Everybody Into The Sauna? 1

Spending more time in the sauna may lead to a longer and healthier life– at least if you live in Finland, according to a new study published in JAMA Internal Medicine.

Finnish researchers analyzed data from the Kuopio Ischemic Heart Disease Risk Factor Study. The new analysis focused on 2,315 middle-aged men who had 1, 2-3, or 4-7 sauna bathing sessions per week. After 20 years of followup the rate of sudden cardiac death, fatal coronary heart disease, fatal cardiovascular disease, and all-cause mortality was significantly reduced in people who used the sauna more often.

Click here to read the full post on Forbes, including comments from Franz Messerli, Harlan Krumholz, and John Ryan…

 

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Medtronic And Boston Scientific Plan To Resume Blood Pressure Trials This Year Reply

Medtronic and Boston Scientific have announced plans to start phase 2 clinical trials this year for their updated renal denervation catheters. The once promising new technology is intended to treat hypertension unresponsive to drug therapy. The failure last year of Medtronic’s Symplicity HTN-3, the first large pivotal trial to rigorously test renal denervation, sent manufacturers back to their drawing boards to redesign the devices.

Click here to read the full post on Forbes.

 

No, The New Cholesterol Drugs From Sanofi And Amgen Aren’t Going To Cost $150 Billion A Year Reply

In an article on the Health Affairs blog 4 CVS executives speculate that the new cholesterol lowering PCSK9 inhibitors from Amgen and Sanofi might achieve yearly sales of $150 billion or even higher. I think these numbers are a bit silly. But first let’s take a look at their extremely bullish case….

Click here to read the full post on Forbes.

 

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More Guideline Controversy: The Tricky Business Of Calculating Cardiovascular Risk Reply

Calculating cardiovascular risk has become a central and highly controversial component of cardiovascular guidelines. Now a study in the Annals of Internal Medicine finds that most of the commonly employed tools seriously overestimate the risk of people today.

Click here to read the full post on Forbes.

Very Simple High-Fiber Diet Stands Up To American Heart Association Diet Reply

Diets notoriously fail to help people lose a lot of weight. One problem is that most diets include a broad range of restrictions and guidelines that many people find difficult to follow. Another problem is that negative recommendations may have unintended consequences, such as low-fat recommendations leading to increased consumption of refined carbohydrates. Now a new study published in the Annals of Internal Medicine indicates that a radically simple diet containing only one positive rule — eat more fiber — might be nearly as effective and much easier to swallow than a more traditional complex diet.

Click here to read the full post on Forbes.

 

Three Trials Show Benefits Of Thrombectomy In Stroke Patients Reply

Three new studies offer important additional evidence that early treatment with current thrombectomy devices that extract clots from blood vessels in the brain can lead to improved outcomes in carefully selected stroke patients. The trials were stopped early based on efficacy following positive findings last year from another trial, MR CLEAN. The three new trials were presented today at the AHA/ASA International Stroke Conference in Nashville; two of the trials were published simultaneously in the New England Journal of Medicine.

Click here to read the full post on Forbes.

 

New US Guidelines Will Lift Limits On Dietary Cholesterol Reply

The influential  Dietary Guidelines Advisory Committee has recommended that limitations on dietary cholesterol be removed from the upcoming 2015 edition of Dietary Guidelines for Americans. Recommendations to reduce dietary cholesterol have been a mainstay of the USDA and other guidelines for many years, starting with guidelines from the American Heart Association in the 1960s.

Click here to read the full post on Forbes.

 

 

Another Study Raises Questions About Blood Pressure Guidelines Reply

Although the general benefits of lowering high blood pressure are widely accepted, there has been intense debate over specific goals for treatment and the threshold at which therapy should be initiated.  A large new meta-analsysis published in JAMA helps shed lights on this important controversy.

UK and Australian researchers analyzed the effect of lowering blood pressure in people with type 2 diabetes using data from more than 100,00 people who participated in 40 trials.

Click here to read the full post on Forbes.

 

New Heart Drug From Novartis: Will It Raise The Risk of Alzheimer’s Disease? Reply

LCZ696 is a heart failure drug from Novartis that many observers think will gain FDA approval later this year and go on to become a blockbuster. Perhaps the biggest obstacle to the drug’s success is the fear that it might raise the risk of Alzheimer’s disease. Now a new article in a top cardiology journal lays out the detailed basis for this concern. The authors do not contend that the Alzheimer’s issue will likely ruin the drug’s chances, but they do maintain that the problem needs to be carefully monitored.

I spoke with Milton Packer, the co-principal investigator of PARADIGM-HF, the mega trial that set off the mega excitement about the drug last year. He offers several persuasive arguments that Alzheimer’s disease won’t be the Achilles’ heel of LCZ696.

But first let’s look at the paper…

Click here to read the full post on Forbes.

 

Novel Device Offers Hope For Heart Patients With No Alternatives Reply

An entirely predictable consequence of medical progress is the growing number of heart patients with persistent and symptomatic angina who have run out of treatment options. A small study published in the New England Journal of Medicine raises the possibility that a new and novel device one day may provide them some relief. The experimental device, called the Neovasc Reducer, is a coronary sinus reducer system. It is delivered through a catheter to the coronary sinus, where it is then expanded with a balloon, blocking flow through most of the vessel except for a small central orifice. Once in place the device causes an increase in coronary sinus pressure that appears to relieve angina, though the authors acknowledge that the “physiological rationale for a beneficial effect… remains unclear.”

Investigators in the Coronary Sinus Reducer for Treatment of Refractory Angina (COSIRA) trial studied 104 patients with angina class III or IV angina who were not considered suitable candidates for revascularization.

Click here to read the full post on Forbes.

 

No, Too Much Jogging Probably Won’t Kill You 1

One again lazy health journalists have fallen down on the job and performed a disservice to the public. The new outrage: a multitude of media reports about a small study on the effect of jogging on mortality. Here are just a few headlines, published minutes after the study was published in the Journal of the American College of Cardiology:

But a careful reading of the paper shows that this small study provides nowhere near enough evidence to support these headlines.

Click here to read the full post on Forbes.

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Study Tests High Blood Pressure Control During Pregnancy Reply

High blood pressure during pregnancy is increasingly common, largely due to older age and obesity. Although there is widespread agreement that hypertension in these women should be treated when it is high enough to raise the risk of stroke, there is little agreement about whether or how to treat mild hypertension.

In a study reported in the New England Journal of Medicine, investigators from Canada reported on 986 hypertensive pregnant women who had diastolic blood pressure of 90 to 105 mm Hg (or, for women already taking a blood pressure drug, 85 to 105 mm Hg). The women were randomized to less tight blood pressure control (target diastolic blood pressure, 100 mm Hg) or tight blood pressure control (target, 85 mm Hg). Three-quarters of the women had hypertension predating their pregnancy.

Click here to read the full post on Forbes.

 

FDA Approves New Heart Pump From Abiomed Reply

Abiomed has announced that it received FDA approval for its Impella RP System, the first percutaneous single access heart pump that provides support to the right side of the heart. The approval, under a Humanitarian Device Exemption (HDE), is based on results of the single arm Recover Right study, in which 30 patients were enrolled. The overall survival rate was 73% at 30 days.

Click here to read the full post on Forbes.

 

 

Califf To Leave Duke To Become FDA Deputy Commissioner Reply

The FDA announced today that Duke University cardiologist Robert Califf will be the next FDA Deputy Commissioner for Medical Products and Tobacco. The agency said that Califf will be responsible for the Center for Drug Evaluation and Research, the Center for Biologics Evaluation and Research, the Center for Devices and Radiological Health and the Center for Tobacco Products.”

Click here to read the full post on Forbes.

 

Sanofi And Regeneron Leapfrog Amgen In New Cholesterol Drug Race Reply

Early on Monday Sanofi and Regeneron leapfrogged their rival Amgen to gain leadership in the race to bring a new class of cholesterol drugs to market. The new development could potentially give Sanofi and Regeneron a month on the market by itself before facing competition from Amgen.

Sanofi and Regeneron announced early on Monday that the FDA had accepted for priority review the Biologics License Application (BLA) for alirocumab, their PCSK9 inhibitor…

Click here to read the full post on Forbes.

 

Salt, Science, And The American Heart Association’s Double Standard Reply

Once again the American Heart Association is sticking by its recommendation that pretty much everyone should consume no more than 1,500 milligrams of sodium each day. This is dramatically lower than the 3,500 mg/d the average American now consumes. In a blog post reprinted on MedPage Today the president of the American Heart Association,  Elliott Antman, assails a study published earlier this week which found no benefits– and even a hint of harm–  for elderly people with low sodium consumption.

But Antman only tells one side of the story.

Click here to read the full post on Forbes.

 

New Device to Lower Resistant High Blood Pressure Shows Early Promise 1

A novel implantable device appears to show early promise in the treatment of resistant hypertension. The “Coupler” device from privatelyheld ROX Medical is about the size of a paper clip and is delivered via a catheter to the upper thigh, where it creates a connection between the vein and the artery, which lowers blood pressure in the arteries by letting some of the blood drain off into the veins.

In a paper published in the Lancet, European investigators report the results of an open-label trial in in which 83 patients with persistent high blood pressure despite taking multiple antihypertensive drugs were randomized to implantation of the Coupler device or current treatment…

Click here to read the full post on Forbes, including comments from Franz Messerli, Sripal Bangalore, and Deepak Bhatt.

 

Why Doctors, Like Airline Pilots, Should Not Be Completely Trusted.  Reply

I would never get on an airplane if I didn’t feel highly confident that the pilot was fully competent. In order to fly a commercial airplane a pilot has to  undergo rigorous and continuous training and testing. I’d walk before flying with a pilot whose only credential was his assurance that he’d been diligently “keeping up with his field” and that he was extremely confident in his abilities. I’m glad to know that the FAA and the airlines have extremely demanding programs to ensure the competency of pilots.

I would trust 99% of pilots to remain competent on their own. But when it comes to flying 99%” isn’t good enough. We need to know, within the bounds of what is reasonable, that all pilots are competent. Unfortunately, because of the few bad ones, the remaining 99% have to undergo all the rigorous training and tests.

Doctors are like pilots: what they do is far too important to let them individually decide for themselves whether they are competent, or how they should demonstrate their competency. Just because the vast majority of pilots and doctors are competent doesn’t mean that we should loosen our standards.

This topic is important now because of a current red-hot debate over what physicians have to do during their career to maintain their certification– called maintenance of certification, or MOC…

Click here to read the full post on Forbes.

 

Intense Exercise Doesn’t Eliminate the Hazard of Intense Sitting Reply

James Brown had it right. There may be no better medical advice these days than to “Get Up Offa That Thing.

A large new analysis published in Annals of Internal Medicine supports earlier observations that the health hazards of sedentary behavior aren’t completely neutralized by exercise.

Researchers in Toronto scoured the literature to find studies that assessed the health effects of sedentary behavior adjusted for physical activity. They found 47 studies, including 13 that assessed all-cause mortality, 14 that assessed cardiovascular disease and diabetes, and 14 that assessed cancer. Sedentary behavior was defined as “waking behaviors characterized by little physical movement and low-energy expenditure,” including sitting and television watching.

Click here to read the full post on Forbes.

 

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How Much Salt Should Old People Consume? Reply

A new study offers fresh evidence that current salt recommendations should be taken with, well, a grain of salt. Current guidelines now recommend that everyone should have sodium intake levels below 2300 mg per day. For many people at higher risk, including everyone over 50 years of age, sodium intake should be below 1500 mg/d. (The American Heart Association promotes the more rigorous goal of 1500 mg/d for everyone.) But a 2013 report from the Institute of Medicine, along with findings from the PURE study published last year, have raised concerns that the lower target level in particular is neither practical nor beneficial.

The new study, published in JAMA Internal Medicine, looks at the growing and important elderly patient population…

Click here to read the full post on Forbes.

 

 

Buried Clinical Trial Data: The Dam Is About to Burst Reply

Two important new developments may mean that many more researchers will soon be able to access and analyze data from many more clinical trials.

… a preliminary report from the prestigious Institute of Medicine lends strong support to the open data movement. The IOM report states that investigators should be required to establish a data-sharing plan at the same time the trial is registered. The report includes detailed recommendations for when and how the data should be made available. Among the major recommendations: data underlying a trial analysis should be made available within 6 months after journal publication, and all data should be made available no later than 18 months after the last patient visit in the trial.

… the Yale University Open Data Access (YODA) Project announced that Johnson & Johnson is expanding its plans to share data.

Click here to read the full post on Forbes.

 

AstraZeneca Drug Improves Outcomes After Heart Attacks Reply

For the first time a very large trial has shown that dual antiplatelet therapy (DAPT) improves cardiovascular outcomes when given to patients one to three years after a heart attack. Because it has been shown previously to reduce the high risk of recurrent events for up to a year following a heart attack, DAPT is considered to be standard therapy during this time period. But whether or not longer term treatment after a year would be also beneficial has been controversial.

AstraZeneca  today announced that the Pegasus-TIMI 54 study had successfully reached its primary endpoint.

Click here to read the full post on Forbes.

 

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.