More Guideline Controversy: Blood Pressure Expert Decries ‘Political Correctness’ Reply

Now add “political correctness” to the long list of criticisms directed against the recent publication of new and updated cardiovascular guidelines. One leading hypertension expert writes that the authors of the recent AHA/ACC/CDC Science Advisory on blood pressure control were chosen not for their expertise but for political expediency.

Click here to read the full post on Forbes.

Confusion
Confusion (Photo credit: quinn.anya)
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Missing High Blood Pressure Guideline Turns Up In JAMA Reply

After  years of delay and many twists and turns, the hypertension guideline originally commissioned by the NIH has now finally been published in JAMA. The evidence-based document contains a major revision of hypertension treatment targets and includes new and somewhat simplified recommendations for drug treatment.

The previous US hypertension guideline was published more than a decade ago. After many delays the new guideline was ready for publication earlier this year, but then the NIH decided to get out of the guidelines business. The American Heart Association and the American College of Cardiology assumed responsibility for the development and publication of cardiovascular guidelines and last month published four new cardiovascular guidelines, with the notable exception of the hypertension guideline. As an accompanying JAMA editorial explains:  “Rather than go through an additional review process with the AHA and the ACC the authors decided to publish their guideline in JAMA on their own.”

The big headline of the new guideline is an important change in treatment targets.

Click here to read the full story on Forbes.

Original illustration by Max Husten

Original illustration by Max Husten

Slouching Toward Phase 3: Progress Report On New Cholesterol Drugs At The AHA Reply

The American Heart Association meeting in Dallas this year brought new phase 2 data about several promising new cholesterol drugs. But before jumping on any bandwagons it would be good to remember that even for the drugs most far along in development we still haven’t seen any phase 3 data. In addition, it bears repeating that the FDA may well be raising the entry bar for new cholesterol medications. As I wrote not too long ago, there is a good chance that the FDA will require completed outcomes studies for new cholesterol drugs. There’s good reason to be interested in these drugs but any predictions at this point would be hopelessly speculative.

One Year Results For Amgen’s PCSK-9 Inhibitor 

HDL Drug From CSL Limited

Esperion’s Novel Agent

Click here to read the full story on Forbes.

TACT Substudy Suggests Possible Strong Benefit for Chelation in Diabetics Reply

One year ago the results of the TACT trial were published in JAMA, sparking an enormous controversy over the propriety of publishing a trial suggesting that chelation therapy might be beneficial in people with cardiovascular disease. Chelation therapy has long been a staple of alternative medicine, but until the publication of TACT it had received no credit whatsoever in mainstream medicine. TACT was supported by the NIH as part of an initiaitve to test the scientific basis of alternative medical therapies.

The JAMA paper reported positive results for the prespecified subgroup of patients who had diabetes at the start of the trial. Now a new paper, presented at the American Heart Association Scientific Sessions and published online in Circulation: Cardiovascular Quality and Outcomes, focuses on this important subgroup, and provides even stronger evidence for a possible benefit for chelation in patients with diabetes. The authors speculate that ethylene diamine tetra-acetic acid (EDTA) chelation might have an effect on metal-catalyzed oxidation reactions in the development of advanced glycation end-products, which appear to play a central role in diabetic complications.

The primary endpoint of the main trial – the composite of death, MI, stroke, coronary revascularization, or hospitalization for angina – was significantly lowered from 30% in the placebo group to 26% in the chelation group (HR 0.82, 0.69-0.99, p=0.035).

Click here to read the full post on Forbes.

 

No Value For Renal-Artery Stenting In CORAL Reply

Previous small studies have failed to find any benefit associated with renal-artery stenting, but the trials have been small and were not powered for clinical outcomes. Now, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trial, presented at the American Heart Association meeting and published simultaneously in the New England Journal of Medicine, offers strong and persuasive evidence that renal-artery stenting is not beneficial.

A total of 947 patients with renal-artery stenosis and either systolic hypertension, despite taking two or more antihypertensive agents, or chronic kidney disease were randomized to medical therapy plus stenting or medical therapy alone. There were no significant differences after 43 months in the primary composite endpoint of cardiovascular and renal events (death from cardiovascular or renal causes, MI, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy):

Click here to read the full post on Forbes.

 

Controversy Erupts Over Accuracy Of Cardiovascular Risk Calculator For Guidelines Reply

In the face of a highly critical story in the New York Times by Gina Kolata about the new cardiovascular guidelines, authors of the guidelines and leaders of the American Heart Association and the American College of Cardiology defended the value and integrity of the guidelines.

The Times story claims that the cardiovascular risk calculator used to assess individual risk in the new guidelines is deeply flawed. “In a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.” The story quotes former ACC president Steve Nissen: “It’s stunning. We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

But the guideline authors and AHA/ACC officials strenuously defended the guideline at a news conference Monday morning at the American Heart Association meeting in Dallas. They said  the new risk calculator is far superior to previous efforts, incorporating far more data that now includes stroke assessment and for the first time provides specific predictions for African Americans.

The assembled officials rejected any call to delay implantation of the guidelines, but one author, Donald Lloyd-Jones said that “over time we will modify the risk scores so that they get better and better.”

“We think we’ve done our due diligence,” said AHA president Mariell Jessup. “We have faith and trust in the people who developed the guidelines.”

Click here to read the full story on Forbes.

 

Press Conference

The Fate Of New Cholesterol Drugs Depends On IMPROVE-IT Reply

Prospects for the highly anticipated new class of cholesterol-lowering drugs, the PCSK9 inhibitors, took a wild roller coaster ride this week. The publication of new lipid guidelines by the American Heart Association and the American College of Cardiology led many observers to think that the promising new drugs under development by Regeneron (in partnership with Sanofi), Amgen, and Pfizer might suffer significant delays.

The guidelines delivered a strong statement questioning the increasingly controversial theory that LDL lowering by itself is beneficial. “We found that non-statin therapies really didn’t provide an acceptable risk reduction benefit compared to their potential for adverse effects in the routine prevention of heart attack and stroke,” said the co-chair of the guideline. This led many observers to think that the FDA would likely require the developers of PCSK9 inhibitors to complete cardiovascular outcome trials before getting US approval. This decision would delay approval for several years.

Then, on Thursday, the companies developing PCSK9 inhibitors received some apparent good news. Bloomberg News reported that an FDA official said that the drugs “will only have to meet the U.S. Food and Drug Administration’s existing standards for clearance, including whether they cut cholesterol and reduce blood pressure or inflammation.”

But then the FDA added one other very important caveat. Here’s how they phrased it to me:

Click here to read the full post on Forbes.

 

After Long Wait, Updated US Cardiovascular Guidelines Now Emphasize Risk Instead Of Targets 1

Updated cardiovascular health guidelines were released today by  the American Heart Association (AHA) and the American College of Cardiology (ACC). The guidelines are designed to provide primary care physicians with evidence-based expert guidance on cholesterol, obesity, risk assessment, and healthy lifestyle.

The new guidelines reinforce many of the same messages from previous guidelines, but also represent a sharp change in philosophy. That change is most evident in the new lipid guidelines, in which the focus has shifted away from setting numerical targets for cholesterol levels in favor of treatment decisions based on individual risk status.

“This guideline represents a departure from previous guidelines because it doesn’t focus on specific target levels of low-density lipoprotein cholesterol, commonly known as LDL, or ‘bad cholesterol,’ although the definition of optimal LDL cholesterol has not changed,” said Neil J. Stone, chair of the lipid expert panel that wrote the new guideline. “Instead, it focuses on defining groups for whom LDL lowering is proven to be most beneficial.”

The long-awaited and often controversial guidelines are the successors to the extremely influential NHLBI guidelines, including the Adult Treatment Panel (ATP) series of guidelines that brought cholesterol to the consciousness of millions of people. Earlier this year the NHLBI announced that it would no longer issue guidelines but would, instead, provide support for guidelines produced by other organizations. Following the NHLBI announcement, the AHA and the ACC said that they would take over publication of the guidelines.

Statins Indicated for Four Broad Groups

Click here to read the full post on Forbes.

Guideline Maze

Original illustration by Max Husten

 

American Heart Association Announces Late-Breaking Clinical Trials Reply

AHA 2013 logoThere are still a few days left in August and the European Society of Cardiology meeting doesn’t start until this weekend in Amsterdam. Nevertheless, the American Heart Association has released the list of late-breaking clinical trials for the annual meeting in November.

Late-Breaking Clinical Trials 1: Acute Cardiovascular and Cerebrovascular Care

  • Sunday, Nov 17, 2013, 4:00 PM – 5:19 PM

Moderators:

  • Lance Becker, Philadelphia, PA
  • Stephen Bernard, Melbourne, Australia

4:00 PM: Nitrites in Acute Myocardial Infarction

  • Nishat Siddiqi, Univ of Aberdeen, Aberdeen, United Kingdom
  • Discussant: Kenneth Bloch, Boston, MA

4:13 PM: Blood Pressure Reduction Among Acute Ischemic Stroke Patients: A Randomized Controlled Clinical Trial

  • Jiang He, Tulane Univ, New Orleans, LA
  • Discussant: Cathy A Sila, Cleveland, OH

4:35 PM: Randomized Clinical Trial of Pre-hospital Induction of Mild Hypothermia in Out-of-Hospital Cardiac Arrest Patients Using a Rapid Infusion of 4oC Normal Saline

  • Francis Kim, Univ of Washington, Seattle, WA
  •  Discussant: Maaret Castrén, Stockholm, Sweden

4:57 PM: Target Temperature Management 33°C versus 36°C after Out-of-hospital Cardiac Arrest, a Randomized, Parallel Group, Assessor Blinded Clinical Trial

  • Niklas Nielsen, Helsingborg Hosp, Lund Univ, Helsingborg, Sweden
  •  Discussant: Benjamin S Abella, Philadelphia, PA

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Late-Breaking Clinical Trials 2: Prevention: From Schools to Countries

  • Monday, Nov 18, 2013, 9:00 AM -10:28 AM

Moderators:

  • Donna K Arnett, Birmingham, AL
  • Lynne Braun, Chicago, IL

9:00 AM: Promotion of Cardiovascular Health in Preschool Children: 36-month Cohort Follow-up

  • Jaime Céspedes, Fundación CardioInfantil Insto de Cardiología, Bogotá, Colombia
  • Discussant: Gerard R Martin, Washington, DC

9:22 AM: Randomized Trial of Social Network Lifestyle Intervention for Obesity: MICROCLINIC Intervention Results and 16-Month Followup

  • Eric L Ding, Harvard Sch of Public Health, Boston, MA
  • Discussant: Lawrence J Appel, Baltimore, MD

9:44 AM:  Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures (Medication Study) After Acute Coronary Syndrome Hospital Discharge

Michael Ho, VA Eastern Colorado Health Care System, Denver, CO

Discussant: Nancy Albert, Cleveland, OH

10:06 AM: China Rural Health Initiative – Sodium Reduction Study: the Effects of a Community-Based Sodium Reduction Program on 24hr Urinary Sodium and Blood Pressure in Rural China

  • Nicole Li, The George Inst for Global Health, Sydney, Australia

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Late-Breaking Clinical Trials 3: Medical and Surgical Approaches to Improving Heart Failure Outcomes

  • Monday, Nov 18, 2013, 10:45 AM -12:13 PM

Moderators:

  • Frederick A Masoudi, Aurora, CO
  • Adrian F Hernandez, Durham, NC

10:45 AM: Atrial Antitachycardia Pacing and Managed Ventricular Pacing Reduce the Endpoint Composed by Death, Cardiovascular Hospitalizations and Permanent Atrial Fibrillation Compared to Conventional Dual Chamber Pacing in Bradycardia Patients: Results of the Minerva Randomized Study

  • Giuseppe Boriani, Univ of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Bologna, Italy
  • Discussant: Anthony Tang, Victoria, BC, Canada

11:07 AM: Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE AHF) Trial

  • Horng H Chen, MAYO Clinic, Rochester, MN
  • Discussant: Marco Metra, Brescia, Italy

11:29 AM: Severe Ischemic Mitral Regurgitation: Is it Better to Repair or Replace the Valve?

  • Michael A Acker, Hosp of the Univ of Pennsylvania, Philadelphia, PA
  • Discussant: Timothy J Gardner, Newark, DE

11:51 AM: Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT)

  • Marc A. Pfeffer, Brigham & Women’s Hosp, Harvard, Boston, MA
  • Discussant: Margaret M Redfield, Rochester, MN

.

Late-Breaking Clinical Trials 4: Therapeutic Advances in Coronary and Peripheral Vascular Disease.

  • Monday, Nov 18, 2013, 3:45 PM – 5:13 PM

Moderators:

  • John G Harold, Washington, DC
  • Mark A Creager, Boston, MA

3:45 PM: One Year Mortality in STEMI Patients Randomized to Primary PCI or a Pharmaco-invasive Strategy. The Stream 1 Year Follow-up

  • Peter Sinnaeve, Univ of Leuven, Leuven, Belgium
  • Discussant: Harold Dauerman, Burlington, VT

4:07 PM: Secretory Phospholipase A2 Inhibition with Varespladib and Cardiovascular Events in Patients with an Acute Coronary Syndrome: Results of the VISTA-16 Study

  • Stephen Nicholls, South Australian Health and Medical Res Inst, Adelaide, Australia
  • Discussant: Philippe Gabriel Steg, Paris, France

4:29 PM: Randomized Comparison of Endovascular Revascularization Plus Supervised Exercise Therapy Versus Supervised Exercise Therapy Only in Patients With Peripheral Artery Disease and Intermittent Claudication: Results of the Endovascular Revascularization and Supervised Exercise (ERASE) Trial

  • Farzin Fakhry, Erasmus MC, Rotterdam, Netherlands
  • Discussant: Mary McDermott, Chicago, IL

4:51 PM: A Randomized Multicenter Clinical Trial of Renal Artery Stenting in Preventing Cardiovascular and Renal Events: Results of the CORAL Study

  • Christopher J Cooper, Univ of Toledo, Toledo, OH
  • Discussant: Thomas Zeller, Bad Krozingen, Germany
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Late-Breaking Clinical Trials 5: New Strategies for Atrial Fibrillation Patients: Rhythm and Thrombosis

  • Tuesday, Nov 19, 2013, 10:45 AM -12:03 PM

Moderators:

  • Augustus O Grant, Durham, NC
  • Keith A Fox, Edinburgh, United Kingdom

10:45 AM: RADAR-AF Trial. A Randomized Multicenter Comparison of Radiofrequency Catheter Ablation of Drivers versus Circumferential Pulmonary Vein Isolation in Patients with Atrial Fibrillation

  • Felipe Atienza, Hosp Gregorio Maranon, Madrid, Spain
  • Discussant: Mark Link, Boston, MA

11:07 AM: A Randomized Trial Comparing Genotype-Guided Dosing of Warfarin to Standard Dosing: The EU Pharmacogenetics of Anticoagulant Therapy (EU-PACT) Warfarin Study

  • Munir Pirmohamed, Univ of Liverpool, Liverpool, United Kingdom

11:17 AM: The Clarification of Optimal Anticoagulation through Genetics (COAG) Trial

  • Stephen E. Kimmel, Univ PA Sch of Med, Philadelphia, PA

11:27 AM: Discussant of EU-PACT Warfarin Study and COAG Trial: Patrick T. Ellinor, Boston, MA

11:41 AM: ENGAGE AF-TIMI 48 Primary Results

  • Robert P Giugliano, Brigham and Women’s Hosp, Boston, MA
  • Discussant: Elaine Hylek, Boston, MA

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Observational Study Lends Support to CRT Guidelines Reply

A large observational study published in JAMA suggests that patients with left bundle-branch block (LBBB) and longer QRS duration derive the most benefit from a cardiac resynchronization therapy defibrillator (CRT-D). The findings appear to support current, but often criticized, guidelines from the American College of Cardiology, American Heart Association, and the Heart Rhythm Society, in which a class I recommendation is restricted to patients with LBBB and QRS duration of 150 ms or greater.

Click here to read the full post on Forbes.

 

 

 

The Guidelines Are Dead. Long Live The Guidelines. Reply

Following last month’s surprising announcement that the National Heart, Lung, and Blood Institute would no longer issue guidelines, leaders of the American Heart Association and the American College of Cardiology have now announced that are “officially assuming the joint governance, management and public distribution” of the enormously influential cardiovascular prevention guidelines, including the much-delayed and much-anticipated hypertension and cholesterol guidelines (formerly known as JNC 8 and ATP IV). The ACC and AHA will also assume responsibility for guidelines on cardiovascular risk assessment, cardiovascular lifestyle interventions and obesity.

In an editorial published in Circulation and the Journal of the American College of Cardiology, leaders of the NHLBI, AHA, and ACC provide a little more information on how the new model will work. One important announcement, that “all chairs and members of the current writing panels have been invited to continue to work together with the ACC and AHA to finalize the guidelines,” might indicate that the hypertension and cholesterol guidelines could see the light of day in the not-too-far-distant future. In June the NHLBI’s Michael Lauer expressed confidence that these guidelines would appear in less than a year, but the AHA said that no timeline had yet been established.

Click here to read the full story on Forbes.

English: sm team guidelines logo

Sex And The Cardiac Patient Should Not Be A Taboo Subject 3

It’s not an easy conversation to have. After a heart attack or other major cardiac event, talking about sex is awkward, and often avoided by patients, their partners, and physicians. But a new consensus statement from several major cardiology organizations urges physicians to get over their reluctance or embarrassment and counsel their cardiac patients about this important, but often neglected, aspect of their lives.

After a patient has a heart attack, stroke, cardiac surgery, cardiac device implantation, or is newly diagnosed with a cardiovascular condition, physicians and other healthcare professionals should provide individually tailored information and advice about a wide variety of issues relating to sexual activity, according to the consensus document developed by the American Heart Association (AHA) and the European Society of Cardiology and published in Circulation and the European Heart Journal. The advice “should address topics such as when to resume sex, specific methods and recommended positions, and the role of intimacy without sex,” said the American Heart Association in a press release.

The statement cites numerous concerns, both psychological and physiological, that patients may have after a coronary event, including “general anxiety, fear of having another MI, feeling unwanted by their partner or not good enough, changes in self-perceptions, inadequate knowledge regarding the impact of heart medications, and finally, partner concerns.”

Click here to read the full story on Forbes.

 

 

Cardiology Goes Better With Coke 3

Diet Coke - get cancer, not fat

At the bottom of this post I’ve reprinted an email cardiologists are receiving from the American College of Cardiology. See the bottom of the message for the disclosure that Coca Cola is paying for this educational program. I don’t have much to say about this though I wonder what the faculty of this program will say about the role of sugared soda and obesity. I also wonder what position the ACC will take on public health efforts to curb sugar consumption.

There’s no reason to be surprised about this. Last year the president of the ACC was one of 22 participants chosen by the Coca-Cola Company to carry the Olympic Flame. And the ACC is far from the only mainstream medical organization to take money from Big Sugar. Coke pays a lot of money to the National Heart Lung and Blood Institute to put a red dress logo on the Diet Coke label and the American Heart Association has struck deals with, among others, Cheetos and Subway.

See Yoni Freedhoff’s Weighty Matters blog for much more about Coca Cola’s efforts to influence medical organizations.

Here’s the ACC email:

The American College of Cardiology is teaming up with the Preventive Cardiovascular Nurses Association (PCNA) to offer Never Too Early, Never Too Late: Cardiovascular Health for Women Throughout the Lifespan, an educational webinar, on Wednesday, August 14th from 1:00 p.m. – 2:00 p.m. EDT. This complimentary webinaroffers a comprehensive view of women’s cardiovascular health as they age. Our expert faculty, Jo-Ann Eastwood, PhD, RN, CCNS, ANCP-BC and Martha Gulati, MD, MS, FACC, will provide perspectives on clinical encounters during the childbearing years, perimenopausal period and in later life, while presenting opportunities to focus on, when indicated, cardiovascular disease (CVD) risk reduction, and the session will be moderated by JoAnne Foody, MD, FACC. During this webinar, the educators will encourage clinicians to seek and seize opportunities to discuss optimal cardiovascular management with their women patients in clinical practice settings, and as equally important, to champion them with their colleagues in the primary care and women’s health fields.Webinar highlights include:

  • A look at how gestational diabetes, pregnancy-associated hypertension and preeclampsia predict future CVD risk
  • Exploration into the prevalence of hypertension in women vs. men throughout the lifespan
  • Why gender differences matter with regard to tobacco use and cessation
  • The impact of women’s physical activity level on cardiovascular risk
  • Examples of successful cardiovascular health improvement programs targeted to women in a variety of age cohorts
  • One hour of CME, CNE and RD credit

Click here for additional registration, accreditation and faculty information for this complimentary educational course, Never Too Early, Never Too Late: Cardiovascular Health for Women Throughout the Lifespan. We hope you will join us on August 14th from 1:00 p.m. – 2:00 p.m. EDT!

This course is being presented by the American College of Cardiology and the Preventive Cardiovascular Nurses Association (PCNA) through an educational grant from

Hypertension And Cholesterol Guidelines Delayed Again As NHLBI Gets Out Of The Guidelines Business Reply

The National Heart, Lung, and Blood Institute (NHLBI) will no longer issue guidelines, including the much-delayed and much-anticipated hypertension (JNC 8) and cholesterol (ATP IV) guidelines. Instead, the NHLBI will perform systematic evidence reviews that other organizations, including the American Heart Association and the American College of Cardiology, will use as a resource for their own guidelines.

The exact fate and form of the delayed hypertension and cholesterol guidelines has not yet been decided, though the NHLBI’s Michael Lauer said he was confident that these guidelines would appear in less than a year. But a lot of work remains before the documents can be published. ACC President John Harold said that  “the ACC has not formally agreed to or begun the process of updating” the NHLBI documents, “but we are open to this role and look forward to working out details with NHLBI and the American Heart Association.”

Click here to read the full story on Forbes.

 

NHLBI Director Dr. Gary Gibbons

NHLBI Director Dr. Gary Gibbons

Dramatic Increase in Use of Radial Artery Access for PCI in the U.S. Reply

In the last six years interventional cardiologists have dramatically increased their use of radial access for PCI, according to a retrospective study published in Circulation. Using data from the CathPCI registry on more than 2.8 million procedures between January 2007 and September 2012, Dmitriy Feldman and colleagues found that radial access PCI increased 13-fold, from a negligible 1.2% at the beginning of the study to 16.1% at the end.

Click here to read the full story in Forbes.

 

Infographic from the American Heart Association

Salt Report From IOM Sparks Much Heat, Only A Little Light Reply

An Institute of Medicine report on salt earlier this week sparked a lot of controversy. The report concludes that there’s no evidence to support current efforts to lower salt consumption to less than 2,300 mg/day. Unfortunately, the press coverage offered little insight into the science behind the issue. On the Knight Science Journalism Tracker blog, Faye Flam deftly uncovers the almost universal shallow coverage in the media.

The one exception, the one story worth reading that “dug into the science,” according to Flam, is Gina Kolata’s story in the New York Times:

Click here to read the full post on Forbes.

 

English: A close up of salt crystals.

The Mediterranean Diet: The New Gold Standard? 1

Earlier today I summarized the important new PREDIMED study published in the New England Journal of Medicine showing the cardiovascular benefits of the Mediterranean diet. This study– a rare and much welcome instance of a large randomized controlled study of a diet powered to reach conclusions about important cardiovascular endpoints– has been widely praised and will undoubtedly have a major effect in the field of nutrition and will influence lots of people to adopt some form of a Mediterranean diet.

The study’s major potential weakness appears to be that the control group didn’t get a fair chance.

Dean Ornish, probably the best-known and most passionate advocate of low-fat diets, goes much further in attacking the credibility of the trial…

The really great thing about the Mediterranean diet, by contrast, is that we know with 100% certainty that it is possible for people to live and eat this way, since they’ve been doing so for millennia. It’s true, though, that the new study didn’t really demonstrate that the Mediterranean diet is better than a true low-fat diet. But it did demonstrate that a Mediterranean diet is healthier than what most people are currently eating. So it’s a good example of a real world trial.

…Now that the Spanish PREDIMED study has been published, I think it must be considered the gold standard. Now it is up to the AHA, and Ornish, to prove that their diets are better than, or even as good as, the Mediterranean diet.

Click here to read the complete story on Forbes.

olive oil and almonds copy

Back To The Future: Resurrected Data From 1960s Trial Might Impact Contemporary Dietary Fat Debate 2

In an exceedingly strange turn of events, data from a clinical trial dating from the 1960s, long thought to be lost, has now been resurrected and may contribute important new information to the very contemporary controversy over recommendations about dietary fat composition.

The American Heart Association has long urged people to increase their consumption of polyunsaturated fatty acids (PUFAs), including omega 6 PUFAs, and reduce their consumption of  saturated fatty acids. The recommendations are based on the simple observation that PUFAs lower total and LDL cholesterol while SFAs have the opposite effect. However, the cardiovascular effects of substituting PUFAs for SFAs have never been tested in randomized, well-controlled clinical trials, and a growing proportion of experts now suspect that simple changes in total cholesterol and LDL cholesterol may not tell the whole story.

One trial that actually tested the hypothesis was the Sydney Diet Heart Study, which ran from 1966 through 1973. In the trial, 458 men with coronary disease were randomized to a diet rich in linoleic acid (the predominant omega 6 PUFA in most diets) or their usual diet. Although total cholesterol was reduced by 13% in the treatment group during the study, all-cause mortality was higher in the linoleic acid group than in the control group. However, in the original publications, and consistent with the practice at the time, deaths from cardiovascular (CVD) and coronary heart disease (CHD) deaths were not published.

Now, in a new paper published in BMJ, Christopher Ramsden and colleagues report that they were able to recover and analyze data from the original magnetic tape of the Sydney Diet Heart Study. The new mortality findings are consistent:

Click here to read the full story on Forbes.

Delorean DMC-12

Large Meta-Analysis Finds No Harm Associated With Eggs 2

No food has had more ups and downs over the last century or so than the common egg. Following a long period in which eggs were ubiquitous and highly regarded, eggs fell from favor with the rise of concerns over cholesterol. Currently the American Heart Association recommends that people restrict dietary cholesterol to 300 mg per day, which effectively limits people to 1 egg per day at most. However, the relationship of dietary cholesterol and serum cholesterol  is, at best, tenuous, and a significant number of experts now believe that egg consumption poses no risk to cardiovascular health.

In a new paper published in BMJ, a group of researchers from China and Boston performed a meta-analysis of 8 studies that included 263 938 participants for coronary heart disease (CHD) and 210 404 participants for stroke and followed them for 8 to 22 years. The authors found no evidence for an association between egg consumption and either coronary heart disease or stroke…

Click here to read the full story on Forbes.

American Heart Association Lists Top 10 Research Advances Reply

The AHA has published its annual list of the top 10 advances in heart disease and stroke research. It’s probably worth remarking that not a single item on the list is related to drug therapy. I haven’t gone back and checked past lists, but I would bet this hasn’t happened before.

Here’s the list:

  1. Extended CPR saves lives
  2. Converting “non beating” heart cells into “beating” heart cells
  3. Biopsied heart cells improved heart function and reduced scars
  4. “Disconnecting” the kidneys might be the key to treating high blood pressure
  5. Progress for children in transplant bridging and Kawasaki Disease
  6. Why children and adolescents should “just say no” to sugary drinks
  7. Global impact: ECHO screening for rheumatic heart disease
  8. Devices for stroke
  9. Ideal cardiovascular health practices lead to longer life, lower risk
  10. Bypass surgery vs. drug-coated stents for diabetes patients

Click here to read the full AHA press release. with full explanations and citations…

State Of The Heart: AHA Publishes Year-End Statistical Update Reply

Although deaths from cardiovascular disease have been declining for many years, continued progress is threatened by disturbing trends in US lifestyles. That’s the clear message from the American Heart Association’s year-end report, “Heart Disease and Stroke Statistical Update 2013,” published in Circulation.

“Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop,” said Dr. Alan S. Go, the chairman of the report’s writing committee, in an AHA press release. “If not, we’ll quickly lose the momentum we’ve gained in reducing heart attack and stroke rates and improving survival over the last few decades.”

Here are some of the key statistics contained in the hefty report:

“The Epidemic of Poor Health Behaviors”

  • Among adults, 21.2% of men and 17.5% of women continued to smoke cigarettes. 18.1% of high school students are smokers.
  • Among high school students, 17.7% of girls and 10.0% of boys reported they had less than one hour of moderate-to-vigorous exercise.
  • Thirty-three percent of adults reported engaging in no aerobic leisure-time physical activity.
  • From 1971 to 2004, calorie intake increased from 1542 to 1886 kcal/d (22%) in women and from 2,450 to 2,693 kcal/d (10%) in men. Most of the change is due to an increased consumtpion of starches, refined grains, and sugars.
  • 68.2% of adults are overweight or obese. 34.6% are obese.
  • 31.8% of children 2-19 years of age are overweight or obese. 16.9% are obese.

“Prevalence and Control of Health Factors and Risks Remains an Issue for Many Americans”

  • 13.8% of US adults have serum serum cholesterol levels ≥240 mg/dL.
  • 33.0% of US adults have hypertension. About 82% are aware of their condition, 75% receive antihypertensive therapy, but only a little more than half (53%) have achieved target blood pressure levels.
  • 8.3% of US adults have been diagnosed with diabetes. 38.2% have abnormal fasting glucose levels (prediabetes).

CV Disease and Mortality

  • Although the percentage of deaths attributable to CV disease has been declining for decades, in 2009 CV disease  was responsible for nearly one-third (32.3%) of all deaths in the US.
  • About 635,000 people have a first MI or CHD death each year. About 280,000 have a second MI.
  • About 795,000 people have a new or recurrent stroke each year.
  • The 2009 total direct and indirect estimated cost of CVD and stroke:  $312.6 billion.
  • The 2008 total direct and indirect estimated cost of all cancer and benign neoplasms: $228 billion

Click here to read the AHA press release:

Walking With the American Heart Association: Valerie Bertinelli and Chester Cheetah 1

A few weeks ago Chester Cheetah, the official mascot for Frito Lay’s Cheetos, played an official part in  the American Heart Association’s Dallas Heart Walk. Yoni Freedhoff, on his Weighty Matters blogpretty much says what needs to be said about this disgraceful association between Frito Lay and the AHA.

This weekend I received a press kit from Jenny Craig. The diet company was publicizing the participation of  tabloid celebrity Valerie Bertinelli, a Jenny Craig “brand ambassador,”  in the AHA’s Los Angeles Heart Walk on Saturday. At first glance, Jenny Craig’s relationship with the AHA does not appear to be as awful as Frito Lay’s. After all, whatever else you may think about the company and its methods, obesity is a major problem, and if some people can defy the odds and lose weight with Jenny Craig then all the better for them.

But the Jenny Craig relationship brings up another, more subtle harm caused by these sort of increasingly popular arrangements in which nonprofit organizations accept money from for-profit corporations. I was astonished to read the second paragraph of the Jenny Craig press release:

Bertinelli, who has lost weight on the Jenny Craig program, recognizes the importance of being in good heart health, and owes her mother’s life to Jenny Craig.  Bertinelli’s mother, Nancy, lost 54 pounds* on Jenny Craig after witnessing her daughter’s success on the program. In October of 2008, Bertinelli’s mother required emergency heart valve replacement surgery.  After the successful surgery, the cardiologist pulled Bertinelli and her brother aside and told them that if their mother hadn’t previously lost weight, she would not have survived the surgery.

Scientifically and medically, this is an entirely irresponsible statement, if in fact a cardiologist did make this statement. My source for this assertion? The AHA itself. Here’s what an AHA science advisory had to say about this exact topic:

Severe obesity has not been associated with increased mortality in patients undergoing cardiac surgery but has been associated with an increased length of hospital stay and with a greater likelihood of renal failure and prolonged assisted ventilation.

One of the most important roles of the AHA is to encourage, develop, and support the use of evidence-based medicine. Why then does the AHA agree to partner with companies that flagrantly (Frito Lay) or more subtly (Jenny Craig) undermine that effort?

Fun facts: Jenny Craig is a wholly owned subsidiary of Nestlé. Frito Lay is owned by Pepsi.

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Click here to read the Jenny Craig press release…

Subway Meals Get American Heart Association Endorsement 2

The American Heart Association (AHA) announced today that it had initiated a new program that it claims will help people choose healthy meals at restaurants. The Subway restaurant chain will be the first to display the Heart-Check Meal Certification logo next to certain selected meals.

In a press release the AHA’s president, Gordon Tomaselli, said the program would make “it easy for consumers to make smart choices that are heart-healthy when eating outside the home, knowing they often don’t have the benefit of reviewing the nutrition facts.” The meal certification program is an expansion of the AHA’s Heart-Check Food Certification program, which was established in 1995.

Tomaselli told USA Today that certification can cost companies as much as $700,000 annually. “But it’s not pay-to-play,” he told the paper. “The money is used to make sure what we’re telling the public is correct.”

The AHA certification logo will be displayed on Subway meals that meet the AHA’s nutritional criteria for levels of sodium, calories, cholesterol, saturated fat and trans-fats. But the new program does not mean that all meals certified by the program will necessarily be heart healthy, as noted on the Heart-Check Meal Certification webpage:

Is it still heart healthy to order my meal with mayonnaise or mustard?

  • The standard SUBWAY® 6-inch sandwiches that are part of the AHA (adult) certified meal are prepared on 9-grain wheat bread and contain the following vegetables: lettuce, tomatoes, onions, green peppers and cucumbers.
  • These sandwiches were evaluated without the addition of condiments such as mustard or mayonnaise. Adding condiments containing sodium (such as mustard) or fat (such as mayonnaise) may result in the meal no longer meeting AHA meal criteria.
  • Condiments such as mayo and mustard add saturated fat, sodium and cholesterol that can easily be avoided. These small choices throughout the day can help keep eating habits on track.
  • Additions such as pickles, cheese, and olives also make the sandwich less healthy.
  • Considering the freshness of the bread and the flavor and juiciness provided by the vegetables, these sandwiches are tasty without the addition of other toppings or condiments.

Subway said that it had been an AHA supporter for 12 years. On the AHA website, Subway is listed as a member of the Industry Nutrition Advisory Panel (INAP). Here is the mission of the INAP, according to the AHA website:

The American Heart Association (AHA) Industry Nutrition Advisory Panel (INAP) is a strategic relationship between the AHA Nutrition Committee and food industry leaders. INAP provides a platform for sharing information and planning cooperative programs in the areas of diet and nutrition and cardiovascular disease.

INAP industry members pay a $10,000 yearly membership fee to participate in meetings with “science representatives” from the AHA and other industry members. Here is the AHA description of the benefits of membership:

The primary benefit of INAP is bringing together industry and science representatives to exchange dialogues on areas of mutual interest pertaining to nutrition. Benefits of this dialogue include:

  • Networking and relationship building with industry leaders
  • Education on relevant topics from the nutrition, physical activity, metabolism and obesity areas
  • Members get the latest updates on all AHA initiatives and are given the opportunity to provide input to the AHA regarding statements and positions on these topics
  • Direct access to AHA staff involved in nutrition-related issues
  • An organized relationship with the Nutrition Committee that allows for open communication on topics of interest

Members also receive one complimentary registration to attend the AHA’s spring science conference and council dinner coordinated by the Nutrition, Physical Activity and Metabolism Council (NPAM) and the Council on Epidemiology (EPI).

In addition to Subway, some of the other members of INAP are Uniliver, Coca-Cola, Dr. Pepper, Frito-Lay, Hershey, Kellog, Kraft, McDonald’s, Sara Lee, The Sugar Assocaition, Welch’s, and Yumi Brands (Taco Bell, KFC, Pizza Hut).

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AHA Scientific Statement Spotlights Peripheral Artery Disease in Women Reply

Although peripheral artery disease (PAD) raises the risk of heart disease and stroke, it often goes undiagnosed and untreated, especially in women, according to a scientific statement issued by the American Heart Association and published in Circulation.

Here are a few highlights of the statement:

  • Although women develop PAD later than men, the total number of women with PAD is greater than the number of men.
  • Like men, most women with PAD do not present with “classic symptoms” of intermittent claudication; rather, many are asymptomatic or have atypical leg symptoms.
  • Women with PAD are more likely than women without PAD to have greater functional impairment and a more rapid functional decline. Women, and black women in particular, have a greater risk for graft failure and limb loss than men.
  • Although women have slightly lower normal ABI levels than men, physicians should use the same diagnostic criteria for PAD in men and women.
  • Although the evidence is limited because of the underrepresentation of women in clinical trials, exercise training is equally effective in men and women.
  • At-risk women should be educated about PAD risk factors, symptoms, and cardiovascular risk by all healthcare providers.

“The rate of deaths and the healthcare costs associated with PAD are at least comparable to those of heart disease and stroke,” said the lead of the author of the AHA statement, Alan Hirsch, in an AHA press release. “Women, in particular, suffer an immense burden from peripheral artery disease, yet current data demonstrate most women still remain unaware of their risk.”

Adapted with permission from Physician’s First Watch.
Click here to read the AHA press release…