Is the use of high-intensity atorvastatin associated with memory impairment?

High-intensity statins are the cornerstone of medical management in Acute Coronary Syndromes (ACS). However, their effect on neurocognition are less clear. In this prospective observational study, we gave guideline-directed high-intensity atorvastatin 40 mg to middle-aged statin-naïve ACS patients. Memory assessments were performed before and 6 months after statin therapy using 2 validated scales-the PostGraduate Institute Memory Scale (PGI-MS), and the Logical Memory Passage Test (LMPT). There was no significant difference in the mean PGI-MS test scores (baseline 75.4 ± 7.9, 6months 76.5 ± 8.2;p ¼ 0.26) or the overall composite scores (baseline 32.02 ± 3.2, 6months 32.8 ± 3.1; p ¼ 0.20), after 6 months of statin use. There was a small improvement in immediate recall (baseline score 8.5 ± 2.5, 6 months 9.04 ± 1.8; p ¼ 0.05), and delayed recall (baseline 6.1 ± 2.6, 6 months 6.9 ± 1.9, p ¼ 0.002). High-intensity atorvastatin use did not affect memory at 6 months among statin-naïve middle-aged patients with ACS.

Aspirin for primary prevention: Is this the end of the road?

Aspirin is one of the oldest and most commonly used cardiovascular drugs. Despite there being high-quality evidence supporting the use of aspirin for patients with known cardiovascular disease, a definitive consensus regarding its use for patients at risk for cardiovascular disease (and without established cardiovascular disease) has never been reached. Many randomized control trials have produced conflicting results, and consequently, society guidelines have issued differring recommendations. Three major trials were published in 2018, which supplement the existing data on aspirin's role in primary prevention and provide further guidance on this contentious issue. This article reviews the history of aspirin through the last two decades, with special emphasis on these new trials.

The 'middle path' and the perils of moderation in medicine.

The ‘middle path’ has been touted as a virtue in life and in medical practice, much more so in India, perhaps because of the cultural influence of the Gita (akarma, inaction) and the teachings of the Budhha (madhyamâ-pratipada, the middle way). While being moderate is in general a good trait in a medical practitioner, it can sometimes lead to inappropriate clinical decisions if these are guided solely by considerations of moderation. The chances of such an occurrence are high, given that medicine is an inexact science and often we do not have convincing evidence for or against a particular treatment or practice, and the doctor’s personality and personal convictions play a major role in determining the course of action. Even though practitioners exhibit the entire behavioural spectrum from therapeutic nihilism to cowboyish aggression, the large majority of doctors can be described as being moderate. Therefore, potentially more (albeit unintended) damage may be caused by this large group of well-meaning practitioners if they uncritically adopt a middle path for apparently no reason other than the fallacious assumption that moderation is always good.

Clinical judgement & evidence-based medicine: time for reconciliation.

There is a popular perception that clinical judgement and evidence-based medicine are at loggerheads with each other. We examine the concepts of evidence and judgment as applied to clinical practice, and attempt to understand the reasons behind this imaginary divide.

Preclinical and early clinical experience with a biodegradable polymer-based, rapamycin-eluting, Indian drug-eluting coronary stent: the BIO-RAPID study.

OBJECTIVE: To evaluate the performance of a biodegradable polymer based rapamycin-eluting coronary stent in a porcine model and demonstrate its safety and efficacy in the treatment of patients with de novo coronary stenosis. BACKGROUND: The indefinite presence of the polymer after the implantation of drug-eluting stents may initiate and sustain inflammation and contribute to the occurrence of late complications. METHODS: Seven study stents and 5 polymer-coated (control) stents were implanted in porcine carotid arteries. Histomorphometric analysis was performed 8 weeks after stent implantation. After establishing the safety of the stent in the animal model, a single-center, non-randomized study in patients with de novo coronary artery lesions was performed. Forty-nine stents were implanted in 43 patients. The 6-month clinical follow-up was 91% (39/43) and angiographic follow-up was 67% (29/43). The primary safety endpoint was the occurrence of 30-day major adverse cardiovascular events (MACE) and the principal efficacy endpoint was the 6-month angiographic late loss and binary restenosis rate. RESULTS: In the porcine model, the study stent showed acceptably low injury, inflammation and fibrin scores. There was a quantitative reduction in neointimal hyperplasia which was not statistically different from the control stent. However, in the first-in-man evaluation, there was significant suppression of intimal growth as evidenced by an angiographic late loss of 0.28 +/- 0.45 mm at 6 months. The restenosis rate was 10.3% (3/297). There was no death, stent thrombosis or myocardial infarction at 30 days or at 6 months. The 6-month target lesion revascularization rate was 3.47 percent; (1/29). CONCLUSION: This preclinical and early clinical experience demonstrates the safety and efficacy of a novel biodegradable polymer-based rapamycin-eluting coronary stent.