Routine screening for CAD in asymptomatic type 2 diabetics is not warranted, according to a new study in JAMA that was also presented this morning at a JAMA news conference.

“Rather than viewing this study as a negative screening study, clinicians might consider the results as a positive message: patients with type 2 diabetes without symptoms to suggest CAD, receiving contemporary medical care, close follow-up, and appropriate diagnostic evaluation for symptoms of ischemia have relatively favorable outcomes in the current era,” said Frans J Th Wackers, in a JAMA press release.

In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study, Wackers and colleagues randomized 1,123 type 2 diabetics to MPI screening or no screening. After 4.8 years of followup there were no significant differences between the two groups in the incidence of nonfatal MI and cardiac death. In the first 120 days the rate of coronary angiography was 4.4% in the screening group versus 0.5% in the unscreened group.

Click for commentary from PK Shah and William Boden, and to read the JAMA press release…

In addition to all the good press, statins have also taken a number of hits, but a recent article may have reached a new low by blaming statins for the financial breakdown. Here is how the article, Cholesterol Contrarians Question Cult of Statins, begins:

The near-breakdown of the international financial system and the deep recession it helped create has been attributed to many causes….
Now, a Florida physician proposes an alternative explanation. Perhaps many of those supposedly sophisticated speculators who believed the party would never end were acting under the influence of drugs.
Cholesterol-lowering drugs.
“There’s a damn good possibility it’s related!” said Mark Goldstein, who has been observing his patients’ reactions to statins for the past three decades.

Click to continue reading…

It’s time to tax soda and curtail its marketing to children, according to a perspective published online in the New England Journal of Medicine and an editorial published in the Lancet.

Soda and other sugar-sweetened drinks “may be the single largest driver of the obesity epidemic,” according to Kelly Brownell, a Yale nutritionist, and Thomas Frieden, the New York City health commissioner, in the NEJM perspective. Noting that taxes on tobacco have been effective in cutting tobacco use, the writers propose a tax on sugared beverages that “would encourage consumers to switch to more healthful beverages.”
Click to continue reading and to read the Lancet press release…

Daiichi Sankyo and Eli Lilly today announced the worldwide launch of prasugrel in the United Kingdom. Prasugrel will be marketed as Efient in the UK. In the US, when and if the controversial drug gets approved, the brand name will gain an extra “f” and be known as “Effient.”

According to a report in Reuters, in the UK Efient will cost 31% more than Plavix (clopidogrel). The cost of a 28-tablet pack of the new drug is 47.56 pounds compared to 36.35 for Plavix.
Click here to read the Daiichi Sankyo press release…

Brucy Psaty is a cardiologist who is well known as an outspoken critic of industry influence in cardiovascular medicine. In a commentary in this week’s JAMA, Psaty recounts his early experience as an assistant professor when, after publishing a paper on antihypertensive drugs:

My family and I were invited to a first-class resort, where I presented the results at a sponsored conference. Although I lacked both the golf skills and the sense of entitlement to make the most of the holiday, the effort did result in a publication in an industry-funded supplement.

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A post-hoc analysis of the CLARITY-TIMI 28 trial has turned up strong evidence that cigarette smoking may enhance the clinical benefit of clopidogrel. The results are published online in the Journal of the American College of Cardiology.

In CLARITY-TIMI 28, clopidogrel was markedly more effective in reducing the rate of death or MI before angiography and at 30 days among STEMI patients who smoked 10 or more cigarettes per day, according to the new analysis. As a pro-drug, clopidogrel is transformed in a two-step oxidization process by CYP450 enzymes into its active metabolite. Cigarette smoking is known to induce one of these enzymes, CYP1A2.

CardioBrief asked study investigator Marc Sabatine about the difficulty of interpreting this study for the general public. Sabatine said:
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Upsetting the long-held but crumbling dogma that the heart can’t regenerate itself, a new study from Sweden and other institutions has provided the best evidence yet that human myocardial cells can be, and are, replaced over the course of a life, at the rate of about 1% per year at the age of 25. The study relies on measuring radioactive-labeled cells. Although it is unethical to perform such an experiment in humans, the team of researchers realized that a “natural” experiment was available in people who were born prior to the ban on above-ground nuclear testing in 1963.
Click here to continue reading, and to read a press release from the Lawrence Livermore National Laboratory

JUPITER substantially overestimates the benefits of rosuvastatin, according to Salim Yusuf and colleagues, in a comment in the Lancet, and Sanjay Kaul, in a response provided to CardioBrief. JUPITER leader Paul Ridker disagrees, of course, in a comment to CardioBrief.

In their Lancet comment, Yusuf et al note that the benefits observed in JUPITER were considerably greater than would be expected from previous trials with the drug. The “real benefit” of rosuvastatin is “unlikely to be larger than a 20-30% reduction in relative risk for ischemic events, and a 10% reduction for total mortality. Both estimates are within the 95% CI of the estimates on specific events observed in JUPITER.” In addition, “the role of CRP as a predictor of risk remains controversial.”
Click here to read comments from Paul Ridker and Sanjay Kaul…

The FDA’s Endocrinologic and Metabolic Advisory Committee voted 10-2 in favor of saxagliptin, (Onglyza, Bristol-Myers Squibb and AstraZeneca), deciding that the drug did not have an unacceptable cardiovascular risk profile. However, the panel voted that the companies be required to perform a post-marketing trial to confirm the drug’s safety.

On Thursday liraglutide will be considered by the same committee.

You can read coverage of the panel meeting in a Dow Jones newswire story or a MedPage Today story.
Click to read the Bristol-Myers Squibb and AstraZeneca press release…