Study Suggests Link Between Viagra And Melanoma Reply

In recent years researchers have uncovered a potentially important pathway whereby PDE5A inhibitors (which include sildenafil– Viagra– and other drugs used to treat erectile dysfunction and pulmonary hypertension) could potentially increase the risk of developing melanoma. Now a new study provides early evidence showing an association between sildenafil and melanoma, though, like all observational studies, it is unable to demonstrate a cause-and-effect relationship.

Click here to read the full post on Forbes.

 

Title: Pathology: Patient: Melanoma Descriptio...

 

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Boehringer Ingelheim’s Pradaxa Gains New Indication 1

The new oral anticoagulants continue to gain additional indications from the FDA. Earlier today Boehringer Ingelheim announced that the FDA had approved Pradaxa (dabigatran) for the treatment of venous thromboembolism (VTE), which includes both deep venous thrombosis (DVT) and pulmonary embolism (PE).

 Click here to read the full post on Forbes.

 

 

Cardiovascular Disease Declines in Rich Countries but Grows Elsewhere Reply

A new Global Cardiovascular Disease (CVD) Atlas portrays a divided world where rich countries are gradually freeing themselves from the yoke of CVD but where many poor and middle-income countries are still struggling.

Ischemic heart disease and stroke were the two biggest contributors to the global burden of disease in 2010, accounting for 5.2% and 4.1%, respectively, of all disability adjusted life years (DALYs)….

Click here to read the full post on Forbes.

 

Aspirin and Clonidine Fail to Help Surgery Patients Reply

Heart attacks (myocardial infarctions) are among the most common and serious side effects of noncardiac surgery. An effective regimen to minimize this risk has been the subject of considerable debate in recent years. The controversy was recently exacerbated because the recommendation to use beta-blockers in this setting was based on research which has now been discredited. Substantial evidence against the use of perioperative beta blockers came from the original POISE trial.

Now a second POISE trial, the Perioperative Ischemic Evaluation 2 (POISE-2) trial, casts doubt on the value of two other proposed strategies to reduce death and MI in patients undergoing noncardiac surgery. Results of POISE-2 were presented at the American College of Cardiology meeting in Washington, DC and published simultaneously in two papers in the New England Journal of Medicine.

Click here to read the entire post on Forbes.

 

High-Sensitivity Troponin Test Could Identify Low Risk Chest Pain Patients In The ED Reply

Approximately 15-20 million people in Europe and the United States go to the emergency department every year with chest pain. Many can be discharged early if they are not having an acute coronary syndrome. A large new single-center observational study, presented at the American College of Cardiology meeting in Washington, DC and published simultaneously in the Journal of the American College of Cardiology, provides fresh evidence that high-sensitivity cardiac troponin T (hs-cTnT) may be useful in helping identify chest pain patients in the emergency department who do not need to be admitted to the hospital.

Click here to read the full post on Forbes.

 

Glucose Measurements Don’t Improve Cardiovascular Risk Assessment Reply

Although blood glucose and glycated hemoglobin (HbA1c) play a central role in diabetes, the value of these measurements to assess cardiovascular risk has been unclear. Now, in a paper published in JAMA, members of the Emerging Risk Factors Collaboration analyze data from nearly 300,000 people without known diabetes or cardiovascular disease who were enrolled in 73 prospective studies.

Click here to read the full post on Forbes.

 

 

12.8 Million More Adults Now Eligible For Statin Therapy Reply

Millions more people are now eligible for statin therapy under the new cholesterol guideline, according to a new estimate published in the New England Journal of Medicine.

There have been many attempts to quantify just how many more people are now eligible for statin therapy under the new guideline. Now in the new paper in NEJM, Michael Pencina and colleagues estimate that the new guideline results in a net increase of 12.8 million people who are now eligible for statins.

Click here to read the full post on Forbes.

 

Studies Provide Little Support For Guidelines On Dietary Fats And Supplements Reply

The precise cardiovascular effect of dietary fats and supplements has been the subject of heated controversy. Although there is no strong supporting evidence from clinical trials, current guidelines tend to discourage or minimize the role of saturated fats and trans fats and to encourage the intake of omega-3 polyunsaturated fatty acids. Two new studies published today help clarify some of the issues. Both studies demonstrate the shaky underpinnings of the guidelines but are unlikely to provide firm support for a new perspective on these issues.

Click here to read the full post on Forbes.

 

Phase 4 Actelion Study Misses Primary Endpoint Reply

Actelion announced today that a phase 4 study with its blockbuster drug bosentan (Tracleer) had failed to meet its primary endpoint.

The COMPASS-2 trial was a prospective, randomized, double-blind, placebo-controlled trial evaluating the effect of bosentan on the time to first confirmed event in patients with symptomatic pulmonary arterial hypertension (PAH) already receiving treatment with sildenafil.

Click here to read the full post on Forbes.

 

Reassuring News About Statins From Two Very Different Studies Reply

Although clinical trials have consistently demonstrated the benefits of statins, the perception that the drugs can cause serious side effects has prompted some patients to discontinue or not take the drugs. Now two new very different studies, one a large meta-analysis and one a tiny study with only a handful of patients, provide some convincing reassurance that most of the side effects that have been tied to statins do not appear to be actually caused by the drugs.

Click here to read the full post on Forbes.

 

Apixaban Gains Indication For DVT Prophylaxis After Knee And Hip Replacement Surgery Reply

The FDA has approved a new indication for apixaban (Eliquis), the anticoagulant drug manufactured by Bristol-Myers Squibb and Pfizer. The new indication is for the prophylaxis of deep vein thrombosis (DVT) in patients who have undergone hip or knee replacement surgery. DVT can lead to the life-threatening condition of pulmonary embolism (PE). The DVT prophylaxis indication joins the previously approved indication of stroke prevention in patients who have nonvalvular atrial fibrillation.

Click here to read the entire post on Forbes.

 

US Patients More Likely Than English Patients To Receive Life-Saving Surgery Reply

Patients with a ruptured abdominal aortic aneurysm (rAAA)– a very serious life-threatening illness that occurs more often in elderly men– have better outcomes in the United States than in England, according to a new study published in the Lancet.

Researchers at the University of London compared hospital data from 11,799 rAAA patients in England with 23,838 rAAA patients in the U.S. They found that U.S. patients were more likely than English patients to have a procedure to repair the rAAA and to survive their hospital stay.

Click here to read the full post on Forbes.

Heart Failure: The Missing 800 Pound Gorilla In Diabetes Trials Reply

Is heart failure the missing 800 pound gorilla in diabetes trials? That’s the argument proposed by a group of  prominent cardiovascular and diabetes researchers.

It was long believed that by virtue of their glucose-lowering properties diabetes drugs would confer substantial cardiovascular benefits. Now, however, that belief is no longer widely held and the FDA now requires cardiovascular outcome trials for new diabetes drugs. But, write the researchers in  an article published in The Lancet Diabetes & Endocrinology, these trials are failing to track and analyze one key cardiovascular endpoint, thereby diminishing the value of these trials in assessing the cardiovascular effects of diabetes drugs.

Click here to read the full post on Forbes.

 

FDA Sprinkles Some Rain On the PCSK9 Inhibitor Parade Reply

In the last few years the PCSK9 inhibitors have been one of the few bright lights in an otherwise dismal field of new cardiovascular drugs. Now the FDA is raising questions that could dramatically slow down the progress of these new cholesterol-lowering drugs.

Last month Regeneron disclosed that it had been “advised by the FDA that it has become aware of neurocognitive adverse events in the PCSK9 inhibitor class.”

Click here to read the full post on Forbes.

 

Warfarin Benefits Extended To Patients with Chronic Kidney Disease Reply

Anticoagulation is a cornerstone of therapy for atrial fibrillation because it lowers the heightened risk for stroke in this population. People with chronic kidney disease are also at increased risk for stroke, but the benefits of anticoagulation are less clear in this group, and anticoagulation is used less often in AF patients who have CKD. Now, a large observational study offers some reassurance that anticoagulation in AF patients with CKD may be beneficial.

Researchers in Sweden analyzed data from more than 24,000 survivors of acute myocardial infarction who had AF….

Click here to read the full post on Forbes.

 

Pfizer Starts Testing For Over-The-Counter Lipitor Reply

Looking backward to improve its future, Pfizer will once again try to gain FDA approval to market its blockbuster drug, atorvastatin (Lipitor), over-the-counter (OTC). Peter Loftus reports in the Wall Street Journal that the company has started a clinical study to support the application for low-dose atorvastatin (10 mg).

Click here to read the full post on Forbes.

 

Vitamin Supplements Come Up Short Once Again 1

Once again the U.S. Preventive Services Task Force (USPSTF) has concluded that there is no good evidence to support the routine use of multivitamins or most individual or combination vitamins by healthy adults to prevent cardiovascular disease or cancer.

The USPSTF also recommended against the use of two specific vitamins — beta-carotene and vitamin E. Beta-carotene has been linked to a significant increase in the risk for lung cancer among smokers, while “a large and consistent body of evidence has demonstrated that vitamin E supplementation has no effect on cardiovascular disease, cancer, or all-cause mortality.”

For other vitamins or multivitamins, the task force found few significant harms, though they said the evidence was insufficient to allow definitive assessments of the risks and benefits.

Click here to read the full post on Forbes.

Lower Blood Pressure Found In Vegetarians Reply

A new study provides the strongest evidence yet that a vegetarian diet is strongly associated with lower blood pressure. Although various health benefits of a vegetarian diet have often been proposed, a rigorous examination of the effect on blood pressure has not been previously performed.

In a paper published in JAMA Internal Medicine, Japanese researchers analyzed data from 7 clinical trials, including 311 participants, and 32 observational studies, including 21,604 participants….

Click here to read the full post on Forbes.

 

 

 

 

Newly Elected President Of Institute of Medicine Is On The Pepsico Board Of Directors 4

Earlier today I reported the news that Victor Dzau, the chancellor for health affairs at Duke University and the CEO of the Duke University Health System, would become the next president of the Institute of Medicine. But I  failed to remember that I had written about Dzau several years ago. I think it will be of interest to many observers that Dzau currently serves on the Board of Directors of Pepsico. I’ve asked the IOM for a comment about this.

Here’s what I wrote in 2010 about Dzau.

Artery Zapping Little Better Than Drugs In Atrial Fibrillation Patients Reply

Atrial fibrillation is the most common heart rhythm disorder. Although AF is not as lethal as some other arrhythmias, AF patients are at high risk for stroke and other serious complications. AF is also very difficult to treat. Although drugs are ineffective in a large percentage of patients, drugs are considered first line therapy in current guidelines.

Zapping arteries with electric energy, or radio frequency ablation (RFA) was originally hoped to be a cure for AF. Those earlier hopes have been dashed but some experts have held out hope that RFA therapy would be better than drug therapy as initial treatment.

Now a new trial offers scant support for earlier use of radio frequency ablation to treat atrial fibrillation.

Some 127 patients with paroxysmal AF were randomized to antiarrhythmic therapy or RFA as initial treatment in the RAAFT-2 trial…

Click here to read the full post on Forbes.

 

No, An Apple Device Won’t Tell You If You’re Having A Heart Attack 2

No one knows for sure but Apple appears to be strongly interested in adding medical applications and technologies to its current and future products. We know that Apple has patented a heart sensor that could be incorporated in a future iPhone or iWatch, though it seems more likely that it would be used for security rather than health purposes. We also know that top Apple executives have met with FDA commissioner Margaret Hamburg and top FDA device regulators, though the details of their discussion have not been disclosed.

But one new report on SF Gate is almost certainly wrong: an Apple device won’t be able to tell you if you’re about to have a heart attack.

 Apple is exploring ways to measure noise “turbulence” as it applies to blood flow. The company wants to develop software and sensors that can predict heart attacks by identifying the sound blood makes as it tries to move through an artery clogged with plaque, the source said.

Click here to read the full post on Forbes.

 

FDA Investigating Heart Failure Risk Linked To Onglyza Reply

The FDA said today that it was conducting an investigation of a possible increased risk for heart failure associated with the diabetes drug saxagliptin. Saxagliptin is marketed by AstraZeneca as Onglyza and Kombiglyze XR. (AstraZeneca recently completed the purchase of all rights to the drug from its manufacturer, BristolMyers-Squibb.)

The investigation stems from findings from the cardiovascular outcomes trial SAVOR-TIMI 53 trial  in which more than 16,000 type 2 diabetics were randomized to the DPP-4 inhibitor saxagliptin or placebo.

Click here to read the full post on Forbes.

 

 

 

 

Leading European Cardiologist Accused Of Plagiarism Reply

Thomas Lüscher, the editor of the European Heart Journal and one of the most prominent cardiologists in Europe, has been accused of plagiarism. An irony in the case is that  Lüscher has taken a strong public position against scientific misconduct of all sorts, including plagiarism.

Click here to read the full post on Forbes.

 

This Blog Is ‘Not Suitable For Dissemination Through The Internet’ 1

The editors of the prestigious European Heart Journal have decided that this blog, or at least one recent post, “is “not suitable for dissemination through the internet.”

I beg to differ.

In an EHJ editorial, Is the panic about beta-blockers in perioperative care justified?the authors, the editors of the journal, led by editor-in-chief Thomas Lüscher, repeatedly criticize a post I wrote a few weeks ago with an intentionally provocative headline, “Medicine Or Mass Murder? Guideline Based on Discredited Research May Have Caused 800,000 Deaths In Europe Over The Last 5 Years.”

Their editorial begins:

Controversial issues need proper discussion, both in science and clinical medicine. Sometimes the interpretation of the available data is complex and not suitable for dissemination through the internet.1

That reference at the end refers to my earlier article.

Click here to read the full post on Forbes.

 

Censorship
Censorship (Photo credit: IsaacMao)

Blood Pressure Trajectory Over 25 Years Predicts Atherosclerosis Risk Reply

Everyone knows that blood pressure is one of the most important measurements of cardiovascular risk. Less well known is that most studies of blood pressure have relied on single or isolated measurements of blood pressure. Few studies have even attempted to examine the significance of blood pressure patterns over a long period of time.

Now, in a paper published in JAMA, researchers present an analysis of data from 3442 adults who participated in the long-term CARDIA study. Study participants were 18-30 years of age at baseline and had multiple blood pressure measurements over the course of the study. After 25 years, they had a CT scan that measured their coronary artery calcium (CAC) score.

Click here to read the full post on Forbes.

 

Blood pressure check
Blood pressure check (Photo credit: Army Medicine)