August 08, 2012Volume 7 - Issue 32

DynaMed Weekly Update

For the week ending August 03, 2012

Last week 643 articles were evaluated via DynaMed's Systematic Literature Surveillance and 309 were added to DynaMed content.   

 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Omega-3 Fatty Acid Supplementation Does Not Reduce Mortality or Cardiovascular Events in Patients with or at High Risk of Diabetes     

   

Evidence for the effect of omega-3 fatty acids on cardiovascular risk has been inconsistent. While some systematic reviews have found little or no evidence that dietary or supplementary omega-3 fatty acid intake alters the risk of death or cardiovascular events in primary or secondary prevention (Cochrane Database Syst Rev 2004 Oct 18;(4):CD003177,  Arch Intern Med 2012 Apr 9 early online), others have shown some benefit for cardiac mortality (BMJ 2008 Dec 23;337:a2931, Ann Med 2009;41(4):301). The recently reported ORIGIN trial examined the effects of supplementation in 12,611 patients with impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes. 

  

Patients > 50 years old (mean age 64 years, 88% with diabetes) were randomized to omega-3 fatty acids 1 g orally once daily (Omacor capsule, sold in United States as Lovaza) vs. placebo. All patients had preexisting cardiovascular disease (myocardial infarction, stroke, or revascularization in 59%) or cardiovascular risk factors at baseline. Patients were also randomized to open-label insulin glargine vs. standard care (with results reported in a companion publication). These groups were pooled for the primary analysis of the effects of omega-3 supplementation.

  

At median follow-up of 6.2 years, there were no significant differences between groups in cardiovascular mortality (9.1% vs. 9.3%) or all-cause mortality (15.1% vs. 15.4%) (level 1 [likely reliable] evidence). There were also no significant differences in fatal and nonfatal myocardial infarction, fatal and nonfatal stroke, heart failure-related hospitalization, or revascularization procedures. Omega-3 supplementation was associated with significant reduction in triglyceride levels (p < 0.001), but had no significant effect on other lipid levels. In subgroup analyses, supplementation had no significant effect on cardiovascular mortality in either the insulin glargine or standard care groups (N Engl J Med 2012 Jul 26;367(4):309).

 

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New Topic added to DynaMed this Week

Call for Peer Reviewers

We are currently seeking reviewers for:

Dietary considerations for patients with type 2 diabetes 

ACE inhibitors for heart failure 

 

Learn more about the DynaMed Contribution Opportunities:

DynaMed Peer Review 

Editorial Policies for Reviewers 

About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: August 08, 2012
Expiration Date: August 08, 2013
Estimated Completion Time:
15 minutes
 
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives
 
Upon successful completion of this educational program, the reader should be able to:
 
1. Discuss the significance of this article as it relates to your clinical practice.
 
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
 
Faculty Information
 
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Disclosures  
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
 

 

No commercial support has been received for this activity.

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ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

 

Program ID: 1102072W

 
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