–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…
Diving Deep Into The ORBITA Trial
November 2, 2017 by 3 Comments
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….
Small Trial Raises Big Concerns That PCI In Stable Angina Is Just A Placebo
November 2, 2017 by 5 Comments
ORBITA trial may spark a heated debate in the cardiology community. It is only a small trial but it may have an enormous impact as it raises major questions about one of the core beliefs of clinical cardiology as it suggests that PCI for stable coronary disease has no more effect than a sham procedure….
New And Improved LDL Lab Numbers
October 27, 2017 by 5 Comments
–Lab companies start reporting more accurate LDL cholesterol measurements. The LDL cholesterol number, which has been the obsessive focus of physicians and patients for several decades now, is getting a major upgrade. A new and improved method to calculate the LDL cholesterol number is starting to filter into standard laboratory reports. Until now LDL cholesterol,…
Blacks Face Higher Mortality from Heart Disease, Stroke
October 23, 2017 by 1 Comment
–CV disease accounts for large portion of health disparities. Cardiovascular disease led to the loss of more than 2 millions years of life in the African-American population between 1999 and 2010. A new scientific statement from the American Heart Association, Cardiovascular Health in African Americans, makes clear that, compared to whites, African Americans suffer disproportionately…
Imaging Studies Offer New Insights Into Inflammation In CV Disease
October 19, 2017 by 2 Comments
–Preliminary evidence that colchicine may reduce coronary plaque. Interest in inflammation has risen considerably in the cardiology community as a result of the recent CANTOS trial. The large 10,000 patient trial validated the role of inflammation by demonstrating the efficacy of canakinumab— a monoclonal antibody that targets interleukin-1β— in reducing cardiovascular events in people with…
New Anticoagulants Not Linked To Excess Bleeding Rates
October 17, 2017 by 1 Comment
–Observational study compares new anticoagulants to warfarin in VTE population. In clinical trials the new oral anticoagulants (NOACs) have been shown to have similar efficacy and safety compared to warfarin, but questions have been raised about whether the results are similar in real world settings. Now a new observational study lends some measure of reassurance…
Why Do Doctors Still Rely On LDL Instead Of Non-HDL Cholesterol?
October 15, 2017 by 4 Comments
–There’s broad agreement that non-HDL is a better measure than LDL. For decades lipid experts have been saying that non-HDL is preferable to LDL cholesterol in the assessment of cardiovascular risk. The subject is not controversial. Although they may disagree about its precise significance, every expert I contacted agreed that non-HDL is superior to LDL….
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…
Genotyping Reduces Adverse Events with Warfarin
September 26, 2017 by 1 Comment
–But still unclear whether benefit justifies the cost. Because its effects can be highly variable, warfarin is a notoriously difficult drug to administer. In recent years warfarin has resulted in more medication-related visits to emergency departments among older patients than any other drug. Researchers have long hoped that genotype-guided dosing of warfarin might reduce the…
Stopping Aspirin Hikes CV risk
September 25, 2017 by Leave a Comment
–37% increase in events seen after discontinuation in Sweden People who quit taking aspirin have an increased risk for a cardiovascular event, a large national registry has shown. The use of aspirin for primary prevention against cardiovascular disease has fallen from favor in recent years but aspirin for secondary prevention is still broadly popular and…
Benefits Of Physical Activity Seen Worldwide
September 21, 2017 by 1 Comment
–Latest findings from the influential PURE study Observational studies have consistently established a link connecting physical activity and cardiovascular health, but the vast majority of this research has occurred in high-income countries, where physical activity is often recreational. Now the latest report from an enormous worldwide observational study offers powerful evidence that the connection exists…
Cardiology Is Dead. Long Live Public Health.
September 7, 2017 by 8 Comments
Cardiology is dead. Here’s two new important pieces of evidence: The FDA’s Cardiovascular and Renal Drugs Advisory Committee hasn’t met since April 2015, and even then it was for the decidedly uninspiring drug cangrelor. And the committee has no meetings scheduled for the rest of this year. Take a look at the list of late-breaking…
SPRINT Substudy Detects Mortality Signal
August 29, 2017 by 1 Comment
–Aggressive blood pressure lowering may sometimes be deadly. BARCELONA — A new examination of data from the SPRINT trial raises the fear that adopting the aggressive blood pressure target of 120 mm Hg in some hypertensive patients with baseline BP of 160 mm Hg or more may increase the risk of death. Tzung-Dau Wang, MD,…
Renal Denervation Resurrected With Modest BP Reduction
August 28, 2017 by Leave a Comment
–Preliminary results from SPYRAL HTN-Off Med BARCELONA – Renal denervation is back from the dead, but only as a faint shadow of its former self. Initial interim results of the SPYRAL HTN-Off Med study suggest that the new and improved version of renal denervation (RDN) produces a real but very modest reduction in blood pressure….
CANTOS Validates Role Of Inflammation In Heart Disease
August 27, 2017 by 8 Comments
–Modest treatment effect of canakinumab may limit clinical role in heart disease, but strong anti-cancer signal sparks interest. Despite questions about its clinical importance, the CANTOS trial is being hailed by experts for finally validating the role of inflammation in heart disease. The cardiovascular benefits in the trial were real but modest. Even more exciting,…
New Economic Analyses Fail To Make Case For PCSK9 Inhibitors
August 23, 2017 by 1 Comment
(Updated) –PCSK9 inhibitors have ‘the dubious distinction of being the most expensive preventive therapies by far in the history of cardiovascular medicine’ Two new economic analyses conclude that PCSK9 inhibitors are far too expensive to be cost effective. Both studies incorporate data from FOURIER, the first and still the only large cardiovascular outcomes trial with…
Big Mismatch In Risk Perception Between Heart Failure Patients and Their Physicians
August 17, 2017 by 4 Comments
There’s a big discrepancy between the way patients with “advanced” heart failure view themselves and the way their doctors view them, a new study published in JACC: Heart Failure shows. In a cohort of 161 ambulatory patients with advanced heart failure, physicians categorized 111 patients (69%) as being at high risk for urgent transplant, LVAD,…
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….
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)…
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