Success For 40-Year Effort In One Rural County To Curb Cardiovascular Disease Reply

A 40-year program in one poor rural county to combat cardiovascular disease appears to have been successful, resulting in reduced rates of hospitalization and death compared with other counties in the same state over the same time period. The new findings from the study are described in a paper published in the Journal of the American Medical Association.

Click here to read the full post on Forbes.

 

Millions Of Americans Taking Aspirin When They Shouldn’t Reply

More than a third of US adults– more than 50 million people– now take aspirin for the primary and secondary prevention of cardiovascular disease. (Primary prevention is the prevention of a first event; secondary prevention is the prevention of a recurrent event.) Although it was once broadly recommended, because of the increased risk of bleeding complications the use of aspirin for primary prevention of cardiovascular disease is now only indicated in people who have a moderate to high 10-year risk. (Aspirin is still broadly recommended for secondary prevention.) Now a new report  published in the Journal of the American College of Cardiology finds that there are still a significant number of people who are receiving aspirin inappropriately.

Click here to read the full post on Forbes.

 

More Turmoil For Troubled Medical Laboratory Company Reply

Problems continue to accumulate for the deeply troubled medical laboratory company Health Diagnostic Laboratory. Following several years of spectacular growth, in which the company grew to $400 million in annual revenue, the company last year began an equally spectacular implosion when it became known that the federal government was investigating the company for giving kickbacks to physicians to use the company’s tests. Additional allegations suggested a broader pattern of serious misconduct based on questionable sales, marketing, and billing practices regarding unnecessary testing.

In the latest development HDL terminated its contract with BlueWave Healthcare Consultants, the sales company that played a crucial role in HDL’s explosive growth. In response BlueWave filed a lawsuit against HDL for $205 million…

Click here to read the full post on Forbes.

 

Three Reasons Why You Don’t Need To Feel Sorry For Doctors Reply

I’m not a doctor and I don’t have strong opinions about how doctors should be certified or, more to the point right now, what they should have to do to maintain their certification over the course of their careers. But recently this last topic– called maintenance of certification, or MOC– has become the subject of a raging debate within the medical community, as thousands of doctors have expressed their displeasure, to put it mildly, with a new recertification scheme established last year by the American Board of Internal Medicine, the official “certifying” body of a large proportion of doctors in the US. From what I’ve read it appears that the critics of the new system have some very legitimate points and that some big changes will likely be necessary. But in the course of the debate I have been disturbed by some of the arguments that have been used to criticize the new MOC. (Unfortunately I haven’t seen a lot of attempts to actually defend the new scheme so I can’t give equal time to the other viewpoint.)

Click here to read the full post on Forbes.

 

FDA Approves New Oral Anticoagulant From Daiichi Sankyo 1

And then there were four.

Late Thursday the FDA announced that it had approved edoxaban, the new oral anticoagulant manufactured by Daiichi Sankyo. The drug will be marketed under the brand name of Savaysa and joins three other new drugs in the large and important new oral anticoagulant marketplace…

Click here to read the full post on Forbes, including a comment from Sanjay Kaul.

 

An Emerging Consensus About Novartis’s New Potential Blockbuster Reply

Last year it became clear that Novartis had a potential blockbuster with its new heart failure drug, LCZ696, which is an angiotensin receptor- neprilysin inhibitor (ARNi) consisting of the company’s own well-known angiotensin receptor blocker valsartan (Diovan) and a novel compound, the neprilysin inhibitor sacubitiril. The results of the PARADIGM trial, which was stopped early because of a large and highly significant reduction in cardiovascular mortality, electrified the cardiovascular community. But the trial also sparked a lot of controversy when skeptics raised questions suggesting that the results were not nearly as impressive as the investigators reported.

Following the initial excitement and discussion we are now starting to get a more measured and realistic view of the drug and the trial. In recent days two important secondary PARADIGM papers have been published. A paper in Circulation looks at the experience of trial participants who didn’t die. A paper in European Heart Journal performs some sophisticated statistical wizardry to estimate how LCZ696 would have performed against placebo instead of an active comparator. It will probably come as no surprise that both papers are highly positive. The Circulation paper shows that LCZ696 was effective in preventing progression of heart failure. The EHJ paper concludes that if it had been compared to placebo in a contemporary, otherwise well-treated population LCZ696 would have produced “striking reductions in cardiovascular and all-cause mortality, as well as heart failure hospitalization.”

Far more important than these papers, in my view, are the accompanying editorials. The Circulation editorialist, Henry Krum, is an influential Australian cardiologist and the EHJ editorialist, Duke University cardiologist Rob Califf, is one of the most influential and respected cardiologists in the world…

Click here to read the full post on Forbes.

 

Healthy Habits Of Young Women Lead To Long-Term Health Benefits 1

It may seem obvious but a new study shows that young women with healthy habits are less likely as they age to get coronary heart disease or go on to develop cardiovascular risk factors like high blood pressure, high cholesterol, or diabetes.

Andrea Chomistek and colleagues analyzed data from more than 88,000 women participating in the Nurses Health Study II and who were between 27 and 44 years of age at the start of the study.

Click here to read the full post on Forbes.

 

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FDA Approves New Medtronic Drug-Coated Balloon To Open Blocked Leg Arteries Reply

Medtronic said today that it had received approval from the FDA to market its In.Pact Admiral drug-coated balloon (DCB) to treat peripheral artery disease (PAD) in the upper leg. The device is the second DCB to gain FDA approval. Last October the FDA approved CR Bard’s Lutonix DCB for a similar indication.

Click here to read the full post on Forbes.

 

MDT DCB

2014 Dubious Innovations In Cardiology Reply

 

  • Dubious Innovative Device: Renal Denervation
  • Dubious Innovative Business Strategy: Health Diagnostics Laboratory
  • Dubious Innovations In Leadership (Tie): The European Society of Cardiology and The Institute of Medicine
  • Dubious Innovative Breakthrough Therapy That Never Actually Breaks Through Anything (repeat winner): Cardiac Stem Cell Therapy

 

Click here to read the full post on Forbes.

 

 

Embattled Stem Cell Researchers Sue Harvard And Brigham And Women’s Hospital Reply

Two embattled and highly controversial stem cell researchers are suing the Brigham and Women’s Hospital and Harvard Medical School for an ongoing investigation into their research. The investigation has already resulted in the retraction of one paper in Circulation and an expression of concern about another paper in the Lancet.

The suit was filed by Piero Anversa, the highly prominent stem cell researcher who is a Harvard professor and the head of a large lab at the Brigham, and his longtime colleague, Annarosa Leri, an associate professor of medicine at Harvard who has coauthored many papers with Anversa. The suit places the blame for any scientific misconduct relating to the two papers on a third colleague and coauthor, Jan Kajstura, their longtime collaborator.

Click here to read the full post on Forbes.

 

New Devices May Bring Improved Treatment To Stroke Patients Reply

A large new trial provides the first substantial evidence that new devices can improve the outcome of patients who have acute ischemic stroke. Earlier, less sophisticated versions of the devices had produced disappointing results in clinical trials. The previous trials may also have been hindered by long treatment delays and difficulties in recruiting suitable patients. The new devices are retrievable stents that extract blood clots from inside vessels.

MR CLEAN (The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), published in the New England Journal of Medicine today,  was designed to address the limitations of these previous trials. 500 patients with ischemic stroke were randomized to usual care or the addition of intraarterial treatment within 6 hours of symptom onset.

Click here to read the full post on Forbes.

 

Continuing Medical Education Payments To Physicians Will Be Exposed To Sunshine Reply

After a long and complicated struggle it now appears highly likely that industry will be required to disclose payments to physicians for continuing medical education (CME). This decision from CMS, which I am told by reliable sources is final, follows a long period in which CMS appeared to waver in its approach to incorporating CME into the Sunshine Act.

Click here to read the full post on Forbes.

 

No Advantage For Low Glycemic Index Diet Reply

In recent years the glycemic index (GI), a measure of a carbohydrate’s impact on blood sugar, has assumed a major role in discussions about diets and nutrition. Now a new study suggests that by itself, within the context of an otherwise healthy diet, GI may not be an important factor in improving cardiovascular risk.

In a paper published in JAMA, Frank Sacks and colleagues report the results of a randomized, crossover-controlled 5-week feeding trial comparing 4 different diets in 163 overweight or obese adults. The diets were either low- or high-carb and either low- or high-GI. Importantly, all the diets were based on previously established healthy dietary patterns based on the DASH diet, which is low in saturated and total fat and includes substantial amounts of fruits, vegetables, and low-fat dairy foods.

Click here to read the full post on Forbes.

 

Get Rid of Sugar, Not Salt, Say Authors Reply

Too much negative attention has been focused on salt and not enough on sugar, write two authors in Open Heart. Reviewing the extensive literature on salt and sugar, they write that the adverse effects of salt are less than the adverse effects of sugar. The evidence supporting efforts to reduce salt in the diet is not convincing and we would be far better off reducing sugar instead of salt in the modern diet.

Click here to read the full post on Forbes.

 

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New Drug From Isis Breaks Important Ground But Unlikely To Dent The Market Reply

The first important results with a new drug under development by Isis Pharmaceuticals may well have an enormous long term impact on our understanding of how blood flows through the body and how that same blood forms clots in response to damage and disease. But it appears unlikely that the new drug– an anticoagulant unlike anything else now available–  will have a major impact on the large and important anticoagulant market.

FXI-ASO, under development by Isis, is an antisense oligonucleotide that reduces the level of factor XI, a key component of the intrinsic (contact) coagulation pathway. All the currently available anticoagulants target the extrinsic (tissue factor) coagulation pathway.

Click here to read the full post on Forbes, including detailed perspectives by Sanjay Kaul and Ethan Weiss.

 

Women: Don’t Use Aspirin For Routine Prevention Of Heart Attacks, Stroke, And Cancer Reply

Although once widely recommended, aspirin for the prevention of a first heart attack or stroke (primary prevention) has lost favor in recent years, as the large number of bleeding complications appeared to offset the reduction in cardiovascular events. But at the same time evidence has emerged demonstrating the long-term effect of aspirin in preventing colorectal cancer, leading some to think that the risk-to-benefit equation for aspirin should be reconsidered.

Investigators in the Women’s Health Study therefore analyzed long-term followup data from 27,939 women who were randomized to placebo or 100 mg aspirin every other day.

Click here to read the full post on Forbes.

 

No, The Mediterranean Diet Won’t Help You Live Forever Reply

A new study published today provides fresh evidence for the healthful effects of the Mediterranean Diet. It even suggests that people who follow the Mediterranean Diet may live longer than people on most other diets. And this is just the latest piece of good news about this diet to appear in the last few years. But I want to warn my readers not to go overboard with this study. It appears to be an excellent, well-performed study, but it has many inherent limitations and is by no means definitive. In the long run it may raise as many questions as it answers.

The new study, published in The BMJfinds that women who more closely followed a Mediterranean diet had longer telomeres on the end of their chromosomes…

Click here to read the full post on Forbes.

 

Study Suggests Epinephrine for Cardiac Arrest May Be Harmful Reply

Epinephrine has been a cornerstone of therapy during cardiac resuscitation after cardiac arrest because of its well-established ability to stimulate the heart and increase the probability of a return of spontaneous circulation (ROSC). In recent years, however, concerns have been raised that people treated with epinephrine may have worse neurological outcomes following their resuscitation.

In a study published in the Journal of the American College of Cardiology, French researchers analyzed data from more than 1,500 patients who were successfully resuscitated after an out-of-hospital cardiac arrest and were subsequently treated at a large hospital in Paris….

Click here to read the full post on Forbes.

 

European Review Confirms Increased Risk with Ivabradine Reply

Following a review provoked by troubling findings that emerged from a large clinical trial, the European Medicines Agency (EMA) is making several recommendations intended to lower the risk of heart problems linked to the heart-rate-lowering drug ivabradine. The drug is marketed by Servier in Europe under the brand names of Corlentor and Procoralan and is indicated for the treatment of heart failure and stable angina. The drug is not available in the U.S. but is under development by Amgen for the indication of heart failure.

Click here to read the full post on Forbes.

 

 

 

Intent To Tweet And A Failure Of Communication Reply

For more than 15 years I’ve been trying to figure out how physicians can get involved with social media without devolving into Beliebers. It’s not easy. I often joke that the job is a bit like being the social director on a cruise for people with Asperger’s. But here’s the twist: it’s easy to be the social director on a cruise for sorority sisters and fraternity brothers, but you’re not really going to bring anything to the party that they won’t bring themselves. By contrast, those Asperger’s cruisers, just like many doctors, really need help making good use of social media.

A new study published in the venerable medical journal Circulation is a great example of the problems traditional medicine is having trying to figure out social media….

Click here to read the entire post on Forbes.

 

Losartan No Better Than Atenolol in Marfan’s Syndrome Reply

Beta-blockers have been the standard treatment for people with Marfan’s syndrome, a rare inherited connective tissue disorder that affects about 1 in 5000 people. The goal of treatment is to prevent or slow down the dilation of the aorta and avoid aortic dissection, the main cause of death. In recent years, studies have raised the hope that losartan, an angiotensin receptor blocker, might be more effective than beta-blockers in slowing aortic enlargement.

The Pediatric Heart Network Investigators randomized 608 children and young adults with Marfan’s syndrome to the beta-blocker atenolol or losartan….

Click here to read the full post on Forbes.

 

 

HDL Raising Drugs Probably Won’t Work But This Might 1

A new study offers important new insights into the protective role of HDL cholesterol (the “good” cholesterol) against cardiovascular disease. Earlier studies with drugs that increase HDL levels, including niacin and CETP inhibitors, have not shown benefit. The new study suggests that simply increasing HDL levels isn’t the way to go. Instead, cholesterol efflux, the ability of HDL to remove cholesterol from cells, part of the process called reverse cholesterol transport, appears to be the key. The results were presented today by Anand Rohatgi at the American Heart Association meeting in Chicago and published simultaneously in the New England Journal of Medicine.

The investigators followed 2,416 people participating in the Dallas Heart Study who were free of cardiovascular disease at the start for 9.4 years….

Click here to read the full post on Forbes.