Duke’s Robert Califf’s is being interviewed for the FDA commissioner job, but the leading candidate is still Baltimore Commissioner of Health Joshua Sharfstein, according to an item on the In Vivo Blog.
The blog doesn’t cite any sources, but says that Califf is the favorite of FDA insiders, while Sharfstein is the internal favorite in the Obama camp. No further word about Steve Nissen, the other cardiologist contender.
A paper in Nature Genetics reports a seven-fold increase in cardiomyopathy in South Asians with a common 25 base pair deletion of the cardiac myosin binding protein C (MYBPC3). The variant occurs more frequently in southern and western India than in the north, and this distribution correlates with higher rates of heart failure in southern India, according to a press release from Nature.
I’d never heard of targeted pulsed electromagnetic field (tPEMF(tm)), or that it might be beneficial in ischemic heart disease, until I ran across the press release below. I’m always wary of press releases like these, especially when they come from tiny precarious companies. Nevertheless, there’s something intriguing about this, but I urge you to exhibit extreme caution. (Also, for the record, the Cleveland Clinic isn’t presenting anything here. Dr. Shen, who is affiliated with the Florida branch of the Cleveland Clinic, is the PI for the trial, but that hardly constitutes an endorsement.)
Update (January 16): A Cleveland Clinic spokesperson has told CardioBrief that the Cleveland Clinic did not approve or authorize the use of their name in this press release.
One of the most intriguing studies at last fall’s TCT was FAME, which tested the value of fractional flow reserve (FFR) versus conventional angiography for guiding PCI. Now the study has been published in the New England Journal of Medicine, accompanied by an editorial written by Stephen Ellis.
The use of FFR resulted in a significant reduction in MACE at one year in FAME. Ellis points out a number of important limitations of the study but holds out hope for the utility of FFR. He believes FFR needs a validation study before it can be considered for routine clinical practice.
Ellis alludes to one potentially controversial aspect of FAME and FFR when he writes that “interventional cardiologists should recognize the limitations of coronary angiography and PCI.” Here’s the point: if FFR in fact can predict which lesions will benefit from PCI, it’s hard to avoid the conclusion that PCI for non-FFR indicated lesions may actually be harmful. I wonder if anyone will have the COURAGE to pursue this line of thought…
You can see the FAME slide set at ClinicalTrialResults.com, where it was originally posted following the initial TCT presentation.
You can also view a video interview with FAME investigator Nico Pijls by C. Michael Gibson on ClinicalTrialResults.com.
Newer antipsychotic agents like olanzapine, risperidone, and quetiapine are just as likely to cause sudden cardiac death as older agents such as haloperidol and thioridazine, according to a new study published in the New England Journal of Medicine.
In an accompanying editorial, Sebastian Scheeweiss and Jerry Avorn argue that in “the absence of clearly established benefits” the use of these drugs should be restricted, especially “in vulnerable populations and outside the labeled indications.” When the drugs are deemed necessary, ECGs should be obtained before and after initiation of drug therapy.
PFO closure devices have been having a tough time. First the trials for treatment of migraine ran into all sorts of trouble. (See below.) Now the first trial for prevention of stroke may be in similar hot water.
Yesterday, NMT medical issued a press release with a very complicated update on the company’s CLOSURE I clinical trial of its STARFlex PFO closure device to prevent stroke and TIA. Enrollment in the trial began 5 years ago and has been problematic.
Today a story in the New York Times reports some more details. The trial was originally supposed to enroll 1,600 patients but after five years has only enrolled 900 patients, although the company believes this number may be sufficient given the number of events that have accrued over 5 years. The story quotes William Maisel, who notes that until recently neither physicians nor industry were motivated to do the necessary clinical trials, since thousands of devices were being implanted under humanitarian exemptions. Now that the FDA has cracked down on this loophole it is time to complete the trials, says Maisel.
A related New York Times story treats the saga of Peter Wilmshurst, the British cardiologist who had been a co-PI of the NMT migraine trial. He is now being sued for slander by NMT Medical. His story has been extensively covered by Shelley Wood on theheart.org (and I should state here that I was Shelley’s editor at the time, though I can’t take credit for her excellent reporting). The Times provides some new details about the case, including more detailed comments from the company’s perspective.
Senator Grassley’s investigation into the Avandia case is turning up new, potentially embarrassing details about GSK’s internal responses to the controversy, according to a story in the Wall Street Journal. In response to the forthcoming Nissen meta-analysis, a GSK consultant wrote: ”The numbers are the numbers, the analysis is very similar to our own.”
The WSJ article quotes an email from Moncef Slaoui, GSK’s director of research: ”FDA, Nissen and GSK all come to comparable conclusions regarding increased risk for ischemic events, ranging from 30% to 43%!” In response, a GSK spokeman said that Slaoui “used imprecise language” and that he “was more precise in written testimony to Congress when he said that the company didn’t agree with Dr. Nissen’s conclusions and thought that his methodology had significant limitations.”
Despite two negative NHLBI-sponsored trials presented at the AHA last November, researchers remain convinced that lifestyle modification is worthwhile, according to a feature news story in JAMA by Mike Mitka. Both FIT Heart and HF-ACTION failed to reach their primary endpoint, but the researchers, Lori Mosca of Columbia and Chris O’Connor of Duke, make a strong case for the continued utility of the interventions tested in their trials.
Medtronic announced today that it had bought Ablation Frontiers, Inc. The company specializes in radiofrequency catheter ablation for AF. Medtronic appears to be committed to covering the AF field. Last fall it acquired Cryocath, which specialized in cryoablation treatments for AF.
You can read the Medtronic press release or the Wall Street Journal story.
The FDA has finally completed its review of ENHANCE that it started in January 2008. It’s finding: there was no difference in clinical outcome between the vytorin-treated and the simvastatin-treated patients in clinical outcomes, though vytorin, as expected, had greater efficacy in lowering cholesterol. The FDA advises patients that, pending the results of IMPROVE-IT, “patients should not stop taking Vytorin or other cholesterol lowering medications and should talk to their doctor if they have any questions about these medications.”
None of this should come as a surprise to anyone reading this blog, I suppose.
Click here to read the FDA statement.
Boston Scientific has announced that it has bought Labcoat Limited, a private company developing advanced DES technology located in Ireland. You can read the press release by clicking below:
The CDC is reporting in MMWR about an Israeli cardiothoracic surgeon who was found to be infected with HIV in 2007. Although he practiced for more than 20 years and performed approximately 150 procedures each year, he does not appear to have transmitted the virus to any of his patients.
In addition to dissecting, like the good pathologist he is, the status of cardiovascular journals (see previous post in this blog), Bill Roberts, AJC editor, looks back on 45 years in the cardiovascular arena. In 1963 he was a cardiology fellow under Braunwald at the NIH. Roberts writes:
That was the year President John F. Kennedy was killed in Dallas, Texas. When he arrived at Parkland Hospital, there was no electrocardiograph in the emergency room. What has occurred in cardiovascular medicine since that fatal November day in 1963 is astounding! No specialty in medicine has had such a transformation.
William Roberts, the editor of The American Journal of Cardiology since shortly after William Harvey discovered the circulation of the blood, makes a bold statement in an online editor’s note (in press): “there are too many cardiovascular journals!”
A US District Court has dismissed a case against Medtronic over the Fidelis lead failures. The decision follows the significant precedent-setting Supreme Court decision last year in Riegel v Medtronic.
You can read the Wall Street Journal story or the Medtronic press release by clicking below.
The ACC, the AHA, and a whole alphabet soup worth of other cardiovascular organizations (SCAI, STS, AATS, ASNC, ASE, HFSA SCCT) have published (or in some cases just endorsed) a report, called the ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization. The report will probably provide comfort to those who were big supporters of COURAGE. I’m guessing this will only initiate a new round of debate. It seems unlikely that there will be a widespread breakout of peace over this issue in 2009.
You can read a Dow Jones news story about the report.
Duke researchers have linked variations in the neuropeptide Y (NPY) gene to early cardiovascular disease. The article appears in the Public Library of Science Genetics.
You can read a news story at Science Daily.
