Lifetime exposure to lead linked to increased CV risk Reply

Lifetime cumulative exposure to lead is associated with significant increases in cardiovascular mortality, according to a new study in Circulation.

By measuring lead concentrations in the bone, the researchers, led by Marc Weisskopf, were able to asess long term exposure to lead. People with patella bone lead levels in the highest tertile were more than five times as likely to die of cardiovascular causes as people in the lowest tertile.
Click to continue reading…

About these ads

“Dr Nobody” in JAMA editors flap speaks his mind 1

Jonathan Leo, the “Dr. Nobody” in the JAMA editors flap, has delivered a long and thoughtful response to the entire sorry episode in an article in the journal Society.

Among many issues, Leo discusses the academic freedom concerns raised by the case. (Recall that the JAMA editors initially demanded that Leo– along with any other JAMA letter writers– had no right to publish without permission from the editors.) Here is what Leo has to say:
Click to continue reading…

Are low-carb, high fat diets “fads”? 4

Should low-carb, high fat diets be considered “fad diets”? A Comment by Mann and Nye published in the Lancet simply assumes that these diets don’t have any scientific credibility, but we’ve seen a number of important studies in major publications, including recent trials in the NEJM by Shai et al and in JAMA, by Gardner et al, to suggest that these diets are very far from being dismissed as mere fads. In fact, there’s plenty of evidence to suggest that they should be taken very seriously indeed. (In fact, as any expert will reluctantly concede, there’s almost no good randomized, controlled data to conclusively demonstrate that any diet is better than any other.)
Click to continue reading…

FDA official reviews his own prasugrel review in NEJM 3

Now that prasugrel has finally been approved, EF Unger, one of its chief reviewers at the FDA, is providing insight into the FDA thought process in a perspective in the New England Journal of Medicine. Along the lines of the old TV ad for EF Hutton, when EF Unger speaks, people interested in prasugrel listen. As Unger writes, the “FDA grappled with a number of complex issues during the review process.” Discussing the TRITON-TIMI 38 trial, Unger says that:
Click to continue reading…

ESC: bivalirudin and otamixaban in ACS Reply

Two new ACS trials with the agents bivalirudin and otamixaban were presented today at the ESC and published simultaneously in the Lancet.

In the first trial, one year followup from the HORIZONS-AMI trial, Roxana Mehran and colleagues reported a reduction in the rate of net adverse clinical events and major bleeding in STEMI patients undergoing PCI who received bivalirudin compared to those who received heparin plus a glycoprotein IIb/IIIa inhibitor.
Click to continue reading…

RE-LY at ESC: dabigatran in, warfarin (finally) on the way out? 3

Is the long, unhappy reign of warfarin possibly drawing to a close? The RE-LY trial may have finally identified a candidate, dabigatran, an oral direct thrombin inhibitor that could one day replace warfarin. Unlike warfarin, dabigatran does not require dose adjustments or anticoagulation monitoring.

RE-LY randomized 18,113 AF patients to either one of two fixed doses of dabigatran (110mg or 150 mg twice daily) or warfarin. The results of RE-LY were presented this morning at the ESC and published simultaneously in the New England Journal of Medicine. The RE-LY investigators concluded that “compared with warfarin, the 110-mg dose of dabigatran was associated with similar rates of stroke and systemic embolism and lower rates of major hemorrhage; the 150-mg dose of dabigatran was associated with lower rates of stroke and systemic embolism but with a similar rate of major hemorrhage.”

Click to continue reading…

ARBITER-6 scheduled as AHA Late-Breaker, Kastelein to be discussant 1

ARBITER-6 is scheduled to be presented as a late-breaking clinical trial on Monday, November 16 at 11:07 AM. The discussant for the trial will be John Kastelein. Several knowledgeable observers have pointed out that, as the principal investigator of the highly controversial ENHANCE trial, and as a lecturer and consultant for numerous companies, including Merck and Schering Plough, which has a drug directly involved in the trial, Kastelein is an unusual and potentially controversial choice for the discussant.

Update: Readers may be interested to learn that Kastelein is the co-author of an article, “Surrogate markers in clinical trials– Challenges and opportunities,” in the September 2009 atherosclerosis.
Click to continue reading…

Topol and Teirstein argue about stents on NPR’s All Things Considered 3

To illuminate the topic of how difficult it is “to get doctors to quit ordering unnecessary procedures and tests,” NPR’s radio news show All Things Considered set up a discussion between Eric Topol and Paul Teirstein.

Reporter Chana Joffe-Walt used the two Scripps Health interventional cardiologists– “same specialty, same city, same hospital, very different points of view”– to demonstrate that “what seems unnecessary to some doctors is standard procedure for others.”
Click to continue reading…