Cardiovascular

Take Note – July/August 2009

Do compression stockings prevent deep vein thrombosis?

Researchers conducted a large, randomized controlled study to determine the effectiveness of thigh-length graduated compression stockings in patients hospitalized within 1 week of an acute stroke. The more than 2,500 patients were randomized either to a group who received routine care and wore thigh-length graduated compression stockings or to a group who received routine care only. After 7 to 10 days and after 25 to 30 days, the patients had compression Doppler ultrasound scans of both legs.

The researchers found no significant decrease in the risk of deep vein thrombosis between the groups. What they did find was significantly more skin breaks, ulcers, blisters, and skin necrosis in the group wearing thigh-length graduated compression stockings.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60941-7/abstract

Treating patients with chronic pain and depression

A randomized controlled study called Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) examined whether combined drug therapy and behavioral intervention could help patients who have both musculoskeletal pain and depression. The 250 patients in the study suffered from moderate-to-severe depression and low back, hip, or knee pain lasting at least 3 months.

Patients were randomly assigned either to a group receiving the usual care or to a group receiving 12 weeks of optimized antidepressant therapy, then 12 weeks of a pain self-management program, and then 6 months of continuation therapy. The care given the latter group resulted in moderate decreases in chronic pain severity and disability and substantial improvement in depression.

http://jama.ama-assn.org/cgi/content/full/301/20/2099


Effects of intensive glucose control on cardiovascular events

In patients with type 2 diabetes, intensive glucose control reduces the risk of myocardial infarction and coronary artery disease without increasing the risk of death. That’s the conclusion of researchers who examined data from five randomized trials comparing standard glucose control with intensive glucose control in more than 33,000 adults with diabetes. The researchers say that previous studies suggested a link between intensive glucose control and increased mortality.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60697-8/fulltext

Early vs. delayed interventions for acute coronary syndromes

In patients with acute coronary syndromes without ST-segment elevation, early and delayed interventions are safe and effective, according to researchers who studied more than 3,000 patients. For the study, early intervention was defined as coronary angiography within 24 hours of randomization and delayed intervention was defined as angiography at 36 hours or later.

The researchers’ primary outcome was a composite of death, myocardial infarction, or stroke at 6 months. Their secondary outcome was death, myocardial infarction, or refractory ischemia at 6 months. The researchers found no significant difference between early and late interventions for preventing the primary outcome. However, early intervention proved better at preventing the secondary outcome.

http://content.nejm.org/cgi/content/short/360/21/2165

Trying to control the novel influenza A (H1N1) virus with seasonal vaccines

According to the Centers for Disease Control and Prevention (CDC), the number of confirmed or probable cases of infection with the novel influenza A (H1N1) virus is now approaching 5,500 in the United States. The virus has also spread to 41 countries.

Producing a vaccine for this virus will take months, so the CDC analyzed whether recent seasonal influenza vaccines might provide protection. Using stored serum specimens collected during previous vaccine studies, the CDC assessed the level of cross-reactive antibody to the novel influenza A virus in children and adults before and after they were vaccinated with the last four influenza seasonal vaccines. Unfortunately, the findings suggest that the seasonal vaccines probably won’t provide protection.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a1.htm

Predicting the risk of late-life dementia

Researchers who studied 3,375 adults with a mean age of 76 and no evidence of dementia at baseline have developed a tool for predicting the risk of late-life dementia. To use the tool, a clinician assigns points to a number of factors, such as age, cognitive test performance, and body mass index.

Based on the total score, a person is considered to have either low, moderate, or high risk of developing dementia within 6 years.

http://www.neurology.org/cgi/content/abstract/WNL.0b013e3181a81636v1

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