EVEREST II: Catheter-based mitral repair system reaches new peak

The MitraClip catheter-based mitral valve repair system appears to be safer than mitral valve repair surgery at 30 days and as effective at one year. Ted Feldman reported the results of EVEREST II (Endovascular Valve Edge-to-Edge Repair Study ) this morning at the ACC. Feldman concluded his presentation by saying that “the MitraClip procedure is an…

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ACCORD fails to find benefits for fenofibrate or lower blood pressure target

When added to statins, fenofibrate failed to improve outcome in patients with type 2 diabetes. In addition, lowering systolic blood pressure to 120 mm Hg or lower was no better than the traditional target of 140 mm Hg. These are the main results of the two arms of ACCORD (Action to Control Cardiovascular Risk in…

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Mipomersen cuts LDL by 25% in homozygous FH but safety concerns remain

Mipomersen significantly reduced LDL in patients with homozygous familial hypercholesterolemia (FH), but most patients failed to reach the therapeutic target. The results, which also raised questions about the drug’s safety and tolerability, appear online in the Lancet in conjunction with a presentation at the ACC meeting….

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ACC: Duke study links stock market to cardiac events

This press release arrived this morning and I’m guessing it will attract a certain amount of attention in the general media. All the usual caveats about the limitations of a single center pilot observational study should apply, but the concept certainly seems plausible. In any case, here’s the press release….

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Let the games begin…

ACC welcome

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Plavix label gets black box warning about poor metabolizers

The FDA announced today that it had added a boxed warning to the Plavix (clopidogrel) label, warning patients and doctors that the drug may be less effective in people who are unable to metabolize the drug and convert it to its active form. The FDA said that healthcare professionals “should consider use of other anti-platelet…

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Landslide of Lancet papers suggest importance of blood pressure variability

By focusing on blood pressure variability in addition to mean systolic BP a UK researcher may have found an important clue to solving some of the most important lingering mysteries in understanding and treating hypertension. With the extraordinary simultaneous publication of three papers in the Lancet and one in Lancet Neurology, Peter Rothwell has cut to…

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NEJM study finds “low diagnostic yield” for coronary angiography

Only a bit more than one-third of patients without known coronary artery disease (CAD)  are found to have obstructive CAD upon elective catheterization, according to data from the ACC National Cardiovascular Data Registry (NCDR). Manesh Patel and colleagues report in the New England Journal of Medicine on nearly 400,000 patients who underwent elective catheterization. Here are…

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Redberg critical of Obama’s coronary calcium scan

Rita Redberg, in an early release editorial in Archives of Internal Medicine writes that she “was troubled to read” that during his recent physical examination President Obama had received an EBCT coronary calcium scan. Redberg writes: “this screening test likely exposed Mr Obama to significant radiation unnecessarily, increasing his risk of future cancer. A single…

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Calcium scans: do they now come with a warranty?

James Min and colleagues followed 422 patients who had normal (CAC=0) calcium scans and asked the question: “What is the ‘warranty period’ for remaining normal”? The study, along with a provocative editorial by Harvey Hecht,  appears in the March 16 issue of JACC. Following their initial scans, study subjects then received annual calcium scans. Over…

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ADVANCE-2 apixaban study published in Lancet

The ADVANCE-2 study, which was initially presented last summer at the ISTH meeting in Boston, has now been published in the Lancet. The trial randomized 3057 patients undergoing knee replacement surgery for thormboprophylaxis with either apixaban (2.5 mg daily) or subcutaneous enoxaparin (40 mg once daily). The primary composite endpoint, consisting of asymptomatic and symptomatic…

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Guest Post: Sanjay Kaul answers questions about rosiglitazone

Editor’s Note: This post originally appeared on CardioExchange, an online cardiology community in the early stages of development by the New England Journal of Medicine.  In the following piece, CardioExchange editor-in chief Harlan Krumholz and associate editors Anju Nohria and Susan Cheng pose questions about rosiglitazone to Sanjay Kaul, lead author of the recent AHA/ACC science…

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ICD implantation may cause cognitive problems, small study suggests

ICD implantation may cause cognitive problems, according to a small study published in Circulation: Arrhythmia and Electrophysiology as a rapid access report. Researchers in the UK administered neuropsychological tests to 52 patients before ICD implantation and then at 6 weeks, 6 months, and 12 months following the procedure. The researchers found that 31-39% of their subjects…

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Screening young athletes: to ECG or not to ECG?

To ECG or not ECG? That is the question ever since Italian investigators claimed that adding an ECG test to the mandatory routine preparticipation screening of young athletes was feasible and effective in reducing the incidence of sudden cardiac death in young athletes. Now two new studies and an accompanying editorial have appeared in Annals…

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CREST finds carotid stenting broadly equivalent to endarterectomy

Carotid endarterectomy and carotid stenting produced broadly similar results in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), the largest comparison yet of the two procedures. The results were presented in San Antonio this morning at the American Stroke Association’s International Stroke Conference 2010. CREST, which was funded by NINDS and Abbott, randomized 2,502 symptomatic and…

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Carotid endarterectomy beats stenting in first results from ICSS

An interim safety analysis of the ongoing International Carotid Stenting Study (ICSS) offers strong temporary evidence that carotid endarterectomy is preferable to carotid stenting. In a paper appearing in the Lancet, the ICSS investigators report on the incidence of stroke, death, or procedural MI in the 1,713 patients enrolled in the trial. In the carotid…

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Avandia: a plaque on both your houses!

Comment on the News: Avandia continues to dominate cardiovascular-related news this week. Last night the AHA and the ACC issued a highly detailed, thoughtful, though perhaps slightly over-diplomatic science advisory on TZDs and CV risk. Taking a completely opposite tack, GSK, in no mood to take prisoners, and apparently about to nominate itself for a…

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JAMA study questions value of platelet function tests in PCI patients

A Dutch study appearing in JAMA concludes that platelet function testing should not be used to influence clinical practice at this time. Breet and colleagues measured platelet function using 6 different tests in over 1,000 patients taking clopidogrel and undergoing elective PCI….

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More Avandia action: Nissen secretly recorded GSK execs, FDA announces safety review

In 2007 Steve Nissen secretly recorded a meeting with 4 GlaxoSmithKline executives, according to a story by Gardiner Harris in the New York Times. Harris reports that Nissen recently “shared the contents of the recording with The Times.”…

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Study finds increased rate of stent thrombosis in primary PCI patients who get distal protection

Stent thrombosis occurred in 11 of 312 STEMI patients who received distal protection (DP) compared to 4 of 314 patients treated conventionally, according to the 15 month results of DEDICATION (Drug Elution and Distal Protection in ST Elevation Myocardial Infarction Trial) published in JACC. The study also found more target lesion revascularizations (31 vs 18)…

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Senate releases Avandia report, GSK responds to attacks

In the wake of Friday night’s New York Times story on the Avandia controversy (see our summary here), the Senate Finance Committee has posted its 334 page report, as well as a press release and the contents of its letter to FDA Commissioner Margaret Hamburg. GlaxoSmithKline has released its own press release in which the…

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NY Times: FDA and senate reports slam continued availability of Avandia (rosiglitazone)

A US Senate investigation concludes, along with some FDA officials, that Avandia (rosiglitazone) should no longer be on the market, according to a front page story in the New York Times by Gardiner Harris. In reports obtained by Harris, FDA officials David Graham and Kate Gelperin conclude that “rosiglitazone should be removed from the market.”  Harris says the…

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ACCOMPLISH: amlodopine may (or may not) be better than hydrochlorothiazide in combo with benazepril to slow progression of kidney disease

Renal outcomes in the ACCOMPLISH trial appear to favor the combination of benazepril plus amlodipine over the combination of benazepril plus hydrochlorothiazide in helping to slow the progression of chronic kidney disease, according to a new report by Bakris and colleagues appearing online in the Lancet. But an accompanying comment says the result “should be…

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ARTS II at 5 years: what have we learned?

Five year results of the ARTS II trial suggest that SES is better than BMS but not as good as CABG, but conclusions are hard to reach given the limitations of the trial. Recall that ARTS II (Arterial Revascularization Therapies Study II) enrolled 607 patients who received a sirolimus-eluting stent (SES). ARTS II patients were then compared…

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Lancet: large meta-analysis confirms small increase in diabetes with statins

People taking statins have a small but apparently real increased risk of developing diabetes, according to a large new meta-analysis appearing in the Lancet. Sattar and colleagues used data from 13 controlled statin trials with over 91,000 subjects and found a 9% increase in the risk of diabetes over 4 years. The risk of developing…

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