A COVID-19 Cardiac MRI Study: What Went Wrong?

We still don’t know what COVID-19 is doing to the heart or how we should be investigating it and treating it. Last month JAMA Cardiology published a German cohort study of 100 patients recently recovered from COVID-19… A number of striking problems with the study were noted on Twitter……

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No, CRISPR Is Not Going To ‘Cure’ Heart Disease

No, CRISPR gene editing technology is not going to “cure” heart disease. But a New York Times story by Gina Kolata on an extremely early study in animals prominently plays up just this extremely unlikely claim. The Times story is based on a press release issued by Verve Therapeutics, a new biotechnology company founded by Sekar Kathiresan, an influential cardiologist and genomic…

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What Can We Learn From The Apple Heart Study?

Do we ever learn from our past mistakes? For many years we believed that technology was an inevitable force for good. It would give us instant access to a near infinite amount of information and allow us to easily and instantly connect with nearly anyone on earth. What could go wrong? The answer is that…

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Health Hype Alert: Beware the Apple Watch

This morning STAT published an Op-Ed piece I wrote about the Apple Watch. Here’s how it starts: Set your smartwatch alarm. You’re about to be barraged by tons of hype about the health benefits of the Apple Watch. Unfortunately, it won’t include essential information and data that can put these claims in proper perspective. Last year,…

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Lancet Paper Adds To Evidence That Reducing Salt To Very Low Levels May Be Dangerous

A new paper from a very large ongoing observational study offers additional and more powerful evidence that dramatic reductions in salt consumption may not be beneficial and might even prove harmful. The finding supports growing criticism that current guideline recommendations to dramatically lower salt intake in the general population may be misguided. The study also…

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No, A Big NIH Trial Did Not Show That Lowering Blood Pressure Will Prevent Dementia

It’s “breakthrough” time again. News reports out of the Alzheimer’s Association International Conference (AAIC) this week have been relentlessly upbeat and positive about findings from the NIH’s SPRINT MIND study. The message: aggressive blood pressure control can help protect the brain. But unless you look very carefully at the news reports and “expert” statements you won’t…

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If You Look For Atrial Fibrillation You Will Find Atrial Fibrillation

If you look hard to find people who have atrial fibrillation (AF) you will in fact find people who have atrial fibrillation, a new paper published in JAMA shows. But the paper offers no evidence whatsoever that the new diagnosis improves outcomes in these people, though it does find that the diagnosis leads to increased use of…

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Salt War Opponents Unite In Call For Randomized Trial In Prisons

The opposing camps in the salt wars don’t agree on much, but they have now found common ground in their belief that the only way to settle the salt question is with a large randomized controlled trial. Further, they now agree that it would be nearly impossible to perform such a trial in the real…

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More Controversy Over Major Cardiology Clinical Trial

Think about this: A new article reports that a major NIH-funded trial runs into trouble. The article raises all sorts of fundamental questions about our ability to perform meaningful clinical research. But instead of expressing concern about these legitimate problems, medical leaders ignore these questions and instead focus their ire and criticism on the article authors,…

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Cardiology World Erupts Into Controversy Over Change In Major Clinical Trial

As a major clinical trial in cardiology nears completion it has provoked a storm of criticism and controversy. The brouhaha erupted in response to a late change to one of the most important— and already controversial— trials in cardiovascular medicine. The NIH-funded ISCHEMIA trial was designed back in 2011 to provide a definitive answer to…

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The ODYSSEY Trial Ends Well— But Will It Be Enough?

Sanofi and Regeneron achieved a modest victory with the much anticipated ODYSSEY Outcomes trial of its cholesterol lowering drug Praluent (alirocumab). The trial met its primary endpoint and even reported a significant improvement in all-cause mortality. But the mortality finding has an asterisk attached to it and it is far from clear whether the overall…

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Esperion Releases Top Line Results For First Pivotal Phase 3 Study

Esperion announced positive results today for the first in a series of pivotal phase 3 studies of its cholesterol lowering drug. The trial (Study 4, or 1002-048) compared bempedoic acid to placebo in 269 patients with atherosclerotic cardiovascular disease (ASCVD) or at high risk for ASCVD who have high LDL cholesterol levels (100 mg/dl or greater)…

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Low-Carb And Low-Fat Diets Battle To A Draw

A new study comparing a low-carbohydrate diet with a low-fat diet found no important differences in weight loss or other important outcomes between the two diets. Some experts believe the result shows that the  debate over the relative worth of these different diets has been overblown and confirms the view that calories count. Others say…

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Moment Of Truth For Struggling And Expensive Cholesterol Drugs

It will be the moment of truth for the expensive new cholesterol drugs known as PCSK9 inhibitors. Next month we will learn much more about the PCSK9 inhibitor class of cholesterol drugs. A lot of the remaining uncertainty about the efficacy— or lack of efficacy— of these drugs will be resolved when a large cardiovascular…

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The Hypertension Guideline War Is Not A Fake War

The war over the new blood pressure guideline is not a fake war or a childish dispute. It is a real war over genuine differences in how we should think about health and disease and prevention. The publication last November of the new US blood pressure guideline sparked a vigorous and important debate. A central part…

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Statin Critic Accused Of Image Manipulation In Earlier Research

A journalist who has been a frequent critic of statins has been publicly accused of scientific misconduct involving image manipulation in an earlier research paper. Maryanne Demasi is an Australian journalist who has a PhD in Rheumatology from the Royal Adelaide Hospital in South Australia. She has been a frequent critic of statins, a proponent of…

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More Mini-Trials And Fewer Mega-Trials?

Just as dinosaurs ruled the earth for millions of years, for more than 30 years now cardiology has been ruled by mega-trials. Over the years the cardiology landscape would shake and tremble as ever more gigantic mega-trials emerged to  dominate the field. Just as the giant dinosaurs paid no attention to the seemingly inconsequential little…

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Nuance And The Healthcare Apocalypse

(Updated) If you actually have a life you may not be aware that there’s been a fierce debate on Twitter and the blogosphere over Lisa Rosenbaum’s NEJM article decrying the oversimplification and self-righteousness of the “less is more crusade.”  In response to fierce criticism, from myself, the Lown Institute, and others, Saurabh Jha praised and defended Rosenbaum for embracing nuance…

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Guest Post: Get Ready For A Tsunami Of ECGs

Editor’s note: Ethan Weiss, a cardiologist at UCSF, reflects on a recent patient who may well be a forerunner of many more patients in the near future. I saw a man in his early 40’s. He’s super healthy. He had a Ziopatch as part of a general medical workup (not really important why). He was…

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FDA Approves ECG Band For Apple Watch

(Updated) —Kardia Band is the first FDA approved medical accessory for the Apple Watch. The FDA has cleared a band for the Apple Watch that records an ECG. According to AliveCor, the Kardia Band is the first medical device accessory cleared by the FDA for the Apple Watch. The Kardia Band is activated with a…

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The Once— And Future?— Catastrophic Cost of MI & Stroke

–Obamacare has protected many people with heart disease. Cardiovascular disease can often have a catastrophic economic effect on people who don’t have insurance. Two studies presented at the American Heart Association in Anaheim illustrate how the Affordable Care Act, aka Obamacare, likely has helped hundreds of thousands of people avoid financial apocalypse. The first study,…

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The Survey Says: BP Measurement In SPRINT Was All Over The Place

–BP measurement question limits the trial’s ability to inform clinical practice. A long-promised report from the SPRINT investigators offers important new information about how blood pressure was monitored in the trial. The report is unlikely to satisfy critics or resolve the larger controversy of how the trial should be interpreted. At the American Heart Association…

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New Blood Pressure Guideline Sets Lower 130/80 Threshold

Expanded guideline means more than 100 million people have high blood pressure. The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg. This means that more than 100 million adults will now have high blood pressure, though many will be unaware of the diagnosis. The 192 page guideline…

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CANTOS Substudy Shows Major Role For Inflammation

–Large reductions in hsCRP appeared to foretell improved outcomes. ANAHEIM — An important CANTOS trial substudy bolsters evidence that inflammation plays an independent role in cardiovascular disease (CVD) and may point toward a new targeted approach to treatment of CVD and perhaps even more profoundly impact cancer treatment. The report, presented by Paul Ridker (Brigham…

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Diving Deep Into The ORBITA Trial

William Boden, Ajay Kirtane, and Dan Mark analyze the ORBITA trial. Editor’s note: I asked a wide variety of cardiologists for their thoughts about ORBITA, presented at the TCT meeting in Denver and published simultaneously in the Lancet. Three of them, William Boden, Ajay Kirtane, and Dan Mark, sent highly detailed comments about the trial….

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