Lipid-lowering therapy use and achievement of cholesterol targets in an Australian diabetes clinic

Patients with diabetes are at high risk for the development of cardiovascular (CV) disease. Statins have been shown to reduce CV events in direct relationship to their low-density lipoprotein cholesterol (LDL-C)-lowering effect.

In this report from St Vincent’s Hospital in Melbourne the authors review data from their diabetic clinic. 75.9% of the patients had type 2 diabetes and 18.2% had a history of cardiovascular disease.

The authors compared the usage of statins between 1993–1995 and 2014–2016. Statin usage increased from 6 to 69% between these periods. This corresponded to a decrease in low-density lipoprotein cholesterol from 3.7 to 2.4mmol/L (P<0.01).

Internal Medicine Journal 2018; 48:201–204

Atraumatic versus conventional lumbar puncture needles

Postdural-puncture headache is the most common complication after lumbar puncture, affecting up to 35% of patients. This may be due to leakage of cerebro-spinal fluid from the dural defect caused by the needle.

This meta-analysis compares outcomes associated with the use of conventional and atraumatic lumbar puncture needles. Conventional needles have a sharp slanted tip whereas the atraumatic needles are blunt with a closed pencil point tip and a side port for injection or collection. Data from 110 trials including 31,412 patients was reviewed. There was a significant reduction in the incidence of postdural puncture headache in the atraumatic cohort.

The authors of the meta-analysis report that among patients who had lumbar puncture, atraumatic needles were associated with a decrease in the incidence of postdural-puncture headache and in the need for patients to return to hospital for additional therapy, and had similar efficacy to conventional needles.

Lancet 2018; 391:1197–204

Catheter ablation for atrial fibrillation with heart failure

Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. This report is of a randomised trial which compares catheter ablation with medical therapy (rate or rhythm control) in such patients.

Three hundred and sixty-three patients with paroxysmal or persistent atrial fibrillation and heart failure were randomised to catheter ablation or medical treatment. The composite end point was death from any cause or hospitalisation for worsening heart failure. At median follow-up at 37.8 months the end point was significantly less in the ablation cohort-hazard ratio 0.62.

It was concluded that catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalisation for worsening heart failure than was medical therapy.

N Engl J Med 2018; 378:417–27

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