Missing High Blood Pressure Guideline Turns Up In JAMA

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….

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Dispatch From The Wild Frontier Of The Statin Wars

The long simmering controversy over the relative benefits and harms of statins has heated to a high boil with the release of the new AHA/ACC US guidelines. But nowhere is the battle more intense right now than in Australia where, according to the National Heart Foundation, a TV show may be the cause of 2,000 heart attacks…

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FDA Panel Gives Support To Novel Stroke Prevention Device From Boston Scientific

The FDA’s Circulatory System Devices Panel yesterday gave a vote of confidence to Boston Scientific’s Watchman left atrial appendage closure device for the prevention of stroke in atrial fibrillation patients. By a large majority the panel agreed that the device was effective, that it was safe, and that the benefits outweighed the risks. In each case the…

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Should You Be Worried About The Treatment For Low-T?

The ubiquitous ads ask: “Should I be worried about Low-T”? But now there’s a good chance there’s a more important question: “Should I be worried about the treatment for low-T?” A new study published in JAMA raises the distinct possibility that testosterone therapy may increase the risk of death, heart attack, and stroke. The findings are hardly definitive, but may raise…

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Radiation Dose Linked To Cardiac Risk In Breast Cancer Patients

    In the past, cardiovascular risk has been linked to the radiation dose received by breast cancer patients. Now, a new study published in JAMA Internal Medicine attempts to calculate the cardiac risk of breast cancer patients today undergoing current radiotherapy protocols.   David J. Brenner and colleagues calculated the excess cardiac risk for 48 patients who…

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Surgery Preferable To Stents In Elderly People With Carotid Disease

Age should play an important role in choosing a revascularization procedure for people with blocked carotid arteries, according to a new paper published in JAMA Surgery.  Carotid endarterectomy surgery (CEA) is preferable to carotid artery stenting (CAS) in elderly people; for younger patients the two revascularization procedures are broadly similar. George Antoniou and colleagues analyzed data from 44…

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FDA Approves New Pulmonary Hypertension Drug From Actelion

The FDA today approved macitentan (Opsumit, Actelion), a new oral endothelin-receptor antagonist that is an enhanced version of the company’s bosentan (Tracleer). The drug is indicated to delay disease progression in patients who have pulmonary arterial hypertension (WHO Group I). … Click here to read the full post on Forbes.  …

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News From Our ‘Statin Civilization’: High-Dose Statins Found To Reduce Gum Disease Inflammation

In addition to their well-known benefits in heart disease, high-dose statins appear to reduce gum inflammation caused by periodontal disease, a new report published in the Journal of the American College of Cardiology shows. The findings offer more evidence that heart disease and gum disease may be linked, and also help support the view that statins achieve at least…

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Study Raises Questions About Digoxin Use Today

Digitalis is one of the oldest medicines in the cardiovascular arsenal. When William Withering identified digitalis as the active ingredient in the foxglove plant more than 200 years ago he was only codifying a longstanding folk remedy for heart failure, or “dropsy” as it was known then. Digitalis fully entered the modern era with the…

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Clear! CPR in the Hospital Is Not Always Good for the Patient

On TV it always seems clear and simple. A patient in the hospital goes into cardiac arrest and the medical team springs into action. After a few tense moments of furious activity, and only after all seems lost, the patient is successfully revived. A few scenes later the smiling and now fully healthy patient thanks…

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New Test Could Speed Heart Attack Treatment In The Emergency Department

Only 1 in 10 patients with acute chest pain in the emergency department turn out to have an actual heart attack (myocardial infarction), yet many are not released from the hospital until after 6-12 hours of cardiac monitoring and multiple ECG and troponin tests. The search for a test that can rule out MI early in…

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Kaiser Program Yields Big Improvements In Hypertension Control

A large percentage of the 65 million people with high blood pressure in the United States do not know they have hypertension or have not succeeded in controlling their hypertension. Although many programs have been proposed, there is little evidence that any method can produce long term improvement in hypertension control. In a paper published in JAMA,…

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Possible Cognitive Benefits Found In Dementia Patients Taking Centrally Acting ACE Inhibitors

An observational study from Ireland raises the intriguing possibility that certain blood pressure lowering drugs, centrally acting ACE inhibitors, may help slow the cognitive decline that is a hallmark of people with Alzheimer’s disease and other forms of dementia. The study, published in BMJ Open, followed the rates of cognitive decline in 3 groups of patients: dementia patients being treated…

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Take Your Blood Pressure Pills Or Increase Your Risk Of Stroke

A large new observational study demonstrates that people who don’t take their antihypertensive medications are much more likely to have a stroke. The new study, published in the European Heart Journal, used nationwide prescription, hospital and mortality records from 73,527 hypertensive patients in Finland. The Finnish investigators compared 26,704 patients who were hospitalized or died of stroke…

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

NHLBI Director Dr. Gary Gibbons

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….

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Unconventional Analysis Finds Threshold For LDL Reduction With Statins

Using an unconventional mathematical approach, a group of Japanese researchers say there may be no good reason to reduce LDL cholesterol more than 40 mg/dl. Their research letter has been published online in JAMA Internal Medicine. According to the authors, members of the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group, most meta-analyses use linear models…

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Cuban History Offers Important Lessons For Global Health Today

A large new study from Cuba shows the impressive benefits that can be achieved with weight loss and increased exercise. Much more ominously, the same study shows the dangers associated with weight gain and less exercise. In the study, published in BMJ, researchers took advantage of a “natural” experiment that occurred in Cuba as a result of a…

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Controversial PFO Closure Trials Published In NEJM

Amplatzer

Two controversial trials testing PFO closure with the Amplatzer PFO Occluder (St. Jude Medical) in patients with cryptogenic stroke, first presented last fall at the TCT meeting, have now been published in the New England Journal of Medicine. Both trials missed their primary endpoints but contained suggestions of possible benefit. The results appear unlikely to resolve…

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High Potency Statins Linked To Increased Risk For Acute Kidney Injury

Although the beneficial effects of high-potency statins have been well-characterized in clinical trials, these same trials have lacked the power to illuminate rare but potentially important adverse events. A suggestion of one such area of concern, acute kidney injury, was first raised in the JUPITER trial. Now, a new study published in BMJ provides further information about this…

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Radiotherapy For Breast Cancer Increases Heart Disease Risk

A new study published in the New England Journal of Medicine offers the best look yet at the increased risk for heart disease produced by radiotherapy for breast cancer. Further, this increased risk may just be the tip of the iceberg of more radiation-related problems, warns a cardio-oncologist in an accompanying editorial. The new study, based on data…

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Large Study Finds Genetic Links To Aortic Valve Calcification

A genetic component is believed to play an important role in valvular heart disease, but the specific genes involved have not been identified. Now an interntional group of researchers has identified genetic variations that increase the risk for valvular calcification. In a paper published in the New England Journal of Medicine, members of the Cohorts for Heart and…

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Becoming Your Own Doctor In The Brave New World Of Personalized Medicine

Lately there’s been a lot of talk about personalized medicine. There’s a bold idea going around that people should take control of their own healthcare and manage the flood of new data stemming from a whole bunch of new technologies, including, but hardly limited to, personal genomes, biomarkers, wireless sensors, and iPhone ECGs. … …boutique-style…

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Amgen Trial Fails To Show Benefit Of Anemia Drug In Heart Failure Patients

  The bad news continues for Aranesp (darbepoetin alfa), Amgen’s long-acting erythropoietin-stimulating agent. The drug is intended to stimulate red cell blood production in patients with anemia. Amgen today announced the top line results of a large phase 3 heart failure trial of the drug and said  the trial had failed to meet its primary endpoint.   The RED-HF…

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Large Meta-Analysis Finds No Harm Associated With Eggs

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…

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Autopsy Studies Find Large And Dramatic Drop In Early Atherosclerosis Over 60 Years

Service members who died over the past decade were far less likely to have atherosclerosis than service members who died in Korea or Vietnam, according to a new study published in JAMA. Although it is impossible to fully understand the causes and implications of the finding, the results provide powerful new evidence pointing toward a very…

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