Can 50 Million Blood Pressure Prescriptions Each Year Be Wrong?

–For decades physicians may have been prescribing the wrong diuretic. Now an innovative new trial will settle the question. A radically innovative large new VA trial will finally shed light on a decades-old unresolved question that could have important public health implications. According to guidelines thiazide diuretics are the first-line treatment for hypertension. Hydrochlorothiazide accounts…

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Major Shift As Deaths From Cancer Overtake CV Disease In Western Europe

–In 12 high-income countries cancer is now a bigger cause of death than cardiovascular disease. In Europe as in the rest of the world cardiovascular (CV) disease remains the number one cause of death. But in 12 western European countries cancer now kills more people than CV disease. The finding, which likely presages a major…

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The Twitter Debate Over Cholesterol Screening In Kids

–Cardiologists discuss the screening controversy in 140 characters or less. My recent post on the debate over cholesterol screening in children provoked a fascinating discussion on Twitter, including comments from several highly knowledgeable experts and clinicians. The discussion started when James Stein, a preventive cardiologist at the University of Wisconsin), tweeted: Lipid screening in kids….

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Experts Disagree About Cholesterol Screening In Kids

(Updated) –Lack of evidence leads to major disagreement over guidelines. Once again the US Preventive Services Task Force (USPSTF) has performed an invaluable— and almost certainly thankless— service. In a series of papers published in JAMA and Annals of Internal Medicine the USPSTF states unequivocally that there is no good high quality evidence to evaluate…

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Changes In Eskimo Diet Linked To Increase In Heart Disease

New paper explores the fascinating history of research into the Eskimo diet. The Eskimo diet and its effect on the heart has been a source of confusion and contention for decades. The observation that Eskimos, who traditionally consumed large amounts of saturated fat and small amounts of carbohydrates, had low rates of heart disease appeared…

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FDA Places Roadblock On Approval Path Of Novel Cholesterol Drug

Could this be the end of LDL as a surrogate? A possible shift in policy at the FDA means that a much heralded novel new cholesterol drug won’t reach the US market until 2022 at the earliest. Esperion Therapeutics’ bempedoic acid (formerly known as ETC-1002) had previously been thought to be eligible for approval within…

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Bad News Bears: After Scary Headlines Some Patients Stopped Taking Statins

Study provokes discussion about the responsibilities of medical journals and the general media. A new study and surrounding discussion raises important questions about the role and responsibility of researchers, editors, and journalists when tackling topics with potentially life-affecting consequences. The new study, published in the BMJ, found that many people stopped taking statins in the…

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Time For Cardiologists To Start Prescribing Diabetes Drugs?

There’s an emerging consensus that now may be the time for cardiologists to start thinking seriously about prescribing diabetes drugs. Until now most cardiologists have not considered this to be part of their job description. But now new data from large cardiovascular outcome trials (CVOTs) shows that these drugs may one day become, like statins and…

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Study Questions ‘Lower Is Better’ For Cholesterol

–No added benefit for statin patients who reached very low LDL levels A large observational study suggests that moderate lowering of LDL may be just as effective as intensive lowering. “Our results do not provide support for a blanket principle that lower LDL cholesterol is better for all patients in secondary prevention,” the authors conclude….

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Cholesterol Skeptics Launch Another Attack

–But most experts say their study is highly flawed Once again, a group of cholesterol skeptics has published an inflammatory attack on the cholesterol hypothesis. But critics say that the paper is deeply flawed and should not be used to influence treatment or policy decisions. In a paper published in BMJ Open, Uffe Ravnskov, MD,…

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Clinical Trial Expert’s Deep Dive Into The Important New Liraglutide Trial

–Sanjay Kaul plunges into the LEADER data pool There will be a lot of discussion in the near future about the LEADER trial, the large new trial assessing cardiovascular outcomes with liraglutide (Victoza, Novo Nordisk). The trial is the latest in a series of large CVOTs with new diabetes drugs showing benefit— or at least…

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First PCSK9 Outcome Trial Results Pushed Back To 2017

Uptake of the new drugs likely to lag without strong outcomes data. Uptake of the new drugs likely to lag without strong outcomes data.Uptake of the new drugs likely to lag without strong outcomes data.   –Uptake of the new drugs likely to lag without strong outcomes data. There’s probably nothing more eagerly awaited in cardiovascular…

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FDA Proposes Voluntary Sodium Cuts by Food Industry

–AMA, AHA, ACC, etc voice support, but not everyone agrees. After decades of discussion and inaction, the FDA today took a first concrete step toward reducing sodium levels in the general population: It issued draft guidance for voluntary sodium reduction targets for the food industry. The FDA said that the new recommendations come from “leading…

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Women with Migraine Face Increased CV Risk

–But clinical implications are unclear since there’s no known mechanism Women who have migraine headaches have a significantly increased risk of cardiovascular disease, according to new results from a large observational study published in the BMJ. Earlier studies have established a strong link between migraine and stroke, which the the new study now extends to…

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New Anticoagulant May Cut VTE In Medically Ill

–Generally positive results for Portola’s betrixaban, despite missed key endpoint Betrixaban may yet become the first new oral anticoagulant to gain approval for extended venous thromboembolism (VTE) prophylaxis in the important and underserved group of medically-ill patients, even though its pivotal trial was damaged by a self-inflicted statistical wound. There were consistent differences in favor of…

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The American Heart Association’s Strong Stance Against Science

Once again the American Heart Association has taken a strong stance against science. Of course, that’s not how the AHA phrases it. In its own words the AHA says it “strongly refutes the findings” of a “flawed study” which “you shouldn’t use… to inform yourself about how you’re going to eat.” But in fact the…

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Flu Vaccine May Benefit Heart Failure Patients

–Studies find fewer hospitalizations and less dementia after vaccination Two new observational studies offer new evidence that heart failure patients may benefit from the flu vaccine. The studies were presented in Florence, Italy, at the Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure. In the first study Kazem Rahimi (University of…

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Study Suggests Salt Restriction Only Beneficial In People With Hypertension

–More questions raised about broad efforts to restrict salt; AHA condemns study A large new analysis offers more evidence that broad salt restriction doesn’t benefit most people and may even harm some people. The study did find that salt restriction may be beneficial to the minority of people with high blood pressure who also consume…

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ASGR1 Gene Tied to Heart Health

(Updated) –May have stronger impact than PCSK9 variants on disease risk A large new study from Iceland has identified variants in a gene that appear to have powerful cardioprotective effects, perhaps an first early step toward a novel therapy for heart disease prevention and treatment. The gene, ASGR1, was identified by the well known genetic…

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You Say Potato, I Say Worthless Epidemiology

(Updated) –Observational study links potatoes to high blood pressure Depending on your position in the dietary wars, potatoes are now either a newly-confirmed nutritional villain or an innocent victim of overzealous and misapplied epidemiology. A new study, published in The BMJ, is the first to establish a direct link between potato consumption and blood pressure….

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Noted Skeptic Calls For More Randomized Nutrition Trials

Defying conventional wisdom Ioannidis says we need more negative trials to clear away all our misconceptions about nutrition Defying conventional wisdom Ioannidis says we need more negative trials to clear away all our misconceptions about nutritionDefying conventional wisdom Ioannidis says we need more negative trials to clear away all our misconceptions about nutritionDefying conventional wisdom…

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Pioneering Lipoprotein Researcher Richard Havel Dead

–Nobel laureates Brown and Goldstein say when they were starting out Havel taught them 90% of what they knew Richard Havel, a scientist who helped create the entire entire modern field of research in lipoprotein metabolism, died last month. In response to the news scientists in the field have poured extravagant praise on the man…

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Experts Foresee Major Role For Generic Crestor

— Finally there’s a challenger to the long reign of Lipitor The FDA approval on Friday of the first generic version of Crestor (rosuvastatin calcium) marks the end of an era and the beginning of a major shift in cardiovascular medicine. Over time, as the price of the drug drops with generic competition, it seems…

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No Evidence To Support Screening Young Athletes

–More questions raised about key study suggesting ECG screening can save lives There is no good evidence to support screening young athletes to prevent sudden cardiac arrest, concludes a new analysis published in the BMJ. The analysis also raises new and troubling questions about a key Italian study that has been the main study used…

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New Company Bets Hundreds Of Millions Of Dollars On A Genetic Strategy To Resurrect A CETP Inhibitor

–But skeptics think CETP inhibitors are a dead end A new company is betting hundreds of millions of dollars that it can snatch victory from the jaws of defeat. Over the last decade no class of drugs has undergone a reversal of fortune as dramatic as the cholesterol ester transfer protein (CETP) inhibitors, the once…

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