–More questions raised about broad efforts to restrict salt; AHA condemns study A large new analysis offers more evidence that broad salt restriction doesn’t benefit most people and may even harm some people. The study did find that salt restriction may be beneficial to the minority of people with high blood pressure who also consume…
Study Suggests Salt Restriction Only Beneficial In People With Hypertension
May 22, 2016 by 3 Comments
Entresto Gets Boost in Updated HF Guidelines
May 20, 2016 by 1 Comment
–Valsartan/sacubitril earns Class I recommendation Cardiology groups in the U.S. and Europe have updated their heart failure guidelines to include much-awaited recommendations for Entresto (the combination of valsartan and sacubitril manufactured by Novartis). The new guidelines offer broad support for the new drug. Since its approval last summer Entresto has struggled to gain a foothold…
New Cardio Drugs Off To Very Slow Start
April 27, 2016 by Leave a Comment
–Heart failure experts divided over how and when to use Entresto To many long-time observers, the approval last year of two new cholesterol drugs and a heart failure drug appeared to herald a rebirth of the cardiovascular marketplace after a long period of dormancy. But so far in 2016, those new drugs have hardly made…
FDA Expands Metformin Label
April 10, 2016 by Leave a Comment
— The diabetes drug can now be used in more patients with reduced kidney function The FDA on Friday greatly expanded the indication for the type 2 diabetes drug metformin. Until now use of metformin in patients with reduced kidney function had not been recommended. The new label states that metformin “can be used safely…
How Should SPRINT Influence High Blood Pressure In Children And Adolescents?
March 28, 2016 by 2 Comments
–Editorialists say pediatric hypertension in children is ready for a ‘paradigm shift’ Last year’s influential— and highly controversial— SPRINT trial should be used to better inform and influence our understanding and management of hypertension in children, write two influential physicians who have played a key role in the cardiovascular guidelines for children and adolescents. They…
Top HF Expert Decries ‘Unbelievable Folly’ of Clinical Trials and Guidelines
March 23, 2016 by Leave a Comment
–Milton Packer, MD, calls the system to test and evaluate heart failure drugs dysfunctional The system is completely broken, writes heart failure specialist Milton Packer, MD, in an editorial in Circulation: Heart Failure. The results of important clinical trials are not being incorporated into guidelines quickly, intelligently, or consistently, Packer argued. The most important reason…
Why Guidelines Are Bad For Science
January 21, 2016 by 2 Comments
Bad guidelines don’t just give bad advice. They also harm science and impede research. The new US Dietary Guidelines– which I’ve already called a recipe for disaster— are a perfect example of why we need to have fewer, shorter, and, crucially, better guidelines. Back in 2014, in response to the controversy over salt guidelines, I…
Recipe For Disaster: The New US Dietary Guidelines
January 18, 2016 by 4 Comments
The science of nutrition is a disaster. For a variety of very good reasons it is nearly impossible to perform high quality, long term randomized controlled trials to provide satisfactory answers to most of the pressing questions of the day. But many experts are convinced they do know the answer to many of these questions….
Paper Raises More Questions About Salt Restriction In Heart Failure
December 28, 2015 by 6 Comments
Sodium restriction is a cornerstone of heart failure management, but many people would be surprised to learn that there is no good supporting evidence for the practice. In the 2009 heart failure guidelines sodium restriction in heart failure received a Class I recommendation (recommended), but this was based only on expert consensus (a C level of evidence of…
Lancet Sprints To The Front With A Blood Pressure Meta-Analysis
November 6, 2015 by 1 Comment
A new meta-analysis published in the Lancet on Friday lends fresh support to calls for more intensive blood pressure treatments. The publication comes only days before the highly anticipated presentation of the NIH’s SPRINT trial at the American Heart Association, which is also expected to offer support for stricter blood pressure control. Blood pressure goals were relaxed after the ACCORD…
Slow Start For New Novartis Heart Failure Drug Entresto
November 2, 2015 by 1 Comment
Initial sales of Entresto (the combination of sacubitril and valsartan, formerly known as LCZ696) have been slow. In the first few months after its approval in July the drug only had $16 million in sales, the drug’s manufacturer, Novartis, reported last week during its quarterly earnings report. The novel heart failure drug is widely expected to be…
Primary PCI Guideline Update: Multivessel Interventions In, Thrombectomy Out
October 21, 2015 by Leave a Comment
The guidelines for primary PCI for ST-elevation MI (STEMI) have been updated to reflect major findings from recent trials: PCI of a noninfarct artery is now acceptable for some STEMI patients with multivessel disease. In previous guidelines PCI of noninfarct arteries had been considered unsafe. Routine thrombectomy prior to primary PCI for stent implantation is now…
Heart Failure Experts SPRINT To An Early Finish
October 7, 2015 by Leave a Comment
According to a recent news report a group of prominent heart failure doctors have eagerly embraced a lower blood pressure target of 120 mm Hg for heart failure patients based on the preliminary results of the SPRINT trial announced last month. But another equally prominent heart failure doctor says that it is far too early to…
SPRINT Trial To Be Presented At The American Heart Association Meeting In November
September 29, 2015 by Leave a Comment
Update: I have now received confirmation that SPRINT will be presented on Monday, November 9 at 2 PM. The SPRINT trial, which provoked a storm of excitement and controversy a few weeks ago, will be presented in November at the American Heart Association meeting in Orlando. The trial is not currently on the list of late-breaking clinical trials but…
BMJ Paper Criticizes Proposed US Dietary Guidelines
September 24, 2015 by 2 Comments
Once again experts are passionately disagreeing about the proper role of saturated fats and carbohydrates in the diet. The latest volley comes from a full-scale critique published in the BMJ of proposed new US dietary guidelines. The author of the critique, Nina Teicholz, is the author of The Big Fat Surprise: Why Butter, Meat, & Cheese Belong in a Healthy Diet. In both the…
NIH Trial, Stopped Early, Supports More Intensive Blood Pressure Targets
September 11, 2015 by Leave a Comment
More stringent blood pressure targets could save lives and reduce cardiovascular events, according to preliminary results from a large NIH clinical trial that was stopped early. The SPRINT (Systolic Blood Pressure Intervention Trial) trial randomized 9,361 hypertensive patients 50 years of age or older to the standard systolic blood pressure target (when the trial began) of 140…
Doctors Halt Squabbling And Agree How To Manage Hypertension In People With Blocked Arteries
March 31, 2015 by Leave a Comment
There’s been a lot of drama in the hypertension field over the past few years. Initially sparked by the decision of the National Institutes of Health to end its sponsorship of national guidelines, the subsequent appearance of multiple guidelines with divergent recommendations led to even more controversy and discussion. Now, however, the appearance of a new scientific statement…
More Guideline Controversy: The Tricky Business Of Calculating Cardiovascular Risk
February 17, 2015 by Leave a Comment
Calculating cardiovascular risk has become a central and highly controversial component of cardiovascular guidelines. Now a study in the Annals of Internal Medicine finds that most of the commonly employed tools seriously overestimate the risk of people today. … Click here to read the full post on Forbes….
New US Guidelines Will Lift Limits On Dietary Cholesterol
February 10, 2015 by Leave a Comment
The influential Dietary Guidelines Advisory Committee has recommended that limitations on dietary cholesterol be removed from the upcoming 2015 edition of Dietary Guidelines for Americans. Recommendations to reduce dietary cholesterol have been a mainstay of the USDA and other guidelines for many years, starting with guidelines from the American Heart Association in the 1960s. … Click here to read…
Another Study Raises Questions About Blood Pressure Guidelines
February 10, 2015 by Leave a Comment
Although the general benefits of lowering high blood pressure are widely accepted, there has been intense debate over specific goals for treatment and the threshold at which therapy should be initiated. A large new meta-analsysis published in JAMA helps shed lights on this important controversy. UK and Australian researchers analyzed the effect of lowering blood pressure in people…
Salt, Science, And The American Heart Association’s Double Standard
January 23, 2015 by Leave a Comment
Once again the American Heart Association is sticking by its recommendation that pretty much everyone should consume no more than 1,500 milligrams of sodium each day. This is dramatically lower than the 3,500 mg/d the average American now consumes. In a blog post reprinted on MedPage Today the president of the American Heart Association, Elliott Antman, assails a study published earlier this week which found no…
How Much Salt Should Old People Consume?
January 19, 2015 by Leave a Comment
A new study offers fresh evidence that current salt recommendations should be taken with, well, a grain of salt. Current guidelines now recommend that everyone should have sodium intake levels below 2300 mg per day. For many people at higher risk, including everyone over 50 years of age, sodium intake should be below 1500 mg/d….
Another Diet Myth Exploded: Gradual Weight Loss No Better Than Rapid Weight Loss
October 15, 2014 by Leave a Comment
Once again, a popular weight loss myth has been exploded. It has been widely believed that weight loss, which is nearly always difficult to maintain, is even less likely to stay lost if it is the product of a rapid weight loss. The belief is even enshrined in current guidelines. Now a study published in The Lancet…
A ‘Disappeared’ Article, Finally Published, Finds A Desultory Response To Scientific Misconduct
September 23, 2014 by Leave a Comment
Back in January an article in the European Heart Journal raising the disturbing possibility that guidelines based on fraudulent research may have been responsible for as many as 800,000 deaths was “disappeared” from the journal’s website only minutes after being published. The journal’s editor claimed the article had not been properly peer reviewed. In its place the editors published an editorial refuting…
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