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Up Front | Jan 2014

Medical Updates

A summary of general medicine news that affects your patients, your practice, and you.

Influenza Vaccine May Lower Risk of Cardiovascular Events

Inoculation with the influenza vaccine may be associated with a lower risk of major adverse cardiovascular events, according to a JAMA study.1

Jacob A. Udell, MD, MPH, FRCPC, of the University of Toronto in Ontario, and colleagues conducted a systematic review and meta-analysis of Medline, Embase, and the Cochrane Library Central Register of Controlled Trials for randomized clinical trials comparing the influenza vaccine versus placebo or control in patients at high risk of cardiovascular diseases (CVDs). Two investigators extracted data independently on trial design, baseline characteristics, outcomes, and safety events from published manuscripts and unpublished supplemental data. Risk ratios (RRs) and 95% confidence intervals (CI) were derived for composite cardiovascular events, cardiovascular mortality, all-cause mortality, and individual cardiovascular events. Analyses were stratified by subgroups of patients with and without a history of acute coronary syndrome (ACS) within 1 year of randomization.

One unpublished and five published randomized clinical trials of 6,735 patients (mean age, 67 years; 51.3% women; 36.2% with a cardiac history; mean follow-up, 7.9 months) were included. The influenza vaccine was associated with a lower risk of composite cardiovascular events (2.9% vs 4.7%; RR, 0.64; 95% CI, 0.48–0.86; P = .003) in published trials. A treatment interaction was detected between patients with (RR, 0.45; 95% CI, 0.32–0.63) and without (RR, 0.94; 95% CI, 0.55–1.61) recent ACS (P for interaction = .02). Results were similar with the addition of unpublished data.

“The greatest treatment effect was seen among the highest-risk patients with more active coronary disease. A large, adequately powered, multicenter trial is warranted to address these findings and assess individual cardiovascular end points,” the study authors concluded.

  1. Udell JA, Zawi R, Bhatt DL, et al. Association between the influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013;310(16):1711-1720.


Men With Depression May Have Nontraditional Symptoms

Current diagnostic criteria for depression may not include symptoms that truly describe men’s experiences, a study published in JAMA Psychiatry1 suggests.

Lisa A. Martin, PhD, of the University of Michigan, and colleagues analyzed data from the National Comorbidity Survey Replication and evaluated sex differences in symptom endorsement to identify predictors of depression.

Men reported higher rates of anger or aggression, substance abuse, and risk-taking compared with women. Analyses using a scale that included alternative, male-type symptoms of depression found that a higher proportion of men than women (26.3% vs 21.9%) met the depression criteria. Analyses using a scale that included alternative and traditional depression symptoms found both genders met criteria for depression equally (30.6% men; 33.3% women).

  1. Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women. JAMA Psychiatry. 2013;70(10):1100-1106.


Carotid Artery Stenting Associated With Increased Stroke in Elderly

Carotid artery stenting (CAS) was associated with an increased risk of stroke in elderly patients, but mortality risk appeared to be the same as for nonelderly patients, according to a study in JAMA Surgery.1

George A. Antoniou, MD, PhD, of the Hellenic Red Cross Hospital, Greece, and colleagues analyzed data from 44 observational studies including 512,685 carotid endarterectomy (CEA) and 75,201 CAS procedures. The investigators reported that, in general, the scientific quality of the medical literature was low, and studies used different criteria to distinguish older from younger patients.

While CEA had similar neurologic outcomes (ie, stroke, transient ischemic attack [TIA], or both) in older and younger patients, the procedure was associated with higher mortality risk in older patients. CAS and CEA appeared to increase the risk of myocardial infarction in older patients. Compared with CEA, elderly patients undergoing CAS had a higher risk of developing stroke, TIA, or stroke plus TIA early after the intervention than younger patients.

“The results of the present analysis suggest that careful consideration of a constellation of clinical and anatomic factors is required before an appropriate treatment of carotid disease in elderly patients is selected,” the authors wrote.

  1. Antoniou GA, Georgiadis GS, Georgakarakos EI, et al. Meta-analysis and meta-regression analysis of outcomes of carotid endarterectomy and stenting in the elderly. JAMA Surgery. 2013;148(12):1140-1152.

—Compiled by Callan Navitsky, Senior Editor