Renal denervation is back. Or not. The failure of renal denervation (RDN) was one of the most spectacular failures in cardiovascular medicine in recent years. Great expectations for RDN appeared to die with the Simplicity-3 HTN trial, the first rigorous test of the technology, which showed that it was ineffective in the treatment of resistant…
Generic Atenolol in Short Supply
August 10, 2017 by 1 Comment
–The latest sign of turmoil in the generic drug marketplace. The widely prescribed beta-blocker atenolol is in short supply around the country. The FDA first reported an atenolol shortage on July 26. According to the FDA website, three companies that manufacture generic atenolol — Mylan, Sandoz, and Teva — say that the cause is a…
Pharma Phantasy: The $30 Billion PCSK9 Inhibitor Market
August 8, 2017 by 2 Comments
–Drug company dreams up a study showing all the benefits and none of the costs or risks of PCSK9 inhibitors. Here’s a pro tip for pushing a drug (or, indeed, any aggressive treatment or screening strategy): focus exclusively on the benefits, even if they are modest at best, and completely ignore side effects and costs….
Ethical Questions Raised About NIH Blood Transfusion Trial
August 4, 2017 by Leave a Comment
–Public Citizen says the MINT trial comparing blood transfusion strategies after MI should be halted. Public Citizen is calling for the immediate suspension of a large NIH-sponsored trial comparing blood transfusion strategies after heart attacks. The Myocardial Ischemia and Transfusion (MINT) trial should be halted “because of potentially serious ethical violations,” said the consumer advocacy…
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…
Nissen Calls Statin Denialism A Deadly Internet-Driven Cult
July 24, 2017 by 15 Comments
–“We are losing the battle for the hearts and minds of our patients.” A leading cardiologist has unleashed a blistering attack on “statin denial,” which he calls “an internet-driven cult with deadly consequences.” In an editorial in Annals of Internal Medicine, Steve Nissen (Cleveland Clinic) expresses grave concerns over statistics showing that only 61% of…
Potential Benefits And Dangers of New Troponin Tests
July 24, 2017 by 2 Comments
–What does it mean when 80% of people have detectable levels without CVD? As many as four out of five people without known heart disease will have detectable levels of cardiac troponins with the new high-sensitivity tests, according to a new meta-analysis. Even very low levels within the normal range indicated increased cardiovascular risk, but…
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)…
Coronary Artery Calcium Rises With Intense Exercise
July 13, 2017 by 4 Comments
–But the lesions observed are more likely to appear stable. Exercise is good for you, but is there a point at which more exercise is either no longer beneficial or perhaps even harmful? Two new studies now help clarify — albeit not resolve — the issue. The studies offer evidence that people who exercise for…
Questions Raised About Trump’s New CDC Boss
July 11, 2017 by 3 Comments
–Fitzgerald championed Coke-backed obesity program and practiced ‘anti-aging medicine’ Serious questions are being raised about Brenda Fitzgerald, MD, the Georgia doctor who Trump is appointing to be the new head of the CDC. Fitzgerald is an ob/gyn with long involvement in Republican politics in her state. She currently serves as the Commissioner of the Georgia…
Sudden Death Declining in Heart Failure
July 5, 2017 by Leave a Comment
–Does the trend mean that ICDs are indicated less often? The incidence of sudden death in heart failure patients with reduced ejection fraction, in clinical trials, has declined significantly in the last 20 years, according to a new study published in the New England Journal of Medicine that may impact inclination to recommend implantable cardioverter-defibrillators…
Labscam: Rogue Laboratory Testing At Center Of Addiction Treatment Scandal
July 3, 2017 by 1 Comment
–‘Sober homes’ in Florida are just the tip of the iceberg. A massive scandal involving fraudulent addiction treatment centers and rogue laboratories has recently surfaced. Several recent news reports have focused on the scandal’s epicenter in Florida, but industry observers say that the scandal is the tip of an iceberg of corruption, abuse, and fraud…
Does Whole Genome Sequencing Have A Role in Primary Care?
June 26, 2017 by 2 Comments
–Pilot study confirms feasibility, but clinical value for healthy-seeming people is not obvious Whole genome sequencing (WGS)may one day play an important role in routine medical practice. But the results of a small study suggest that WGS, though perhaps promising, is certainly not ready for prime time. The price of WGS has dropped spectacularly in…
No One Knows What’s Actually In Red Yeast Rice Supplements
June 23, 2017 by 1 Comment
–Despite tighter FDA rules red yeast supplements may not contain the active ingredient– or far too much of it. A new study offers fresh evidence that it is impossible for consumers (or their doctors) to know what they are getting when they buy dietary supplements. Dietary supplements have long been, at best, loosely regulated in…
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,…
Serious Bleeding Risk With Aspirin Soars With Age
June 14, 2017 by 1 Comment
–Routine PPI use might cut the risk of major bleeds in people over 75. Older people who take aspirin to prevent a recurrent cardiovascular event should take a proton-pump inhibitor to lower their risk of serious bleeding complications, say the authors of a new study published in the Lancet. After a transient ischemic attack, ischemic…
Review Lends Modest Support To Chinese Traditional Medicine For CV Disease
June 12, 2017 by Leave a Comment
–Tantalizing suggestion of benefit but evidence is weak and sparse. Traditional Chinese medicine (TCM) is used by hundreds of millions of Chinese people and increasing numbers of people in developed countries. A new state-of-the-art review published in the Journal of the American College of Cardiology suggests that some TCM products may be helpful in different…
Trustee For Zombie Lab Sues Thousands Of Doctors And Dozens Of Nonprofits
June 12, 2017 by 4 Comments
–The suits unveil the scope and sordid details of the massive kickback scheme. Thousands of doctors are being sued by the trustee representing the creditors of Health Diagnostic Laboratory (HDL), the bankrupt laboratory company. The trustee is demanding that the doctors repay thousands of dollars in illegal processing and handling (P&H) fees, a key part…
New Stroke Prevention Device May Not Prevent Strokes
June 7, 2017 by Leave a Comment
–There’s no hard evidence the Sentinel Cerebral Protection System reduces stroke in TAVR. Here’s how to get a second generation medical product or add-on product approved: show that the original device isn’t nearly as safe and effective as believed back in, you know, the dark ages before the new product showed up. Until now proponents…
The Unintended Consequences Of Bicycle Helmets
June 5, 2017 by 11 Comments
(UPDATED) –We should encourage people to cycle, not scare them away. From personal experience I can attest that it is almost impossible, in the US at least, to have an intelligent conversation about bicycle helmets. The universal view is that you have to be crazy not to wear a helmet. Since I almost never wear…
Study Finds Alarming Increase In US Bicycle Accidents
June 1, 2017 by 1 Comment
–But doesn’t consider the public health benefits of cycling The problem: bicycle accidents in adults in the U.S. now cost more than $24 billion a year. The solution: more, not fewer, bikes! A new paper published in the journal Injury Prevention finds that the number and costs of bicycle accidents in the U.S. have risen…
Last Beats of the Failing Heart — Two Views
May 30, 2017 by 1 Comment
–Milton Packer and Richard Lehman compare perspectives, Part 3 Editor’s note: This is the third installment of an ongoing discussion about heart failure (HF) between Milton PackerMD, who has been leading major heart failure clinical trials for decades, and Richard Lehman, MA, BM, BCh, MRCGP, a retired U.K. GP who writes a blog for the…
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