Lancet 11 Sep 2010 Vol 376
875 Trials of new interventions for heart failure have tended to show diminishing returns in an era when everyone with systolic dysfunction is already on at least an ACE inhibitor (or ARB) and a β-blocker if they can tolerate it. This trial recruited over 6500 patients with an ejection fraction under 35% and who either couldn't tolerate a β-blocker or else still had a pulse rate over 70 despite taking one. Ivradabine slows the heart rate by a direct action on the sinus node, and in this pretty huge trial it showed a benefit in symptoms and survival which just reached significance for this atypical group.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61198-1/abstract
BMJ 11 Sep 2010 Vol 341
513 This editorial about rosiglitazone started as a personal commentary and finished as a piece written to a tight deadline with two eminent co-authors, both on holiday. Keep thinking, "This is so blindingly obvious, why has nobody said it before?" The point of treating diabetes is not to lower sugar but to prevent vascular harm, so why on earth are we accepting drugs which cause the very thing they are meant to prevent? Why don't licensing bodies demand evidence of vascular benefit before marketing drugs for diabetes, instead of dithering about the exact level of vascular harm ten years after a drug has been licensed? Somebody needs to ask these questions; and quite a few more.
http://www.bmj.com/content/341/bmj.c4805.extract
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