.

Combination Strategy Associated With Reduced HIV Incidence in Uganda

Mar, 16/01/2018 - 01:00
The incidence of HIV infection declined with a 2-pronged prevention strategy that combined male circumcision and antiretroviral therapy (ART), report a team of international researchers in the New England Journal of Medicine.

Dangers of Substandard or Falsified Medicines

Mar, 16/01/2018 - 01:00
Substandard or falsified medications are a growing global threat, particularly in low- and middle-income countries where more than 10% of drugs examined were either substandard or falsified. The scope and scale of the problem are examined in 2 new reports from the World Health Organization (WHO).

Possible Biomarkers of Deadly Ebola

Mar, 16/01/2018 - 01:00
Molecular analysis of peripheral blood samples from patients with Ebola virus disease (EVD) identified new mechanisms of pathogenesis and possible biomarkers that may help determine which patients infected with the Ebola virus are most at risk of dying from the disease, according to new research in Cell Host & Microbe.

Injectable Buprenorphine Gets FDA Approval

Mar, 16/01/2018 - 01:00
The first once-a-month injectable form of buprenorphine has received FDA approval for adults with moderate to severe opioid use disorder (OUD). The drug is indicated for patients who’ve already started treatment with a transmucosal form of buprenorphine and have received a stable dose for at least 7 days.

Regulatory Pathway for 3D Printing

Mar, 16/01/2018 - 01:00
New guidance is available from the FDA to help medical device manufacturers bring their 3-dimensional (3D)–printed products to market more efficiently.

Second Cancer Biosimilar Approved

Mar, 16/01/2018 - 01:00
The FDA recently approved the first biosimilar for patients with certain breast or stomach cancers. Marketed as Ogivri, trastuzumab-dkst is the second biosimilar approved in the United States to treat cancer.

Embers

Mar, 16/01/2018 - 01:00

Appropriations for City Health Departments

Mar, 16/01/2018 - 01:00
Two years ago, Dr. William C. Woodward, health officer of the District of Columbia, said:

Sleeve Gastrectomy for Weight Loss

Mar, 16/01/2018 - 01:00
This JAMA Patient Page describes the sleeve gastrectomy procedure as a weight loss treatment for obese persons.

JAMA

Mar, 16/01/2018 - 01:00

Highlights for January 9, 2017

Mar, 09/01/2018 - 01:00

Diagnosis and Treatment of Hypertension: 2017 ACC/AHA Blood Pressure Guidelines and the Real World

Mar, 09/01/2018 - 01:00
In this Viewpoint, John Ioannidis discusses implications of the 2017 hypertension guidelines for real-world management of blood pressure (BP), including labeling healthy people as having disease and possible adverse treatment effects at lower BP treatment targets..

Cardiovascular Guideline Skepticism vs Lifestyle Realism?

Mar, 09/01/2018 - 01:00
This Viewpoint discusses practical applications of the recent 2017 ACC?AHA guidelines on hypertension management and the importance of emphasizing healthier lifestyles in the United States.

Funding Innovation in a Learning Health Care System

Mar, 09/01/2018 - 01:00
This Viewpoint discusses reforms to federal funding strategies and systems that might incentivize health care delivery innovation and create learning health care systems focused on improving health more than financial outcomes.

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