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…
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…
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…
Study Fuels Debate Over When to Start Cholesterol Screening
May 15, 2017 by 3 Comments
–For younger adults, study finds low yield of 10-year risk-based screening A new study provides ammunition to supporters of a conservative approach to initiating cholesterol tests in younger adults. But proponents of a more aggressive approach argue that the interpretation does not take into account the enormous burden of cardiovascular disease as people grow older….
Statin Nation ‘Census’ Highlights Major Disparities
November 14, 2016 by Leave a Comment
–Women, minorities treated at significantly lower rates Anyone reading this is almost certainly aware of the enormous importance of statins in the current health scene. But until now they may have had a hard time to bring precise numbers and statistics to this all important story. Now data from a large federal survey confirm that…
No Cognitive Benefit from Heart Drugs in HOPE-3
November 13, 2016 by Leave a Comment
–Substudy finds mental function unimproved by BP, cholesterol treatments NEW ORLEANS — A large substudy of the HOPE-3 trial found no benefit relating to cognitive function in patients who took cholesterol or blood pressure-lowering drugs. In recent years cognitive decline and dementia have emerged as a concern equal if not even greater than cardiovascular disease…
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…
Statin Trialists Seek To Bury Debate With Evidence
September 8, 2016 by 14 Comments
–A Lancet review claims overwhelming evidence in favor of statins for both primary and secondary prevention. Some disagree. A large group of statin researchers argue forcefully that the debate over statins should be ended because the evidence in favor of statins is overwhelming and incontrovertible. But some outsiders say the issue is more nuanced and…
USPSTF Updates Aspirin for Primary Prevention Recommendation
April 11, 2016 by 1 Comment
–But many experts think the evidence base is slim at best. The U.S. Preventive Services Task Force (USPSTF) finalized the update to its guidelines regarding the use of aspirin for the primary prevention of cardiovascular disease and colorectal cancer. The USPSTF is now recommending that people between the ages of 50 and 59 who are at increased…
How Does HOPE-3 Change Thinking About Primary Prevention?
April 2, 2016 by 5 Comments
–The study lends strong support for statins but delivers a mixed message for antihypertensives. The widely reported results of HOPE-3 may bolster the case for primary prevention with statins and blood pressure drugs. But the trial also makes clear that the benefits, though real, are also modest, and may not be evenly distributed between statins…
Millions Of Americans Taking Aspirin When They Shouldn’t
January 12, 2015 by Leave a Comment
More than a third of US adults– more than 50 million people– now take aspirin for the primary and secondary prevention of cardiovascular disease. (Primary prevention is the prevention of a first event; secondary prevention is the prevention of a recurrent event.) Although it was once broadly recommended, because of the increased risk of bleeding…
Large Japanese Trial Casts Further Doubt On Aspirin To Prevent A First Heart Attack
November 17, 2014 by Leave a Comment
Although once quite popular, the use of aspirin to prevent a first heart attack has grown less popular in recent years as evidence has accumulated that the small benefits are outweighed by the increased risk of bleeding. Now a large trial from Japan has once again failed to provide any evidence to support the use…
BMJ Articles Critical Of Statins Provoke Kerfuffle
May 14, 2014 by Leave a Comment
The authors of two BMJ articles have withdrawn statements about the adverse effects of statins. The two papers inaccurately cite an earlier publication and therefore overstate the incidence of adverse effects of statins. As a result, the two papers have drawn much criticism and set off a kerfuffle involving the editor of BMJ and a prominent British trialist who is demanding…
FDA Comes Out Against Aspirin To Prevent First Heart Attacks
May 5, 2014 by 1 Comment
In the latest development in a long-simmering debate, the FDA has announced that aspirin should not be marketed for the prevention of a first heart attack or stroke in people with no history of cardiovascular disease. The announcement follows FDA’s rejection on Friday of Bayer Healthcare’s decade-old petition requesting approval of a primary prevention indication. [PDF of FDA rejection letter]…
Reassuring News About Statins From Two Very Different Studies
March 14, 2014 by Leave a Comment
Although clinical trials have consistently demonstrated the benefits of statins, the perception that the drugs can cause serious side effects has prompted some patients to discontinue or not take the drugs. Now two new very different studies, one a large meta-analysis and one a tiny study with only a handful of patients, provide some convincing reassurance…
Low Rate Of Problems With Statins In Study Of Quarter Million Patients
July 9, 2013 by 1 Comment
A very large analysis of previously published studies finds that statins are generally safe and well tolerated, but helps confirm previous links to a small increased risk for diabetes and elevation of liver enzymes. Some statins were better tolerated than other statins and lower-dose statins were better tolerated than high dose statins. In a paper published…
UK Study Casts Doubts On Value Of Type 2 Diabetes Screening
October 4, 2012 by Leave a Comment
The dramatic growth in type 2 diabetes has resulted in increased interest in screening programs. Now a new study published in the Lancet raises concerns that screening programs may not result in long-term improvement in outcomes. In the ADDITION-Cambridge study, investigators in the UK randomized general practices to either screening or no screening. The practices allocated to…
Real World Bleeding Risk Of Aspirin In Primary Prevention Examined
June 6, 2012 by Leave a Comment
A new study published in JAMA provides substantial new evidence about the real world effects of aspirin, including the risk of bleeding, in a broad population. The study also sheds important new light on the effects of aspirin in a diabetic population. Giorgia De Berardis and colleagues analyzed data from more than 4 million people in…
Fascinating Debate Over Statins For Primary Prevention
May 30, 2012 by 2 Comments
The recent guest post by David Newman has prompted several thought-provoking comments. Since most readers will likely miss the comments, I’ve moved these comments to a separate post. Statin Island May 27, 2012, 3:35 PM: Thank you. Clearly, this important commentary raises questions about the integrity of Lancet as well as the authors of the study. But…
Meta-Analysis Adds New Evidence For Cancer Benefits Of Daily Aspirin
March 20, 2012 by 1 Comment
Although daily aspirin was originally proposed to reduce cardiovascular events, the effects on cancer of daily aspirin have become increasingly apparent while the vascular benefits, especially in primary prevention, have become less clear. Now a new meta-analysis in the Lancet adds significantly new details to our understanding about the effects of aspirin and increases the…
Guest Post: Another Round in the Debate on Diabetes and Statins
March 6, 2012 by 4 Comments
Another Round in the Debate on Diabetes and Statins by Roger Blumenthal Let me start by saying that I am proud to have Eric Topol as a friend and a trusted advisor over the past 20 years. His work has been an inspiration to cardiovascular health professionals for several decades. His new book, The Creative Destruction…
Eric Topol, Megamind
March 5, 2012 by 2 Comments
Ralph Waldo Emerson famously wrote that “a foolish consistency is the hobgoblin of little minds.” If this is true then Eric Topol, who earlier today wrote a New York Times editorial highly critical of statins, is Megamind. Here’s what he wrote in a 2004 editorial in the New England Journal of Medicine: Even today, only a…
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