CardioExchange Archive

Cardiovascular risk assessment guidelines are not always in agreement and may not always be reliable, according to a systematic review published in the Archives of Internal Medicine. Only 16 of the 27 guidelines reported possible conflicts of interest and only 17 “showed considerable rigor.” In an accompanying comment, Sidney Smith wrote that future “progress will depend on our ability to develop guidelines that are free from external bias, an agreement on a definition for global cardiovascular risk that is broadly applicable, and the identification of target populations in terms that take into account important regional variations in risk and health care delivery.”“Two much sitting is bad for health.” That’s the message of a new report from Australia published online in Circulation. For every hour per day spent in front of the television researchers found an 11% increased risk of death from all causes. “The human body was designed to move, not sit for extended periods of time,” said the study’s lead author in an AHA press release.The New York City Health Department announced proposed targets for voluntary salt reduction in packaged and restaurant foods. A feature story in the the Wall Street Journal finds that food manufacturers are better able to successfully cut salt in their foods when it’s done quietly and gradually. The American Heart Association released a statement in support of the NYC effort, noting that because almost 80% of sodium intake is contained in packaged and restaurant food, “it is extremely difficult for individuals to limit sodium in their diet.”

The much-discussed IMPROVE-IT trial comparing the combination of ezetimibe and simvastatin with simvastatin monotherapy in 18,000 patients won’t be completed until June 2013, a year later than previously announced. (Merck press release and FAQ)

Another trial has found that statin therapy, this time using rosuvastatin 40 mg, was not beneficial in aortic stenosis. ASTRONOMER was published online in Circulation earlier this week. The authors conclude that “statins should not be  used for the sole purpose of reducing the progression of AS.”

Abbot announced today that it’s Xience V everolimus-eluting stent has been approved in Japan. (press release)

Cell magazine launched a beta test of an entirely new format for the presentation of scientific articles online. Is this the beginning of the end of print? Read a message from Cell’s editor-in-chief, or view an article in the new format.

Finally, to end the first week of 2010, you will never find a more succinct and humorous explanation of the important distinction between correlation and causation than this 3 panel cartoon. Enjoy.

The COMPARE trial, published online in the Lancet, found that everolimus-eluting stents outperformed paclitaxel-eluting stents. The COMPARE investigators “suggest that paclitaxel-eluting stents should no longer be used in everyday clinical practice.” CardioBrief has an interesting comment from David Kandzari.The FDA released briefing documents for Monday’s Cardiovascular and Renal Drugs Advisory Committee meeting to review a heart failure indication for nebivolol (Bystolic). In an unusual move, the FDA reviewers issued an unambiguous negative recommendation.Vivus, a small Biopharmaceutical company, announced positive results from a phase 2 trial showing that its much discussed obesity drug, Qnexa (phentermine and topiramate), significantly reduced the number of sleep apnea events. (Vivus press release)

In an NEJM perspective, four FDA officials review the sorry history of erythropoiesis-stimulating agents (ESAs) and call for randomized trials to establish “the optimal hemoglobin target, dosing algorithm, and monitoring approach” for these drugs. They also announce that the FDA intends to convene an advisory panel in 2010 “to reevaluate the use of ESAs in the treatment of anemia due to chronic kidney disease.”

One-quarter of US patients with vascular disease are not receiving aspirin for secondary prevention, according to a report by Chris Cannon et al from the REACH Registry published online in the American Journal of Cardiology.

The FDA gave guidance to ARYx Therapeutics (press release) on the development path for its anticoagulant tecarfarin, which stumbled last summer in a test against warfarin.

Clarke et al. provide convincing evidence that plasma Lp(a) lipoprotein is causally related to coronary artery disease. What’s needed next? First, we need to assess whether knowledge of Lp(a) lipoprotein concentrations improves predictive discrimination over more traditional risk factors. Second, we need an intervention that selectively lowers plasma Lp(a) lipoprotein concentrations and a randomized clinical trial to assess its efficacy. Of currently FDA-approved medications, niacin is the only agent that effectively lowers plasma Lp(a) lipoprotein concentrations. Is it time for a randomized trial of niacin in patients with elevated plasma Lp(a) lipoprotein concentrations?

I work largely in a county hospital, and so I see firsthand the negative effects of underinsurance. However, I confess that when I read the newspaper, I start with the sports page … and pretty much finish with the sports page (unless there is something juicy in the entertainment section).

One of my New Year’s Resolutions is to better understand the impact that the health care reform is likely to have on our hospitals and training programs, even if I have to read the front section of the paper! With some form of major health care reform legislation likely, I would like to learn from those of you who have followed this more closely than I have. What impact do you think this will have on fellowship training?

My friends in cardiology practices have already seen sizable salary reductions and claim that the reform bills will markedly reduce cardiology salaries even further. Do you agree? If so, would this affect the quality of the applicant pool?

I also wonder about the safety-net hospitals that are the basis of so many of our training programs. What potential effects (both positive and negative) on these institutions are we likely to see after a health reform bill passes?

In the “moderator recommends” box on the Fellowship Training Group home page, I show a few stories about health care reform. Please jump in and give us your perspective.

The VTACH trial of catheter ablation of VT prior to ICD implantation has been published in the Lancet. You can find summaries of the trial at Cardiosource, TheHeart.Org and MedPage Today.

The TRITON-TIMI 38 cost-effectiveness substudy of prasugrel vs. clopidogrel in ACS patients appears in Circulation. Lilly also issued a press release.

Two articles in the Wall Street Journal focus on the benefits of exercise:

The Hidden Benefits of Exercise: Even Moderate Physical Activity Can Boost the Immune System and Protect Against Chronic Diseases, by Laura Landro
Why You Should Step Up Yourk Workout, by Kevin Helliker (Article about Paul Williams, who has ignited controversy because of his strong emphasis on progressively greater health benefits with increased workloads of exercise.).

The Seeking Alpha blog discusses Pfizer’s Apo-A1 Milano flop, in which “Pfizer gets $0.01 billion back from its $1.25 billion investment.”

At the start of the year a far more stringent conflict-of-interest policy went into effect at Massachusetts General and Brigham and Women’s Hospital, according to a story in the New York Times. The new policy limits pay for top officials who serve as outside directors for companies and forbids any employee from accepting speaking fees from drug companies.
“We’re the first to go in this deep, and we’re still into it only up to our knees,” said Braunwald in the article. “In all fairness, what was O.K. three years ago is not O.K. now.”