April 17, 2013

DynaMed EBM Journal Volume 8, Issue 16

DynaMed Weekly Updates

Quick Links

Join Mailing List



Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: April 17, 2013

Expiration Date: April 17, 2014

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; Senior 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


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.

Accreditation Statements

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 EducationCompany 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 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, 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 EBM Focus 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: 1210393G


Last week 634 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 215 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Statins Appear Well Tolerated in Most Patients who Restart Treatment After Discontinuation for Statin-Related Adverse Events
Reference: Ann Intern Med 2013 Apr 2;158(7):526,

Statin therapy has been shown to be effective for both primary and secondary cardiovascular disease prevention (Cochrane Database Syst Rev 2013 Jan 31;(1):CD004816) (Arch Intern Med 2004 Jul 12;164(13):1427), and discontinuation has been associated with increased event rates (JAMA 2007 Jan 10;297(2):177). Nevertheless, discontinuation is common, often due to adverse effects associated with statin treatment. A recent, retrospective cohort study investigated the rates of discontinuing and restarting statins in 107,835 patients who received prescriptions from 2000 to 2008.

Statin therapy was discontinued at least temporarily in 53% of patients overall, while only 17% experienced statin-related adverse events. Of those who did have events, 59% discontinued treatment. The most common events were myalgia and myopathy or other musculoskeletal or connective tissue disorders, pain and fatigue. A total of 6,579 patients who stopped statins due to a statin-related adverse event then restarted statins, with 41% restarting the same drug that had been discontinued. 92% of the patients restarting statins remained on treatment at 1 year after the original event. About a third of those who restarted on their original statin were taking the same or a higher dose at 1 year. Of the patients who discontinued for reasons other than adverse events and then restarted, 98% remained on treatment at 1 year after the original discontinuation.

These results suggest that the majority of patients who restart statins may find them tolerable over the long term, even if they have a history of adverse reactions. This information may help clinicians counsel patients regarding the risks and benefits of continued statin therapy.

For more information, see the Statins topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

DynaMed Extras

Article in Previous EBM Focus Retracted

In January, the DynaMed EBM Focus (Volume 8, number 5) reported on a systematic review with evidence associated low sodium diets with mortality in patients with heart failure (Heart 2013 Mar 12 early online). The review has been retracted due to the duplication of data reported in the original publications of 2 included trials. The 6 trials included in the review were all conducted by the same authors (as was the review). They were unable to recover the raw data from these 2 trials to verify the results presented in the review. The citation for the review remains in the Heart failure topic DynaMed, and is now marked as retracted. One of the studies in question is also the single study on the effects of low-sodium diet in patients with heart failure cited in a Cochrane review (Cochrane Database Syst Rev 2011 Jul 6;(7):CD009217).

DynaMed Events

Annual Meeting and Exhibition of the Medical Library Association (MLA), May 3-8, 2013
Editor-in-Chief Brian Alper, MD, MSPH, FAAFP, will be presenting at the 2013 Annual Meeting and Exhibition of the Medical Library Association, held at the John B. Hynes Veterans Memorial Convention Center. The topic of the presentation is “The Pace of Change in Practice-Driving Medical Knowledge in New Models of Publishing” and will be presented from 1:30pm to 3:00pm on May 5th. Representatives will be available at the DynaMed booth (216) to discuss peer review, mobile access, and free trial information.

Visit the Medical Library Association website to learn more about the event and for registration information.

Society of Teachers of Family Medicine (STFM) 46th Annual Spring Conference, May 1-5, 2013
Editor-in-Chief Brian Alper, MD, MSPH, FAAFP, will be attending the Society of Teachers of Family Medicine (STFM) 46th Annual Spring Conference, held at the Baltimore Marriott Waterfront Hotel in Baltimore, Maryland. Representatives will be available to discuss peer review, mobile access, and free trial information.

Visit the Society of Teachers of Family Medicine website to learn more about the event and for registration information.

If you would like to meet with a DynaMed representative at any of our conferences, please contact us at DynaMedCommunity@ebscohost.com.

Call for Peer Reviews

We are currently seeking reviewers for:

Coronary artery disease (CAD)

Infective endocarditis