Saturated Fats Linked To Heart Disease Once Again

–But critics say that observational studies can’t establish causal relationship. A prominent group of nutrition researchers have once again linked saturated fats to increased coronary heart disease. The new paper, published in BMJ, is the third paper in the past year to decry saturated fats. Along with the previous two papers, published in JACC and JAMA Internal…

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Debate Ensues As USPSTF Finalizes Statin Primary Prevention Guideline

–Broad disagreement about how, when, and if to use statins. The U.S. Preventive Services Task Force (USPSTF) has issued final recommendations regarding the use of statins for primary prevention of cardiovascular disease in adults. The recommendations, first proposed last December, are broadly consistent with the 2013 American College of Cardiology/American Heart Association guidelines. But accompanying the…

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Calcium Levels and CV Risk: New Study Finds No Link

–But most agree dietary calcium is preferable to supplements A new review concludes that a high level of calcium intake, whether from food or supplements, is not linked to increased cardiovascular risk, as long as the total calcium intake remains below the tolerable upper level of intake (2,000-2,500 mg/day). The systematic review, published in Annals…

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The Lancet Versus BMJ: Dispatch From The Statin Wars

–The editors of the two top UK medical journals are in a bitter fight over statins. The editors of the two top medical journals in the UK are at war over statins. The bitter fight has its origins in the 2014 publication in the BMJ of two articles that were highly critical of statins. Rory…

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SPRINTing to Lower BP Targets? Not So Fast

–Hypertension experts disagree about how to apply SPRINT results in the real world.  Once again blood pressure experts are disagreeing about how to interpret SPRINT and how its results should be applied in the real world. A new study claims that applying the SPRINT results to US patients who meet SPRINT criteria would prevent more…

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SPRINT: More Controversy And Confusion About ‘Landmark’ Trial

–Blood pressure experts raise new questions and concerns about the controversial trial. More questions and concerns are being raised about SPRINT, the NIH’s “landmark” blood pressure lowering trial. In sharp contrast to the enormous amount of initial hype, many hypertension experts are now saying that the SPRINT trial is difficult to interpret and can’t be readily…

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Cardiologists: Thumbs Down To SPRINT

[Updated, August 29, August 30] –SPRINT should not be used in guidelines to lower blood pressure targets. Should the SPRINT trial be used by guideline committees to lower systolic blood pressure targets? After listening to a high-powered debate at the European Society of Cardiology meeting in Rome on Sunday, most audience members gave thumbs down…

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The Twitter Debate Over Cholesterol Screening In Kids

–Cardiologists discuss the screening controversy in 140 characters or less. My recent post on the debate over cholesterol screening in children provoked a fascinating discussion on Twitter, including comments from several highly knowledgeable experts and clinicians. The discussion started when James Stein, a preventive cardiologist at the University of Wisconsin), tweeted: Lipid screening in kids….

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Experts Disagree About Cholesterol Screening In Kids

(Updated) –Lack of evidence leads to major disagreement over guidelines. Once again the US Preventive Services Task Force (USPSTF) has performed an invaluable— and almost certainly thankless— service. In a series of papers published in JAMA and Annals of Internal Medicine the USPSTF states unequivocally that there is no good high quality evidence to evaluate…

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Study Questions ‘Lower Is Better’ For Cholesterol

–No added benefit for statin patients who reached very low LDL levels A large observational study suggests that moderate lowering of LDL may be just as effective as intensive lowering. “Our results do not provide support for a blanket principle that lower LDL cholesterol is better for all patients in secondary prevention,” the authors conclude….

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The American Heart Association’s Strong Stance Against Science

Once again the American Heart Association has taken a strong stance against science. Of course, that’s not how the AHA phrases it. In its own words the AHA says it “strongly refutes the findings” of a “flawed study” which “you shouldn’t use… to inform yourself about how you’re going to eat.” But in fact the…

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Study Suggests Salt Restriction Only Beneficial In People With Hypertension

–More questions raised about broad efforts to restrict salt; AHA condemns study A large new analysis offers more evidence that broad salt restriction doesn’t benefit most people and may even harm some people. The study did find that salt restriction may be beneficial to the minority of people with high blood pressure who also consume…

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Entresto Gets Boost in Updated HF Guidelines

–Valsartan/sacubitril earns Class I recommendation Cardiology groups in the U.S. and Europe have updated their heart failure guidelines to include much-awaited recommendations for Entresto (the combination of valsartan and sacubitril manufactured by Novartis). The new guidelines offer broad support for the new drug. Since its approval last summer Entresto has struggled to gain a foothold…

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New Cardio Drugs Off To Very Slow Start

–Heart failure experts divided over how and when to use Entresto To many long-time observers, the approval last year of two new cholesterol drugs and a heart failure drug appeared to herald a rebirth of the cardiovascular marketplace after a long period of dormancy. But so far in 2016, those new drugs have hardly made…

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FDA Expands Metformin Label

— The diabetes drug can now be used in more patients with reduced kidney function The FDA on Friday greatly expanded the indication for the type 2 diabetes drug metformin. Until now use of metformin in patients with reduced kidney function had not been recommended. The new label states that metformin “can be used safely…

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How Should SPRINT Influence High Blood Pressure In Children And Adolescents?

–Editorialists say pediatric hypertension in children is ready for a ‘paradigm shift’ Last year’s influential— and highly controversial— SPRINT trial should be used to better inform and influence our understanding and management of hypertension in children, write two influential physicians who have played a key role in the cardiovascular guidelines for children and adolescents. They…

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Top HF Expert Decries ‘Unbelievable Folly’ of Clinical Trials and Guidelines

–Milton Packer, MD, calls the system to test and evaluate heart failure drugs dysfunctional The system is completely broken, writes heart failure specialist Milton Packer, MD, in an editorial in Circulation: Heart Failure. The results of important clinical trials are not being incorporated into guidelines quickly, intelligently, or consistently, Packer argued. The most important reason…

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Why Guidelines Are Bad For Science

 Bad guidelines don’t just give bad advice. They also harm science and impede research. The new US Dietary Guidelines– which I’ve already called a recipe for disaster— are a perfect example of why we need to have fewer, shorter, and, crucially, better guidelines. Back in 2014, in response to the controversy over salt guidelines, I…

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Recipe For Disaster: The New US Dietary Guidelines

The science of nutrition is a disaster. For a variety of very good reasons it is nearly impossible to perform high quality, long term randomized controlled trials to provide satisfactory answers to most of the pressing questions of the day. But many experts are convinced they do know the answer to many of these questions….

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Paper Raises More Questions About Salt Restriction In Heart Failure

Sodium restriction is a cornerstone of heart failure management, but many people would be surprised to learn that there is no good supporting evidence for the practice. In the 2009 heart failure guidelines sodium restriction in heart failure received a Class I recommendation (recommended), but this was based only on expert consensus (a C level of evidence of…

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Lancet Sprints To The Front With A Blood Pressure Meta-Analysis

A new meta-analysis published in the Lancet on Friday lends fresh support to calls for more intensive blood pressure treatments. The publication comes only days before the highly anticipated presentation of the NIH’s SPRINT trial at the American Heart Association, which is also expected to offer support for stricter blood pressure control. Blood pressure goals were relaxed after the ACCORD…

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You Don’t Know It But The Debate About SPRINT Is Already Over

On Monday you’re going to hear a lot– an awful lot– about SPRINT. That’s the big NIH blood pressure trial which was stopped early. On September 11 an NIH press release trumpeted the positive results without revealing most of the important details. This Monday, finally, the results are scheduled to be presented at the American Heart…

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Slow Start For New Novartis Heart Failure Drug Entresto

Initial sales of Entresto (the combination of sacubitril and valsartan, formerly known as LCZ696) have been slow. In the first few months after its approval in July the drug only had $16 million in sales, the drug’s manufacturer, Novartis, reported last week during its quarterly earnings report. The novel heart failure drug is widely expected to be…

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Primary PCI Guideline Update: Multivessel Interventions In, Thrombectomy Out

The guidelines for primary PCI for ST-elevation MI (STEMI) have been updated to reflect major findings from recent trials: PCI of a noninfarct artery is now acceptable for some STEMI patients with multivessel disease. In previous guidelines PCI of noninfarct arteries had been considered unsafe. Routine thrombectomy prior to primary PCI for stent implantation is now…

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Heart Failure Experts SPRINT To An Early Finish

According to a recent news report a group of prominent heart failure doctors  have eagerly embraced a lower blood pressure target of 120 mm Hg for heart failure patients based on the preliminary results of the SPRINT trial announced last month. But another equally prominent heart failure doctor says that it is far too early to…

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