December 30th, 2011
CYP2C19 Genotyping: Down For The Count?
Richard A. Lange, MD, MBA and L. David Hillis, MD
The controversy over the use of genetic testing to guide antiplatelet therapy reminds us of a WWF (Worldwide Wrestling Federation) tag team match. What we agree upon (the match rules): Clopidogrel is a prodrug activated by several enzymes, including CYP2C19, and common genetic variations alter CYP2C19 activity. Here’s where the wrestling match begins: Are the CYP2C19 genetic […]
December 29th, 2011
J&J Applies for ACS Indication for Rivaroxaban (Xarelto)
Larry Husten, PHD
Based on the promising results of the recently published ATLAS ACS 2 TIMI 51 trial, Johnson & Johnson has submitted a supplemental new drug application to the FDA for the approval of rivaroxaban (Xarelto) to reduce the risk of thrombotic cardiovascular events in ACS patients. Following a succession of failed trials, ATLAS was the first trial […]
December 28th, 2011
No Mortality Benefit of Low-Molecular-Weight Heparin in Acutely Ill Patients
Larry Husten, PHD
Although venous thromboembolism (VTE) is a serious problem for acutely ill patients in the hospital, a new study published in the New England Journal of Medicine failed to find any improvement in mortality associated with thromboprophylaxis. Ajay Kakkar and the LIFENOX investigators randomized 8307 acutely ill patients to receive enoxaparin or placebo for 10 days. All patients wore […]
December 27th, 2011
Possible Role for New Troponin Test to Diagnose MI
Larry Husten, PHD
A new study from Germany provides evidence that a new high-sensitive troponin I (hsTnI) assay may improve and speed the early diagnosis of acute MI. In an article published in JAMA, Till Keller and colleagues report on 1818 patients with acute chest pain in whom numerous biomarker tests were conducted at admission and at 3 and […]
December 27th, 2011
Clopidogrel Testing Comes Under Fire
Larry Husten, PHD
The phenomenon of clopidogrel resistance has been much discussed, but no consensus has emerged about the best, or any, response to the problem. Now a review published in JAMA finds no clinically relevant relationship between the CYP2C19 genotype and cardiovascular events. Michael Holmes and colleagues performed a meta-analysis of 32 studies involving CYP 2C19 genotyping and more […]
December 22nd, 2011
Chest Pain Is Where Protocol-Driven Medicine Breaks Down
CardioExchange Editors, Staff
This post is from Shadowfax, an ER physician and administrator living in the Pacific Northwest.
December 22nd, 2011
A New Brave New World? Impact of Technology on Fellowship Training
John Ryan, MD
Last week, CardioMEMS failed to get approval from an FDA advisory panel for treating heart failure based on uncertainty regarding the benefit; the advisory panel also raised concerns about study bias. This intracardiac device measures pulmonary artery pressures that clinicians can use (in addition to other clinical signals, such as weight gain) to select therapies […]
December 21st, 2011
Study Examines Changes in Resting Heart Rate Over Time
Larry Husten, PHD
Although resting heart rate (RHR) has been long known to be associated with cardiovascular risk, change in RHR over time has not been well studied. A new paper from Norway published in JAMA demonstrates that an increase in RHR over 10 years helps predict the risk of all-cause and ischemic heart disease (IHD) death. Javaid Nauman and colleagues […]
December 20th, 2011
22 Years Later, Study Shows Life-Prolonging Effect of Antihypertensive Therapy
Larry Husten, PHD
After more than 20 years, the benefits of antihypertensive therapy are still evident, according to a new paper published in JAMA. John Kostis and colleagues performed a 22-year follow-up study on patients enrolled between 1985 and 1988 in the Systolic Hypertension in the Elderly Program (SHEP) trial. In 1991, SHEP found that low-dose chlorthalidone in 4736 elderly patients with […]
December 20th, 2011
ALTITUDE Study of Aliskiren Terminated Early by Novartis
Larry Husten, PHD
Novartis announced today the early termination of the ALTITUDE trial, which was testing the effect of the direct renin inhibitor aliskiren (Tekturna, Rasilez) in patients with type 2 diabetes and renal impairment at high risk for cardiovascular and renal events. The action was based on the recommendation of the independent Data Monitoring Committee, after it found […]