Severe oral phenytoin overdose does not cause cardiovascular morbidity

Exercise, Cardiac Rehabilitation, and Post–Acute Coronary Syndrome Depression

“…2,3 Moreover, a recent Cochrane systematic review of randomized clinical trials in a variety of patient groups showed that exercise programs are superior to no treatment or to placebo control conditions for treating depression. 4 Nevertheless, we also agree with Lavie and colleagues that more randomized clinical trials of exercise as a treatment for depression after ACS are needed. We did not discuss exercise training in the context of the CODIACS Vanguard trial for several reasons.…”

“…3 Finally, population data repeatedly confirms the increased risk of DVT. 4 Third, Dr Hoffer 1 cites 2 studies supporting the IVC filter. Neither is adequate.…”

“…Thus, the more plausible interpretation of their data is that in an era where filter use was widespread, unstable patients with PE, whom physicians elected not to place a filter, were sicker. The study by Spencer et al 4 is an observational study, from which drawing conclusions regarding benefits is tenuous, though such studies are better at assessing harms. The highlighted difference in PE is likely due to ascertainment bias, since physicians were less likely to scan patients with a known filter.…”

“…Interestingly, Dr Hoffer ignores the increased risk of DVT with IVC filters in this study. 4 In summary, there remains no good evidence for the benefits of the filter and only clear documentation of harm. However, we were surprised that the potential value of exercise training (ET) in the routine management of depressed patients with ACS was not mentioned.…”

“…3 A recent single-site randomized clinical trial demonstrated that ET alone was associated with significant reductions in depressive symptoms and improved CHD biomarkers in patients with stable CHD and elevated depressive symptoms; reduced levels of depression were comparable to antidepressant medications, and both ET and medication use achieved greater reductions in depression compared with placebo. 4 In addition, results from the mul- coronary syndrome (ACS) randomized to centralized, stepped, patient-preference depression treatment (psychotherapy or medication use) had substantially fewer depressive symptoms after 6 months compared with those receiving enhanced usual care. We also demonstrated that we could deliver this depression treatment by telephone and/or by webcast across a number of different health care settings in geographically diverse areas.…”