A group of distinguished medical leaders have called on professional medical associations (PMAs) to radically alter their relationship with industry. The Special Communication appeared in JAMA and was co-authored by a diverse group of writers, including first author David Rothman, of the Institute on Medicine as a Profession at Columbia University, JAMA editor Catherine DeAngelis, former ACC president Steve Nissen, and the past or current presidents or CEOs of the American Academy of Pediatrics, the American Psychiatric Association, and the American College of Physicians.

One key proposal is that “PMAs should work toward a complete ban on pharmaceutical and medical device industry funding ($0), except for income from journal advertising and exhibit hall fees.”

Since PMAs can not sever all their financial ties to industry immediately, they recommend a number of interim measures, including:
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Rosuvastatin had no beneficial effect on cardiovascular events in 2,776 hemodialysis patients, according to the results of the AURORA trial, presented in Orlando at the ACC and published simultaneously in the New England Journal of Medicine.
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This morning Arena Pharmaceuticals announced positive results from the first of its two pivotal trials of locaserin, its anti-obesity drug that has been the subject of intense speculation. We’re too busy covering all the cardiology news at the ACC in Orlando to look at this closely right now, but you can read the press release below.

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Early adminstration of eptifibatide is no better than delayed, provisional administration in patients with ACS without ST-segment elevation assigned to an invasive strategy.  There were more bleeding events and transfusions in the early eptifibatide group.

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Rosuvastatin lowers the rate of symptomatic venous thromboembolism (VTE) in healthy people with low LDL cholesterol and high CRP levels, according to the latest results of the JUPITER study, presented in Orlando at the ACC and published simultaneously in the New England Journal of Medicine.

Among 17,802 people, VTE occurred in 60 patients treated with placebo and 34 treated with rosuvastatin, a highly significant 43% risk reduction.

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FIX-HF-5, a study of cardiac contractility modulation (CCM) using a new implantable device that delivers electrical impulses to class 3 and 4 heart failure patients, missed its primary endpoint, but William Abraham, the primary investigator, told an ACC news conference that the device showed enough promise that it should continue to be developed. Results were presented today in a late-breaking clinical trial session at the ACC meeing in Orlando.
Although there were no significant differences in outcome in the primary efficacy endpoint, anaerobic threshold, CCM significantly improved the clinically important secondary endpoints of peak ventilatory oxygen uptake (pVO2) and quality of life, said Abraham. The trial compared CCM to medical care in 428 narrow QRS patients.

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In response to growing concerns that JAMA editors Catherine DeAngelis and Phil Fontanarosa may have responded inappropriately to a researcher who publicly pointed out an undisclosed conflict of interest of a JAMA author, the AMA, which owns the journal, has asked an oversight committee to investigate the affair. This latest episode in the ongoing saga was reported yesterday in a story in the Wall Street Journal by David Armstrong. You can read about the background to this story in our previous post, in which we noted that the JAMA editors did not appear to be doing themselves any favors by taking a strong stance against both conflict of interest and freedom of speech.

UPDATE: A highly respected cardiologist told CardioBrief that he has no doubt that the criticisms being leveled at DeAngelis are absolutely true, since he himself has been the object of similar verbal abuse. For understandable reasons, he requested that his remarks be kept off the record.

Here is the AMA statement from Joseph Heyman, the AMA Board Chair (thanks to David Armstrong for passing along):
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A new implantable device may help patients with nonvalvular AF avoid warfarin therapy, according to results of the Embolic Protection in Patients with Atrial Fibrillation (PROTECT AF) trial. The trial was presented today in Orlando at the ACC Scientific Sessions.

The new device, called the Watchman, blocks the left atrial appendage with a fabric-covered expandable nitinol cage.  707 AF patients were randomized to receive the new device or long-term treatment with warfarin. The combined rate of stroke and cardiovascular death was 3.4 per 100 patient-years in the device group versus 5.0 in the warfarin group.
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CardioBrief will be blogging from Orlando starting Saturday. If you want to know what to expect you can take a look at:

• A Wall Street Journal preview by Ron Winslow
• A preview article by Peter Loftus and Jon Kamp on Dow Jones Newswires,
• A preview article from Heartwire by Shelley Wood

Heartwire has also published a PDF document of late-breaking clinical trials that is much easier on the eye than CardioBrief‘s own list.

Following the death earlier this month of Philip Poole-Wilson (as previously reported by CardioBrief), a number of tributes to the leading cardiologist have appeared that will be of interest to CardioBrief readers .
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The AHA and ACC today released a focused update of their heart failure guidelines, published online in the Journal of the American College of Cardiology and in Circulation.

Key points of the updates, according to a press release from the two organizations, include:

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Stress cardiomyopathy (SCM) may be provoked by intravenous administration of catecholamines and beta-receptor agonists, according to a new study published online in the Journal of the American College of Cardiology. The findings of the observational series of 9 patients “provides compelling evidence that exaggerated sympathetic stimulation is sufficient to precipitate the syndrome of SCM in susceptible individuals,” write the authors.

NICE-SUGAR, published online first in the New England Journal of Medicine, randomized 6,000+ ICU patients to intensive or conventional glucose control. Mortality was 27.5% in the intensive-control group verus 24.9% in the conventional-control group, a difference that achieved statistical significance.

An accompanying editorial, by Silvio Inzucchi and Mark Siegel, notes that physicians “are now left in something of a quandry” but warns against an “overreaction” to the findings:
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