It is often said that medicine is both an art and a science. In an imperfect world this is both inevitable and desirable. But it is extremely important that the two should not be confused with each other. In particular, because the “science” side of the equation has achieved overwhelming prestige and authority, it is…
Don’t Confuse the Art and Science of Medicine: PCI vs CABG for Left Main Disease
August 20, 2020 by 1 Comment
Lancet Paper Adds To Evidence That Reducing Salt To Very Low Levels May Be Dangerous
August 9, 2018 by 4 Comments
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…
Salt War Opponents Unite In Call For Randomized Trial In Prisons
May 21, 2018 by 1 Comment
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…
The Hypertension Guideline War Is Not A Fake War
February 11, 2018 by 14 Comments
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…
Upcoming US Guideline Will Likely Set 130/80 As New Blood Pressure Target
October 6, 2017 by 1 Comment
–The highly anticipated AHA/ACC BP guideline will be published in November. The new magic number will be 130 over 80 mm Hg. That’s the new blood pressure goal that many hypertension experts say will be the centerpiece of the new US blood pressure guidelines. The new guideline will be introduced next month in Anaheim during the…
How Statins Make Some People Crazy
July 30, 2017 by 21 Comments
–Intelligent discussion about statins is threatened by zealous partisans. What is it about statins that causes so many people to go crazy? I’m not talking about any pharmacological effect of the drugs. Instead my focus here is on the zealous partisans— both against and in support of statins— who go off the deep end. Unfortunately…
Forthcoming Expert Guideline May Upgrade PCSK9 Inhibitors
July 21, 2017 by 1 Comment
Results of the FOURIER trial might bolster the embattled cholesterol drugs.Results of the FOURIER trial might bolster the embattled cholesterol drugs.Results of the FOURIER trial might bolster the embattled cholesterol drugs.Results of the FOURIER trial might bolster the embattled cholesterol drugs.Results of the FOURIER trial might bolster the embattled cholesterol drugs.Results of the FOURIER trial…
Study Estimates Benefits Of Broad Primary Prevention Strategies With Statins
July 20, 2017 by 9 Comments
–But the benefits may be substantially diminished when patient preferences are considered. A new analysis provides staunch support for the use of statins for the primary prevention of cardiovascular disease. But the same analysis also emphasizes that this support varies dramatically based on the values and concerns of individual patients. Kirsten Bibbins-Domingo (UCSF) led a…
Aggressive BP Targets Will Hike Falling Risk in Older Patients
July 17, 2017 by 2 Comments
–Another paper raises new questions about applying SPRINT in the real world Applying the intense blood pressure goals used in SPRINT in a real world elderly population might lead to a dramatic increase in injurious falls, according to a new study from Ireland published in JAMA Internal Medicine. The Systolic Blood Pressure Intervention Trial (SPRINT)…
My Beef With The AHA’s Saturated Fat Recommendations
June 21, 2017 by 22 Comments
–We shouldn’t forget the unintended consequences of dietary recommendations. The American Heart Association’s position on saturated fat pretends to be science-based but is not, writes Gary Taubes, in a brilliant and wildly popular guest post published here on CardioBrief late last week. The AHA’s statement, which recommends that saturated fats be replaced with polyunsaturated…
Guest Post: Vegetable Oils, (Francis) Bacon, Bing Crosby, And The American Heart Association
June 16, 2017 by 26 Comments
–Gary Taubes responds to the AHA presidential advisory on dietary fats. Editor’s note: I was planning to write about the American Heart Association’s new statement about dietary fats so I asked Gary Taubes for a brief quote. Taubes, of course, is an investigative science and health journalist who has written three major books (Good Calories,…
Top Cardiologist Blasts Nutrition Guidelines
February 27, 2017 by 15 Comments
–Salim Yusuf says new evidence fails to support many major diet recommendations. One of the world’s top cardiologists says that many of the major nutrition guidelines have no good basis in science. “I’m not a nutrition scientist and that may be an advantage because every week in the newspaper we read something is good for…
International Experts Call Salt Guidelines Far Too Restrictive
February 14, 2017 by 5 Comments
A broad group of international experts are recommending a far more modest and less draconian approach to sodium restriction than current U.S. and international guidelines. In a new paper, published online in the European Heart Journal, they also focused on the broad gaps of knowledge in the field and drew attention to the paucity of…
More Shots Fired in ‘Sugar War’
December 19, 2016 by 1 Comment
–Industry-sponsored study questions current guidelines on dietary sugar. Dietary guidelines relating to sugar— all of which recommend significant reductions in sugar intake— are based on weak evidence and are not trustworthy, according to a systematic review published in Annals of Internal Medicine. But an accompanying editorial points out that the systematic review is itself not…
Saturated Fats Linked To Heart Disease Once Again
November 27, 2016 by 10 Comments
–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…
Debate Ensues As USPSTF Finalizes Statin Primary Prevention Guideline
November 13, 2016 by Leave a Comment
–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…
Calcium Levels and CV Risk: New Study Finds No Link
October 24, 2016 by 1 Comment
–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…
The Lancet Versus BMJ: Dispatch From The Statin Wars
September 15, 2016 by 5 Comments
–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…
SPRINTing to Lower BP Targets? Not So Fast
September 15, 2016 by 2 Comments
–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…
SPRINT: More Controversy And Confusion About ‘Landmark’ Trial
September 6, 2016 by 3 Comments
–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…
Cardiologists: Thumbs Down To SPRINT
August 28, 2016 by 2 Comments
[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…
The Twitter Debate Over Cholesterol Screening In Kids
August 11, 2016 by 1 Comment
–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….
Experts Disagree About Cholesterol Screening In Kids
August 10, 2016 by 3 Comments
(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…
Study Questions ‘Lower Is Better’ For Cholesterol
June 20, 2016 by 3 Comments
–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….
The American Heart Association’s Strong Stance Against Science
May 25, 2016 by 8 Comments
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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