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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SPRINT Trial To Be Presented At The American Heart Association Meeting In November

Update: I have now received confirmation that SPRINT will be presented on Monday, November 9 at 2 PM. The SPRINT trial, which provoked a storm of excitement and controversy a few weeks ago, will be presented in November at the American Heart Association meeting in Orlando. The trial is not currently on the list of late-breaking clinical trials but…

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BMJ Paper Criticizes Proposed US Dietary Guidelines

Once again experts are passionately disagreeing about the proper role of saturated fats and carbohydrates in the diet. The latest volley comes from a full-scale critique  published in the BMJ  of proposed new US dietary guidelines. The author of the critique, Nina Teicholz,  is the author of The Big Fat Surprise: Why Butter, Meat, & Cheese Belong in a Healthy Diet. In both the…

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NIH Trial, Stopped Early, Supports More Intensive Blood Pressure Targets

More stringent blood pressure targets could save lives and reduce cardiovascular events, according to preliminary results from a large NIH clinical trial that was stopped early. The SPRINT (Systolic Blood Pressure Intervention Trial) trial randomized 9,361 hypertensive patients 50 years of age or older to the standard systolic blood pressure target (when the trial began) of 140…

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Doctors Halt Squabbling And Agree How To Manage Hypertension In People With Blocked Arteries

There’s been a lot of drama in the hypertension field over the past few years. Initially sparked by the decision of the National Institutes of Health to end its sponsorship of national guidelines, the subsequent appearance of multiple guidelines with divergent recommendations led to even more controversy and discussion. Now, however, the appearance of a new scientific statement…

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More Guideline Controversy: The Tricky Business Of Calculating Cardiovascular Risk

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….

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New US Guidelines Will Lift Limits On Dietary Cholesterol

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…

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Another Study Raises Questions About Blood Pressure Guidelines

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…

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

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…

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How Much Salt Should Old People Consume?

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….

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Another Diet Myth Exploded: Gradual Weight Loss No Better Than Rapid Weight Loss

Once again, a popular weight loss myth has been exploded. It has been widely believed that weight loss, which is nearly always difficult to maintain, is even less likely to stay lost if it is the product of a rapid weight loss. The belief is even enshrined in current guidelines. Now a study published in The Lancet…

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A ‘Disappeared’ Article, Finally Published, Finds A Desultory Response To Scientific Misconduct

Back in January an article in the European Heart Journal raising the disturbing possibility that guidelines based on fraudulent research may have been responsible for as many as 800,000 deaths was “disappeared” from the journal’s website only minutes after being published. The journal’s editor claimed the article had not been properly peer reviewed. In its place the editors published an editorial refuting…

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Cardiology Group Withdraws ‘Choosing Wisely’ Recommendation

In the end it wasn’t wisdom for the ages. The American College of Cardiology said today that it was withdrawing one of its five recommendations in the “Choosing Wisely” campaign.  In 2012 the ACC recommended that heart attack patients should have only their culprit artery unblocked. It said that patients and caregivers should question whether complete revascularization of all…

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Why Guidelines Should Be Waged Like War

(Updated) Here’s a modest proposal: we need fewer and shorter guidelines. In fact, I’d like to propose that guidelines, like war, should be waged only when there is absolute consensus and overwhelming evidence. Anyone interested in the subject is aware that guidelines are in a complete mess. Just in the past two weeks I’ve written about…

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An Old Study Fuels Debate Over Blood Pressure Guidelines

In the last year new guidelines relating to cardiovascular disease have been the subject of intense criticism and debate. The status of the blood pressure guidelines has been particularly contentious, since several different groups have published contradictory guidelines, while several authors of the most prominent group, the Eighth Joint National Committee, published an impassioned dissent…

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An Expert’s Perspective: Why Salt Is Not Like Tobacco And Why Guidelines Are Tricky

Updated August 15– At the center of this week’s renewed debate on salt was Salim Yusuf, the long influential and occasionally controversial cardiology researcher and clinical trialist based at McMaster University in Hamilton, Ontario. I spoke with Yusuf before the publication of the New England Journal of Medicine papers, which include his own two papers from the PURE study….

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New Studies Fuel The Debate Over Sodium

Three papers and an editorial in the New England Journal of Medicine are sure to throw fresh fuel on the ongoing fiery debate over sodium recommendations. Current guidelines recommend that people should limit their intake of sodium to 1.5  to 2.4 grams per day, but these recommendations are based on projections and have never been tested in clinical…

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Guideline Critics Shift Attacks From Beta Blockers To Statins

With the release today of updated European and US guidelines the ongoing controversy regarding beta-blockers appears to be resolved. But that doesn’t necessarily mean there will be an outbreak of guideline peace and harmony. The critics who helped ignite the controversy over beta blockers now say new statin recommendations contained in the guidelines are based on deeply flawed evidence….

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Dutch Investigation Finds Serious Flaws In Influential New England Journal Of Medicine Study

Erasmus Medical Center says it has wrapped up its investigation of Don Poldermans, the disgraced cardiology researcher who was fired for research misconduct. The full extent of the misconduct has never been known, and from an examination of the Erasmus report it appears likely that it never will be known. One major finding– though downplayed in…

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Prophylactic ICDs Appear Effective In Less Severe HF Patients

ICDs are routinely implanted in heart failure patients with ejection fractions (EFs) of 35% and lower to prevent sudden cardiac death. However, the benefits in patients at the higher end of the spectrum– between 30% and 35%– have not been well demonstrated in clinical trials, since few patients in this range have been enrolled in…

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12.8 Million More Adults Now Eligible For Statin Therapy

Millions more people are now eligible for statin therapy under the new cholesterol guideline, according to a new estimate published in the New England Journal of Medicine. … There have been many attempts to quantify just how many more people are now eligible for statin therapy under the new guideline. Now in the new paper in NEJM, Michael Pencina…

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Heart Societies Issue New Guidelines For Valve Disease

The American Heart Association and the American College of Cardiology today released new practice guidelines [PDF] for the management of patients with valvular heart disease (VHD). Among its most notable features, the new document provides a new system of classification for VHD and lowers the threshold for interventions, including, for the first time, transcatheter as…

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Minority Report: Five Guideline Authors Reject Change In Blood Pressure Goal

It didn’t seem possible but the guideline situation just got even more confusing. Last December, after  years of delay and other twists and turns, the Eighth Joint National Committee (JNC 8) hypertension guideline was published in JAMA. The previous guideline recommended that all adults have a target systolic blood pressure below 140 mm Hg. In the new guideline, the target…

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