November 12th, 2013
After Long Wait, Updated U.S. Cardiovascular Guidelines Now Emphasize Risk Instead of Targets
Larry Husten, PHD
Updated cardiovascular health guidelines were released today by the American Heart Association (AHA) and the American College of Cardiology (ACC). The guidelines are designed to provide primary care physicians with evidence-based expert guidance on cholesterol, obesity, risk assessment, and healthy lifestyle. The new guidelines reinforce many of the same messages from previous guidelines, but also […]
November 12th, 2013
Building Quality of Care for Adult Congenital Heart Disease Patients
Michelle Gurvitz, MD MS and Ariane Marelli, MD, FRCP(C), MPH
Michelle Gurvitz and Ariane Marelli discuss their study group’s development of the first set of quality indicators for adult congenital heart disease care.
November 11th, 2013
Selections from Richard Lehman’s Literature Review: November 11th
Richard Lehman, BM, BCh, MRCGP
This week’s topic is the association between testosterone therapy with mortality, MI, and stroke in men with low testosterone.
November 11th, 2013
Case: An Ironman with a Proximal Circumflex Lesion
John Ryan, MD, JAMES BECKERMAN, M.D. and James Fang, MD
A 48-year-old man who runs 4 to 6 Ironman races per year reports non-exertional chest pain and is referred for a stress echocardiogram. His two sisters suffered MIs and died in their fifties, and his brother underwent CABG at age 49. The patient goes for 17 minutes on the Bruce stress protocol, with lateral and anterolateral […]
November 9th, 2013
Yet Another Blow to Combination Renin-Angiotensin-Aldosterone System Blockade
Larry Husten, PHD
ACE inhibitors and angiotensin-receptor blockers have been found to effectively slow progression of kidney disease. It has been theorized that dual blockade of the renin-angiotensin-aldosterone system (RAAS) might prove even more beneficial, but these hopes have not been realized. Now a new trial published in the New England Journal of Medicine throws further cold water on the once-promising […]
November 7th, 2013
FDA Seeks to Eliminate Trans Fat from Food in the U.S.
Larry Husten, PHD
The FDA said today that it would begin to take efforts to remove trans fat from food in the U.S. The agency has made the “preliminary determination that partially hydrogenated oils (PHOs), the primary dietary source of artificial trans fat in processed foods, are not ‘generally recognized as safe’ for use in food.” If the FDA’s preliminary determination is made final then […]
November 7th, 2013
Internal Mammary Artery Grafting During CABG: How Common, How Effective?
Mark Hlatky, MD
Mark A. Hlatky discusses his research group’s analysis of the prevalence and effectiveness of internal mammary artery grafting during CABG procedures performed in Medicare patients.
November 6th, 2013
FDA Issues Recommendations on Spinal Catheters & Enoxaparin
Nicholas Downing, MD
The FDA is advising clinicians to “carefully consider” the timing of spinal catheter insertion and removal in patients taking low-molecular-weight heparins (e.g., Lovenox and generic enoxaparin), with an additional recommendation to delay dosing these drugs after catheter removal to lower the risk for spinal column bleeding and paralysis. Among the specific recommendations: Spinal catheter placement […]
November 6th, 2013
ACE Inhibitors, Angiotensin-Receptor Blockers Tied to Increase in Kidney Admissions
Nicholas Downing, MD
Increases in prescriptions for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in recent years may have contributed to an increase in hospital admissions for acute kidney injury, according to a PLoS ONE study. U.K. researchers examined national prescription and hospital admission data from April 2007 through March 2011. Nationwide, ACE-inhibitor and ARB prescriptions […]
November 6th, 2013
Perspective On the First New Atherectomy Device in 20 Years
Kush Agrawal, MD
The 2011 ACCF/AHA/SCAI PCI guidelines give rotational atherectomy (RA) a Class IIa LOE C recommendation as reasonable to use in cases where heavily calcified coronary lesions either cannot be crossed by a predilation balloon or if crossed cannot be adequately predilated prior to successful stent delivery. Furthermore, routine use of RA is Class III, contraindicated, […]