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FDA advisors recommend approval of obesity drug Qnexa
Specifically, the panel voted 20 to 2 in favor of approving Qnexa, this despite protracted discussion about the potential adverse effect of the drug on heart rate and concerns over a risk of birth defects in mothers taking the phentermine/topiramate combination.
Scar on MRI portends poor outcome in viral myocarditis
Viral myocarditis has a mortality of almost 20% within five years of follow-up, a new study of patients with biopsy-proven disease illustrates. And among sufferers, those with late enhancement on magnetic resonance imaging had the worst prognosis, the researchers found.
Interventional live case demos are safe, small study shows
Some physicians and regulators have questioned whether live video presentation of procedures at professional education meetings compromises the safety of the procedure, but there are not yet much data on the outcomes of these cases.
Montreal cardiologists accused of taking bribes from patients
A Montreal newspaper reports that giving doctors cash for preferential treatment is somewhat of a regular practice and an "open secret."
AV nodal ablation ups survival in AF patients with CRT
Catheter ablation also seemed to improve NYHA functional class, but not contractile function, in patients with atrial fibrillation receiving device therapy for heart failure.
Is new gene analysis the final chapter in the homocysteine saga?
An international group of distinguished researchers says newly examined, unpublished genetic data provide final proof that homocysteine does not cause coronary heart disease and therefore reducing levels of this amino acid with folate would have no effect. But another expert disagrees.
Six of seven guideline-recommended HF therapies lower mortality at two years
Results of a new study reinforce the importance of adhering to the clinical guidelines, investigators say, stressing the implications of their findings: there is nowhere else in cardiovascular medicine where clinicians can achieve incremental reductions in the range of 80% to 90%.
Young women with MI most likely to have no chest pain
A new analysis of the NRMI registry also finds that women under 55 have the highest risk of death after MI.
Detailed family history improves cardiovascular disease risk assessment
Compared with clinical practices that used traditional risk-assessment models, the systematic collection of a family history identified an additional 5% at high cardiovascular disease risk, according to researchers.
Crossing tricuspid-valve bioprosthesis with pacer/ICD lead generally safe
Some data show a risk of complications in native tricuspids crossed with a lead, but a new retrospective study is the first to look at such risks with bioprosthetic valves.
Resolute zotarolimus stent approved in US
The FDA has approved the new Resolute Integrity zotarolimus-eluting coronary stent, the first DES approved by the regulatory body for use in patients with diabetes, who account for one-third of the nearly one million PCIs performed annually in the US.
Pregnancy complications up CVD risk by 30%
A new study is helping to tease out the contributions of different pregnancy complications to future CVD risk in women; the results show that the mechanisms linking each condition to CV risk likely differ.
EMA: New aliskiren restrictions and decisions on aprotinin, orlistat
The European Medicines Agency's Committee for Medicinal Products for Human Use recommended lifting the suspension on aprotinin, adding new warnings on aliskiren products, and supporting orlistat for some patients, among other opinions issued at its February meeting.
Ten-month Medicare "doc fix" passes Congress, heads for White House
Although it averts a 27.4% Medicare pay cut for physicians set for March 1, the latest doc fix seems to leave everyone unhappy, especially physicians.
Mutations in giant gene a major cause of familial DCM
They probably account for more than a fifth of idiopathic dilated-cardiomyopathy cases, say researchers, pioneers of genetic variation in a massive protein that is a major player in myocardial contraction.
CardioGen-82 returns to market
For its return, the FDA-approved revised labeling for CardioGen-82 includes a new boxed warning. The label warns of unintended radiation exposure when levels of Sr-82 and Sr-85 in the rubidium Rb-82 chloride injection exceed limits.
Exercise, regardless of amount of sedentary time, improves risk factors in kids
Researchers say that children should be encouraged to increase their participation in moderate to vigorous physical activity rather than decrease the amount of time they spend sedentary, as this appears more important in relation to cardiometabolic health.
Stem-cell therapy still needs a lot more study
Stem-cell therapy could regenerate infarcted myocardium, but most of the trials have been small. A new review evaluates the evidence from randomized trials of adult bone-marrow-derived stem cells to treat acute MI.
New ACCP thrombosis guidelines offer weak support for aspirin in primary prevention
UPDATED // In a new development, the guidelines committee was headed by clinicians who specialized in interpretation of clinical trials rather than opinion leaders in the antithrombotic field, which has led to less strong recommendations for antithrombotic therapy than before.
Short-term exposure to air pollutants ups MI risk: Meta-analysis
Of six individual air pollutants, only one didn't seem to raise the risk of MI at exposures of up to a week, according to a meta-analysis.
Vitamin D in CKD: No benefit for CV function, structure
The findings are important, given the prevalence of vitamin-D deficiency in this group of patients, researchers say.
Cardiac stem-cells increase viable myocardium post-MI: CADUCEUS
Researchers and other experts in the field of cardiac regeneration research are excited by the small, phase 1 study, which showed scar to be reduced on cardiac imaging at the same time that viable myocardial mass was increasing, over six and 12 months.
No cancer protection with vitamin B or omega-3 fatty-acid supplements
The investigators did observe a statistically significant interaction by sex, however, with women taking omega-3 fatty acids at an increased for cancer. They caution, however, that the results might be due to chance, given the few cancer cases and cancer deaths that occurred in women treated with the supplements.
Fidelis failures climb: "Strongly consider" replacement at ICD change-out
It may be a good time to replace patients' Medtronic Sprint Fidelis leads, which were recalled due to an increased fracture risk, if they are getting new ICD generators anyway—even if the Fidelis hasn't shown signs of trouble, a group recommends.
New mitral-repair therapies face obstacles
Why has the development of less invasive mitral-valve repair therapies lagged so far behind comparable strategies to treat the aortic valve? Experts from FDA, industry, and academic medical centers offered some possible answers in a roundtable discussion.
More doctors advising patients to exercise
In 2010, one in three patients who visited a physician or other health professional had been told to start or maintain physical activity or exercise.
More hope for factor Xa reversal
A new study has suggested that the anticoagulant effects of edoxaban could be reversed by several hemostatic agents currently used to control excessive bleeding in other situations.
The doctor will see you now (from the other side of the world)
A unique "medical mission" using handheld echo in a remote rural population in India is being hailed as a success after cardiologists around the globe logged on over a two-day period to read the echocardiograms of unseen patients half a world away.
US judge upholds FDA approval of generic enoxaparin
Sanofi-Aventis had sued the agency in 2010, saying it had failed to follow its own rules and had not appropriately established that a generic drug made by a rival company included the same active ingredient as Lovenox.
Biomarker may distinguish ICH from ischemic stroke
The test might eventually be applied at the point of care to help triage patients for treatment.
Over 1300 deaths in Mediator scandal in France
The number of deaths attributable to heart-valve insufficiency as a result of the use of benfluorex in France is likely more than double that previously thought, a new investigation finds.
Referring MDs fall short on ICD-indication guidelines
A lot of generalists and some cardiologists apparently don't know some of the fundamental criteria for indication of a primary-prevention device and so may not be referring all patients who might benefit, a survey suggests.
Apixaban superior for AF patients with previous stroke, TIA
Substudies of the ARISTOTLE and AVERROES trials find apixaban is safe and effective for patients with previous events vs warfarin and aspirin respectively.
Ten foods provide half of sodium eaten in US
New estimates of salt consumption from a recent US survey show that 10 food groups provide almost half of the dietary sodium consumed in the country and that 90% of individuals eat more than the recommended daily amount of sodium.
Like father, like son: Y-chromosome variant may explain CAD
New genetic work has unveiled an association between some lineages of the relatively empty male Y chromosome and coronary artery disease. The hypothesis, while "intriguing," requires more research to confirm, says one expert.
Wide variation in PCI for "unclear indications"
The latest study on this subject has found that 17% of hospitals in a large US sample conducted at least one-fifth of their procedures in patients whose indications for the procedure were unclear.
PCI appropriateness criteria draw criticism
A detailed critique of the national appropriate-use criteria for PCI—questioning the composition of the committee that wrote the criteria, some of the AUCs themselves, and the survey that compared the AUC with current clinical practice—has been published.
More bleeding, thromboembolic events with dabigatran in AF ablation
Dabigatran was stopped the morning of the procedure; its long half-life combined with the use of unfractionated heparin during the procedure likely explains the increased risk of bleeding.
For stroke risk, look for novel lipid/lipoprotein biomarkers
Women with triglyceride levels in the highest quartile had a significant 56% increased risk of stroke compared with women in the lowest quartile. Similarly, for women with highest quartile of VLDL particle size and IDL particle number, there was a significant 59% and 46% increased risk of ischemic stroke compared with women in the lowest quartile.
Braile Biomédica launches transapical valve
A Brazilian group says they're encouraged by the early results with their transapical transcatheter aortic valve.
Wake-up stroke patients may still benefit from thrombolysis
A new study shows tPA was safe for patients who woke up with stroke symptoms, a population not normally treated since they could exceed the 4.5-hour window.
Generalists need education on HF treatment
A unique study trying to drill down into why cardiologists seem to gain better outcomes than generalists when treating heart failure has identified a number of reasons that this is the case. But generalists—who treat the majority of HF—have to deal with older and sicker patients, confounding the issue. The authors hope the work will act as a catalyst to improve HF care.
SWITCH III: Bivalirudin is as safe as heparin after fondaparinux in PCI patients
Recent studies have shown that ACS patients on fondaparinux prior to PCI should switch to another anticoagulant prior to the procedure to avoid thrombus. The SWITCH III trial compares bivalirudin and unfractionated heparin in a small group of these patients.
TRA 2°P: Vorapaxar meets end point but ups bleeding
In its second phase 3 trial, Merck's novel antiplatelet agent reduced ischemic events but increased bleeding, including ICH. Results looked more promising in patients without a history of stroke.
CTO, even in non-infarct-related artery, bodes ill in NSTEMI patients
Swedish researchers examined SCAAR to determine the prognostic significance of a chronic total occlusion in an artery other than the infarct-related one of non-ST-elevation-MI patients.
ICDs charged with sex discrimination: Women get fewer shocks
Differences in appropriate-therapy and device-related complication rates in a prospective study question (once again) whether women and men should have the same ICD-eligibility criteria.
Fitness and fatness independently linked with CVD risk factors
Individuals should be aware that exercising can have positive health effects, even if the weight doesn't necessarily come off, as can losing weight alone, researchers say, although the ideal combination is to improve fitness and lose fat.
MI-shock proposal is cold comfort: Hypothermia might boost survival
Some data suggest therapeutic hypothermia might reduce the currently high mortality from cardiogenic shock; let's do the necessary clinical studies to see whether it might be true, urges a published viewpoint.
Dr Paolo Raggi joins University of Alberta
Dr Paolo Raggi has been named the academic director of the Mazankowski Alberta Heart Institute at the University of Alberta in Edmonton and chief of cardiology at Alberta Health Services.
Lower mortality in NFL players—if weight is kept in check
The reduction in mortality and cardiovascular disease was observed in the smaller players—defensive backs, quarterbacks, and wide receivers, as well as fullbacks, halfbacks, and running backs, among others. For the true giants of the gridiron, the linemen, cardiovascular disease mortality was not significantly reduced compared with the US population.
KEEP: Focus on CKD patients with highest SBP
A new, contemporary study in real-world patients with chronic kidney disease finds that those with systolic BPs of 140 mm Hg and higher are at the greatest risk of developing end-stage renal disease. Hence the current "goal" in CKD patients of 130 mm Hg should be revised upward, say the authors, making the target easier to achieve and allowing physicians to focus on other aspects of care.
"Irrational" choices stall adoption of new antiplatelets
Dr David Cohen points out some of physicians' potential "psychological" barriers to more rapid adoption of new antiplatelet agents, even though they may be the best choice for their patients.
Sitagliptin/metformin once-daily combo approved for diabetes
The extended-release combination of sitagliptin and metformin joins saxagliptin/metformin as a once-daily tablet for type 2 diabetes.
No recurrent stroke prevention seen with clopidogrel plus aspirin
A new study shows that the combination of clopidogrel and aspirin increases risk of hemorrhage and mortality, including nonvascular mortality, vs aspirin alone.
Heart failure linked to loss of brain gray matter
Heart failure is associated with a decline in mental function and loss of gray matter in the brain, which may make it more difficult for patients to follow instructions regarding their medication, a new Australian study has found.
Photos on school lunch trays boost veggie intake
A simple intervention, whereby photographs of green beans and carrots were placed in lunch trays in a school cafeteria, has had some success in boosting consumption of these vegetables among elementary schoolchildren.
Aspirin as effective as warfarin in heart failure: WARCEF
Although there was an edge for warfarin for those treated for four or more years, there is "no compelling" reason to anticoagulate these patients, researchers say.
"Tetherless" power-transmission technology could radically change LVAD therapy
New wireless technology used to power implantable ventricular assist devices has the potential to make them far safer than ever before and bring the therapy to patients at earlier stages of heart failure than are currently recommended.
CMS draft of proposed coverage for TAVI
The CMS has issued a draft of the conditions under which it will provide coverage for transcatheter aortic-valve replacements, as the technology begins to be rolled out in the US.
Severe anemia potent predictor of death poststroke
Study results should prompt physicians to take a closer look at what's causing anemia in stroke patients.
Cardiac telemetry identifies AF in cryptogenic stroke
Outpatient monitoring for 21 days detected atrial fibrillation in 17% of patients, and this could change management.
The flap over flavonoids
The field of flavonoids and polyphenols continues to attract a massive amount of interest, from researchers and the public alike. But can health really be improved by eating chocolate and drinking red wine?
Severe, rapid memory loss could herald stroke
A new study finds that victims of fatal stroke had sharp memory declines before the event.
Dr Mandeep Mehra leaves Baltimore for post at the Brigham
The accomplished specialist in advanced heart failure is taking on new challenges at the head of the Boston institution's Advanced Heart Disease Center.
"Cardiovascular health," new focus of the AHA, linked with reduced mortality
Individuals meeting five of seven cardiovascular health metrics outlined by the American Heart Association had a significantly lower risk of all-cause mortality and deaths from diseases of the circulatory system when compared with unhealthy individuals who met none of the cardiovascular health criteria.
US "roadmap" for TAVI rollout published
A new US expert-consensus document on transcatheter aortic-valve implantation aims to smooth the rollout of this new technology stateside.
Restenosis similar with carotid stenting or surgery: CREST
At two years, carotid restenosis is infrequent and appears similar whether patients were treated with carotid stenting or endarterectomy.
Stroke risk linked to infections in children
A new study finds the risk is highest closer to infection, then tapers off.
Combination type 2 diabetes pill gets FDA nod
The new treatment option combines linagliptin and metformin in a single tablet taken twice daily in adults with type 2 diabetes who require more than one medication to lower blood glucose.
Shifty and dangerous: Worsening diastolic dysfunction ups mortality
Actually, it was just as strong a mortality predictor as worsening systolic function in a retrospective series of patients followed with echocardiography.
"Valve-on-a-stick" transaortic TAVI offers alternative to transfemoral route
A growing number of centers, especially in Europe, are trying a third route for transcatheter valve implants in select patients. Instead of threading the device from the femoral artery or up through the left ventricular apex, they're deploying it directly through the aorta.
New data will shed light on cancer risk from imaging
Ongoing epidemiological studies in children who have undergone CT scans should help provide a better understanding of radiation-associated cancer risks from cardiac imaging over the next few years.
Dr Robert Harrington leaves DCRI for Stanford University
UPDATED // Dr Robert Harrington has been named the chair of the department of medicine at Stanford University and will be leaving Duke University, where he has worked for the past 22 years.
PARTNER CAP data show transapical outcomes improve with practice
Only 104 of the 799 high-risk patients in the PARTNER A trial of the Sapien transcatheter valve were treated with the transapical approach, so it can be considered to be only the preliminary experience with this technique. Now data from 822 patients in the continued-access protocol are available.
SYNTAX, FAME trials influence update to PCI/CABG appropriate-use criteria
The document somewhat expands the appropriateness of PCI in some patients with left main coronary disease, among other indications.
Once-weekly exenatide okayed by FDA for type 2 diabetes
The FDA approved the once-weekly version of exenatide for type 2 diabetes with a list of required postmarketing studies on the potential for cardiovascular events and medullary thyroid carcinoma.
Women do better after TAVI, hints small study
The first foray into possible gender differences in presentation and outcome among patients undergoing TAVI for severe aortic stenosis hints that women may fare better than men after this procedure.
Statins reduce cardiovascular events and all-cause mortality in women: Meta-analysis
Based on the meta-analysis, which included 18 clinical trials, investigators conclude that the benefits of statin therapy for the reduction of cardiovascular outcomes and all-cause mortality extend to both men and women.
ASCERT: Better survival for CABG vs PCI in some high-risk patients
The ASCERT study, a unique collaboration between the CMS, ACC, and STS, compares survival rates with bypass surgery and PCI in over 190 000 patients.
Interarm BP differences increase CVD risk
New research indicates that large differences in systolic blood pressure between the right and left arm of 15 mm Hg or more point to an increased risk of cardiovascular disease and death. The findings should add weight to guidelines, which already encourage doctors to measure BP in both arms, say the authors and editorialists.
3B or not 3B? Should patients get an LVAD before reaching end-stage HF?
Experts debated the evidence supporting the expansion of LVAD therapy to patients whose heart failure has not yet progressed to the so-called end stage.
Surgeons insist TAVI reimbursement rollout won't be repeat of carotid-stenting debacle
Now that the FDA has approved a transcatheter aortic valve, cardiac surgeons and cardiologists are working together to put all of their ducks in a row to secure national Medicare coverage for the procedure.
Don't routinely replace spent ICDs: Proposal
It may have little to offer and it might not be what the patient wants, argues a perspective in the New England Journal of Medicine.
Data mixed on role of parents and caregivers in combating childhood obesity
Despite the mixed data from the clinical trials, experts say there are some parenting strategies, such as monitoring unhealthy behaviors and positive reinforcement, that are helpful in getting children to change their behavior and lose weight.
More data needed on carotid atherosclerosis, CMS advisers agree
The Centers for Medicare & Medicaid Services' Medicare Evidence Development & Coverage Advisory Committee met to once again discuss the latest available evidence on different treatments of carotid atherosclerosis, and the only clear message was these questions remain a moving target.
Contaminated cardiac drugs kill more than 100 in Pakistan
More than 100 people have died in Pakistan and hundreds more have been hospitalized after having received contaminated cardiac drugs.
Riata Summit insights: Vigilance key to following functional but "recalled" ICD leads
UPDATED // Most attending the recent Riata ICD lead summit felt that fluoroscopic screening of Riata recipients was a reasonable thing to do, at odds with some recommendations; remote monitoring has its limits here, say VA data.
Proximal balloon superior to distal protection in carotid artery stenting
Proximal balloon-occlusion devices do not cross the lesion before it is stented, which helps to significantly reduce embolic load in the brain during the carotid procedure, according to researchers.
Dr Gary Roubin to resign as CV chair at Lenox Hill
The cardiologist is best known for his work in carotid stenting and as coinventor of the first FDA-approved coronary stent. He also made headlines when he was tasked with rebuilding the interventional cardiology department at Lenox Hill after the mass departure of some of the most prominent cardiologists in New York City.
Heart attack deaths plummet in three EU nations
New statistics from Denmark, England, and Poland show a roughly 50% drop in deaths due to acute AMI in recent decades.
Heart disease risk begins with middle-age risk factors
Risk-factor-reduction efforts are usually based on short-term risk scores, but most Americans at low risk for cardiovascular disease over the next 10 years are actually at much higher risk for heart problems over the rest of their lives.
Cardiologists flagging woeful patient care say they paid with their jobs
An echocardiographer and cardiac surgeon who say their jobs were axed in retaliation after they lodged numerous complaints of substandard patient care at a county hospital in Santa Clara are suing some of their former bosses, including two other cardiologists. The plaintiffs also claim they suffered severe harassment as a result of expressing their concerns. The defendants' attorney says the case "is hotly disputed."
Vytorin US label updated with SHARP results
But the FDA has not allowed an official indication for chronic-kidney-disease patients, which has concerned investigators who conducted the trial.
Pay for SGR repeal with war savings, say medical groups
A letter to Rep Dave Camp from 110 medical societies admits that war savings from military pullbacks are a "budget gimmick" but says they could retire SGR debt, another budget gimmick.
Black tea lowers blood pressure in small trial
Three daily cups, which provided approximately 400 mg/day of polyphenols, reduced systolic and diastolic blood pressure between 2 to 3 mm Hg, according to researchers.
PLATO: PPI analysis "raises flag" but should not change practice
A new analysis of the PLATO study has found that use of a proton-pump inhibitor was independently associated with a higher rate of cardiovascular events but that this was apparent in both the ticagrelor and clopidogrel arms. The finding is likely due to confounding and should not precipitate any change in advice on this subject, says the lead author.
Carotid images don't boost quit rates or cut CV risk factors in smokers
A new randomized controlled trial is the latest addition to a contentious field of research trying to establish whether "seeing is believing" when it comes to motivating cardiovascular risk reduction.
Cardiologists accused of defrauding Medicare by performing unnecessary cardiac procedures
A new whistle-blower lawsuit filed in US District Court claims that five cardiologists from two medical practices in Erie, PA defrauded Medicare by performing unnecessary cardiac and vascular surgeries and interventional procedures between 2001 and 2005.
Gifts, pep talks have some success post-PCI and in hypertension
Some of the first research showing that positive affect interventions—including phone calls to bolster self-affirming thoughts and small gifts—generate some success in post-PCI and hypertensive patients has been published. An editorialist describes the work as "innovative" and calls for many more studies of this kind.
To prescribe or not to prescribe: That is the statin question, experts debate
The two very different sides of the statin argument are debated today in the Wall Street Journal, with Dr Roger Blumenthal arguing the drugs prevent heart disease in patients with cardiovascular risk factors as well as in those who have already had a cardiovascular event. Dr Rita Redberg, on the other hand, argues against the current practice of prescribing statins to healthy patients with cardiovascular risk factors, including individuals with elevated cholesterol levels.
"Recalled" Riata ICD leads: Brainstorming conference aims for guidance
The lead failures can take years to manifest with inappropriate shocks or a variety of other issues, or they may not cause problems at all. There could be more agreement on how to manage the patients after today's Minnesota Heart Institute Riata ICD Lead Summit.
EMA investigating CV problems with fingolimod
Physicians are being advised to intensify cardiovascular monitoring after the first dose of the new oral agent for multiple sclerosis.
Dapagliflozin declined by FDA
The US Food and Drug Administration has denied approval for the novel diabetes drug dapagliflozin, asking codevelopers Bristol-Myers Squibb and AstraZeneca to provide more studies.
Lower mortality rates at two years with transradial PCI, Italian registry shows
In a propensity-score-matching analysis, the mortality rate at two years was 8.8% among patients treated via the radial artery and 11.4% in the femoral-PCI patients, a statistically significance difference. Transradial PCI was also associated with a significantly reduced need for vascular surgery and blood transfusions.
Pillow talk: First AHA advice on sex and CVD
The first-ever guidance on sexual activity and cardiovascular disease from the AHA encourages doctors, patients, and their partners to discuss the subject during consultations. The majority of those with heart disease can safely engage in sex, which is important to quality of life, it concludes.
Treat risk and not LDL-cholesterol targets, new perspective argues
In focusing on patient risk, rather than LDL-cholesterol treatment targets, doctors would improve patient outcomes and reduce adverse effects and costs that result from treating low-risk, low-benefit patients, say experts.
"High-normal" blood pressure linked to AF
Upper-normal levels of blood pressure in otherwise-healthy middle-aged men appear to predict a higher risk for the development of atrial fibrillation in older age, a new study suggests.
New AF ablation programs need time, money, and data
Starting up an atrial fibrillation ablation program takes more than just a couple of skilled electrophysiologists, Dr Rodney Horton explained at the Boston Atrial Fibrillation Symposium.
FFR shows benefit in FAME II; enrollment halted
An interim analysis of the FAME II study shows a significant benefit of fractional-flow-reserve-guided stenting plus optimal medical therapy over and above optimal medical therapy alone; as a result the data safety monitoring board has said no further patients should be randomized to medical therapy alone.
Mortality climbs with rising PA pressure in heart failure: Community-based study
The finding in a broad community-based HF population confirms and extends what is recognized in the hospital setting.
Contemporary look at VTE after joint surgery
One in 100 patients who have knee-replacement surgery and one in 200 who undergo hip replacement will have a venous thromboembolic event in the hospital, despite receiving modern anticoagulant prophylaxis, a new review shows. These numbers will help inform patients and clinicians, say the authors, but an editorialist notes that to get a better picture, it will be necessary to look at a longer postsurgery time frame.
BRIDGE study published: Cangrelor suited for important antiplatelet niche
The intravenous antiplatelet with a very short half-life is the ideal candidate for bridging patients on clopidogrel or other thienopyridines to surgery, the authors say.
NHANES: One in three adults, one in six children obese
Obesity continues to be a significant public health problem in the US, affecting more than one-third of US adults and 17% of children and adolescents, but 2009-2010 data suggest trends may have plateaued for most groups.
Dronedarone gets another chance to prove itself in ranolazine combo trial
Researchers of the beleaguered antiarrhythmic dronedarone believe the drug may still have a role to play in AF therapy for some patients and are testing it as a low-dose complement to another newer antiarrhythmic drug, ranolazine.
CCTA is less useful in patients with high calcium score
The diagnostic accuracy of any test depends largely on disease prevalence in the tested population. CORE-64 researchers looked at how calcium scores could help identify patients with such a high likelihood of disease that CCTA is not useful.
Thoracic endoprosthesis gets traumatic transection approval
The FDA has expanded approval for the Gore TAG Thoracic Endoprosthesis to include treatment of "life-threatening tears or ruptures of the aorta."
New AF ablation consensus doc previewed at Boston AF symposium
A group of 45 AF experts from North America and Europe will soon publish a major update to the 2007 international clinical consensus statement for the use of catheter and surgical ablation for the treatment of AF.
Resveratrol scientists react to Das fraud scandal: "Research will continue"
As the controversy over the research fraud allegations against Dr Dipak Das enters its third day, researchers told heartwire what the news means for the field of resveratrol research and, more pressingly, an upcoming scientific meeting.
Yoga therapy for AF yields insight into brain-heart axis
Yoga has shown to help some patients manage atrial fibrillation, so researchers are moving forward with investigations of yoga's influence on cardiac autonomics to better understand the biology of meditative practice.
FDA: CardioGen-82 problems site-specific
The generators, used in cardiac nuclear scans, were recalled by the manufacturer last summer, and the FDA previously found fault with manufacturing processes. Now the FDA says the excessive radiation cases appear to have occurred only at specific clinical sites and were unrelated to any manufacturing deficiencies.
Red-wine researcher charged with photo-editing fraud
A University of Connecticut investigation found Dr Dipak K Das guilty of falsifying and fabricating images that appeared in published research.
US bleeding ADRs higher with dabigatran than warfarin
There is particular concern over use of dabigatran in the elderly, in whom there has been a high number of bleeds, including intracranial hemorrhages, reported to the FDA.
Silent atrial fibrillation increases stroke risk
A new study finds device-detected atrial tachyarrhythmias occur frequently and are associated with a significant increase in risk for stroke and systemic embolism.
Very low risk of cardiac arrest and sudden death in long-distance running events
Despite the high-profile deaths of seemingly healthy runners at marathons in the past few years, new data show that the risk of cardiac arrest and sudden death during marathon and half-marathon running races is actually quite low.
Statins cost four times more in US than UK
UPDATED // Based on 2005 numbers, American private insurers paid as much as 400% more for statins than the UK government was paying over the same period. Even for statins sold as brand-name drugs in both countries, US costs were at least double.
Inactivity is a universal risk factor for heart attack
New findings from the INTERHEART study show that being physically active during leisure and work time protects against MI. The message is simple, say the authors: incorporate as much physical activity into daily life as is possible. Not surprisingly, those who own a TV and car have a higher risk of MI, they also show.
Pulmonary hypertension in kids differs from adult PAH
A new registry of children with pulmonary hypertension is helping to differentiate the pediatric population with this disease from the adult one and should aid in better diagnosis and treatment of this condition in kids, say the authors.
Venous thrombosis, pulmonary embolism raise mortality risk
First-time venous thrombosis or pulmonary embolism dramatically increases the long-term mortality rate in individuals with and without malignancy, according to a recent study.
GWTG improves AMI care in Asian Americans
The new data suggest that among participating hospitals in the GWTG program, equitable quality care for many performance measures can be attained across racial and ethnic groups, including Asian Americans, say researchers.
Serum potassium targets in acute MI need rethink, analysis suggests
Recommendations to routinely raise serum potassium levels when ventricular arrhythmias are a concern may be based on outmoded data, according to authors of one of the largest analyses of its kind.
New DES best older stents for deaths, restenosis in latest SCAAR data
The latest data from the Swedish registry that launched the international furor over stent thrombosis with drug-eluting stents is now providing reassuring data about the safety and efficacy of the latest generation of the devices.
Aspirin in primary prevention: New meta-analysis finds bleeding outweighs benefits for most
But there may be a case for aspirin treatment in certain individuals at high risk of heart disease or with a family history of cancer.
New guidelines suggest blood glucose testing for all inpatients
New clinical-practice guidelines from the Endocrine Society say all patients should have a glucose test on admission to the hospital and describe optimal management of hyperglycemia in patients who do not require intensive care.
Aortic stenosis grading system misses rare, high-risk group
A new study has examined the clinical outcomes of asymptomatic aortic-stenosis patients classified by valve area plus flow-gradient patterns instead of the older, inherently inconsistent system based on separate area, gradient, and flow measurements.
Dabigatran: New data on MI and ischemic events
The question of MI risk with dabigatran is in the spotlight once again, with two new papers on the subject published within the last few days.
Statin use associated with significantly increased risk of diabetes: WHI analysis
New data from the Women's Health Initiative hint that the risk of diabetes is higher than suggested by previous studies, with investigators reporting a 48% increased risk of diabetes among women taking the lipid-lowering medications.
Bereavement triggers MI, new study finds
Bereaved people are 21 times more likely to suffer an MI the day after the death of a significant other, and this heightened risk remains for as long as a month afterward, new research finds. Healthcare providers, the bereaved themselves, and their family and friends need to recognize this heightened risk, say the authors.
UK's NICE wants more data on rivaroxaban in AF
The UK drugs cost-efficacy watchdog, NICE, has asked for more data from Bayer before it will sanction use of rivaroxaban for stroke prevention in atrial-fibrillation patients.
Informed consent questioned in Florida patient's death after stem-cell treatment
A Florida cardiologist is accused of malpractice after a patient treated with a novel stem-cell therapy died of a brain infarct.
MitraClip: Encouraging results in nonsurgical patients
While the clip did appear to reduce mitral regurgitation and improve remodeling in patients unsuitable for surgery in the EVEREST II trial, problems with the comparator group make the results difficult to interpret.
Complications, rehospitalizations not uncommon post-AF ablation
Little is known about the complication rates for atrial fibrillation outside of academic hospitals and Medicare data, so researchers in California analyzed data from a state database to estimate the complication risk of AF ablation in the contemporary community setting.
Novel LDL-gene-targeted agent promising
Suppressing the activity of PCSK9, a gene known to mediate low-density-lipoprotein cholesterol metabolism, cut LDL-C levels in a small dose-ranging study.
Excess calories, not proportion of dietary protein, key in causing obesity
Excessive food intake, rather than the mix of protein, fat, and carbohydrates, has been implicated in causing obesity and is key in treating it.
RESPECT PFO/stroke trial completes enrollment
After eight years of sluggish patient accrual, the RESPECT trial looking at the Amplatzer device for the prevention of cryptogenic stroke has finally collected enough events for the trial to be stopped.
Public Citizen requests recall of the Wingspan stent
A consumer-advocacy group argues that the Wingspan Stent System provides less benefit and causes more harm than aggressive medical treatment alone.
BRCA1 cancer gene affects cardiac function
Canadian researchers have discovered that the BRCA1 gene is implicated in cardiac function, at least in mice. The findings may also have implications for cancer sufferers who have mutations in this gene: they may be at increased risk of heart disease and more likely to suffer cardiotoxicity from chemotherapy.
Rivaroxaban filed for ACS in US and EU
The factor Xa inhibitor rivaroxaban has been filed for approval for the additional indication of secondary prevention in acute coronary syndrome in both the US and EU.
Type 2 diabetes adds risk to tissue valves
Type 2 diabetes is a known determinant of degeneration of both native and prosthetic valve implants, so a group of Italian researchers investigated whether bioprosthetic valves also degenerate faster in diabetic patients vs nondiabetic patients.
US leads in shorter hospital stays, early readmission after STEMI
Patients with ST-segment-elevation MI were more likely to be hospitalized again within a month if they had been treated in the US, and American patients had the shortest initial hospitalization, in a retrospective study of data from an international trial. The work identifies national differences in this measure of care—30-day-readmission—and it should help guide future investigations, the authors say.
Bariatric surgery reduces CV events, but mechanisms remain a mystery
The latest data from the Swedish Obese Subjects study show that bariatric surgery reduces the risk of cardiovascular events and CV death among obese individuals, compared with usual care. But weight loss is not the reason behind this reduced risk, meaning that guidelines that use BMI to determine who will get such surgery need updating, say the authors and an editorialist.
Enoxaparin prophylaxis doesn't cut mortality in acute-care setting
Antithrombotic prophylaxis remains important in this group for other reasons, but don't expect it to necessarily prevent death, according to researchers.
Mayo report: It takes docs about 30 TAVIs to achieve proficiency
Two new single-center studies shed light on the contemporary experience with new transcatheter aortic-valve systems. One looks at the "learning curve" required for operators to become proficient with the devices, and the other investigates how patient selection for these procedures has changed over time.
Analysis slams use of clopidogrel loss-of-function gene test; proponents fire back
A new meta-analysis and especially an accompanying editorial argue against current use of CYP2C19 genotyping to define risk of subsequent CV events in patients considered for clopidogrel. Proponents of the test defend its use and describe what they see as flaws in the study.
Troponins at admission and three hours allow MI diagnosis or rule-out
Troponin levels measured using a sensitive or highly sensitive assay can help with early MI rule-out, suggests a study that makes a case supporting the possible approval of the high-sensitivity assay in the US.
Specifically, the panel voted 20 to 2 in favor of approving Qnexa, this despite protracted discussion about the potential adverse effect of the drug on heart rate and concerns over a risk of birth defects in mothers taking the phentermine/topiramate combination.
Scar on MRI portends poor outcome in viral myocarditis
Viral myocarditis has a mortality of almost 20% within five years of follow-up, a new study of patients with biopsy-proven disease illustrates. And among sufferers, those with late enhancement on magnetic resonance imaging had the worst prognosis, the researchers found.
Interventional live case demos are safe, small study shows
Some physicians and regulators have questioned whether live video presentation of procedures at professional education meetings compromises the safety of the procedure, but there are not yet much data on the outcomes of these cases.
Montreal cardiologists accused of taking bribes from patients
A Montreal newspaper reports that giving doctors cash for preferential treatment is somewhat of a regular practice and an "open secret."
AV nodal ablation ups survival in AF patients with CRT
Catheter ablation also seemed to improve NYHA functional class, but not contractile function, in patients with atrial fibrillation receiving device therapy for heart failure.
Is new gene analysis the final chapter in the homocysteine saga?
An international group of distinguished researchers says newly examined, unpublished genetic data provide final proof that homocysteine does not cause coronary heart disease and therefore reducing levels of this amino acid with folate would have no effect. But another expert disagrees.
Six of seven guideline-recommended HF therapies lower mortality at two years
Results of a new study reinforce the importance of adhering to the clinical guidelines, investigators say, stressing the implications of their findings: there is nowhere else in cardiovascular medicine where clinicians can achieve incremental reductions in the range of 80% to 90%.
Young women with MI most likely to have no chest pain
A new analysis of the NRMI registry also finds that women under 55 have the highest risk of death after MI.
Detailed family history improves cardiovascular disease risk assessment
Compared with clinical practices that used traditional risk-assessment models, the systematic collection of a family history identified an additional 5% at high cardiovascular disease risk, according to researchers.
Crossing tricuspid-valve bioprosthesis with pacer/ICD lead generally safe
Some data show a risk of complications in native tricuspids crossed with a lead, but a new retrospective study is the first to look at such risks with bioprosthetic valves.
Resolute zotarolimus stent approved in US
The FDA has approved the new Resolute Integrity zotarolimus-eluting coronary stent, the first DES approved by the regulatory body for use in patients with diabetes, who account for one-third of the nearly one million PCIs performed annually in the US.
Pregnancy complications up CVD risk by 30%
A new study is helping to tease out the contributions of different pregnancy complications to future CVD risk in women; the results show that the mechanisms linking each condition to CV risk likely differ.
EMA: New aliskiren restrictions and decisions on aprotinin, orlistat
The European Medicines Agency's Committee for Medicinal Products for Human Use recommended lifting the suspension on aprotinin, adding new warnings on aliskiren products, and supporting orlistat for some patients, among other opinions issued at its February meeting.
Ten-month Medicare "doc fix" passes Congress, heads for White House
Although it averts a 27.4% Medicare pay cut for physicians set for March 1, the latest doc fix seems to leave everyone unhappy, especially physicians.
Mutations in giant gene a major cause of familial DCM
They probably account for more than a fifth of idiopathic dilated-cardiomyopathy cases, say researchers, pioneers of genetic variation in a massive protein that is a major player in myocardial contraction.
CardioGen-82 returns to market
For its return, the FDA-approved revised labeling for CardioGen-82 includes a new boxed warning. The label warns of unintended radiation exposure when levels of Sr-82 and Sr-85 in the rubidium Rb-82 chloride injection exceed limits.
Exercise, regardless of amount of sedentary time, improves risk factors in kids
Researchers say that children should be encouraged to increase their participation in moderate to vigorous physical activity rather than decrease the amount of time they spend sedentary, as this appears more important in relation to cardiometabolic health.
Stem-cell therapy still needs a lot more study
Stem-cell therapy could regenerate infarcted myocardium, but most of the trials have been small. A new review evaluates the evidence from randomized trials of adult bone-marrow-derived stem cells to treat acute MI.
New ACCP thrombosis guidelines offer weak support for aspirin in primary prevention
UPDATED // In a new development, the guidelines committee was headed by clinicians who specialized in interpretation of clinical trials rather than opinion leaders in the antithrombotic field, which has led to less strong recommendations for antithrombotic therapy than before.
Short-term exposure to air pollutants ups MI risk: Meta-analysis
Of six individual air pollutants, only one didn't seem to raise the risk of MI at exposures of up to a week, according to a meta-analysis.
Vitamin D in CKD: No benefit for CV function, structure
The findings are important, given the prevalence of vitamin-D deficiency in this group of patients, researchers say.
Cardiac stem-cells increase viable myocardium post-MI: CADUCEUS
Researchers and other experts in the field of cardiac regeneration research are excited by the small, phase 1 study, which showed scar to be reduced on cardiac imaging at the same time that viable myocardial mass was increasing, over six and 12 months.
No cancer protection with vitamin B or omega-3 fatty-acid supplements
The investigators did observe a statistically significant interaction by sex, however, with women taking omega-3 fatty acids at an increased for cancer. They caution, however, that the results might be due to chance, given the few cancer cases and cancer deaths that occurred in women treated with the supplements.
Fidelis failures climb: "Strongly consider" replacement at ICD change-out
It may be a good time to replace patients' Medtronic Sprint Fidelis leads, which were recalled due to an increased fracture risk, if they are getting new ICD generators anyway—even if the Fidelis hasn't shown signs of trouble, a group recommends.
New mitral-repair therapies face obstacles
Why has the development of less invasive mitral-valve repair therapies lagged so far behind comparable strategies to treat the aortic valve? Experts from FDA, industry, and academic medical centers offered some possible answers in a roundtable discussion.
More doctors advising patients to exercise
In 2010, one in three patients who visited a physician or other health professional had been told to start or maintain physical activity or exercise.
More hope for factor Xa reversal
A new study has suggested that the anticoagulant effects of edoxaban could be reversed by several hemostatic agents currently used to control excessive bleeding in other situations.
The doctor will see you now (from the other side of the world)
A unique "medical mission" using handheld echo in a remote rural population in India is being hailed as a success after cardiologists around the globe logged on over a two-day period to read the echocardiograms of unseen patients half a world away.
US judge upholds FDA approval of generic enoxaparin
Sanofi-Aventis had sued the agency in 2010, saying it had failed to follow its own rules and had not appropriately established that a generic drug made by a rival company included the same active ingredient as Lovenox.
Biomarker may distinguish ICH from ischemic stroke
The test might eventually be applied at the point of care to help triage patients for treatment.
Over 1300 deaths in Mediator scandal in France
The number of deaths attributable to heart-valve insufficiency as a result of the use of benfluorex in France is likely more than double that previously thought, a new investigation finds.
Referring MDs fall short on ICD-indication guidelines
A lot of generalists and some cardiologists apparently don't know some of the fundamental criteria for indication of a primary-prevention device and so may not be referring all patients who might benefit, a survey suggests.
Apixaban superior for AF patients with previous stroke, TIA
Substudies of the ARISTOTLE and AVERROES trials find apixaban is safe and effective for patients with previous events vs warfarin and aspirin respectively.
Ten foods provide half of sodium eaten in US
New estimates of salt consumption from a recent US survey show that 10 food groups provide almost half of the dietary sodium consumed in the country and that 90% of individuals eat more than the recommended daily amount of sodium.
Like father, like son: Y-chromosome variant may explain CAD
New genetic work has unveiled an association between some lineages of the relatively empty male Y chromosome and coronary artery disease. The hypothesis, while "intriguing," requires more research to confirm, says one expert.
Wide variation in PCI for "unclear indications"
The latest study on this subject has found that 17% of hospitals in a large US sample conducted at least one-fifth of their procedures in patients whose indications for the procedure were unclear.
PCI appropriateness criteria draw criticism
A detailed critique of the national appropriate-use criteria for PCI—questioning the composition of the committee that wrote the criteria, some of the AUCs themselves, and the survey that compared the AUC with current clinical practice—has been published.
More bleeding, thromboembolic events with dabigatran in AF ablation
Dabigatran was stopped the morning of the procedure; its long half-life combined with the use of unfractionated heparin during the procedure likely explains the increased risk of bleeding.
For stroke risk, look for novel lipid/lipoprotein biomarkers
Women with triglyceride levels in the highest quartile had a significant 56% increased risk of stroke compared with women in the lowest quartile. Similarly, for women with highest quartile of VLDL particle size and IDL particle number, there was a significant 59% and 46% increased risk of ischemic stroke compared with women in the lowest quartile.
Braile Biomédica launches transapical valve
A Brazilian group says they're encouraged by the early results with their transapical transcatheter aortic valve.
Wake-up stroke patients may still benefit from thrombolysis
A new study shows tPA was safe for patients who woke up with stroke symptoms, a population not normally treated since they could exceed the 4.5-hour window.
Generalists need education on HF treatment
A unique study trying to drill down into why cardiologists seem to gain better outcomes than generalists when treating heart failure has identified a number of reasons that this is the case. But generalists—who treat the majority of HF—have to deal with older and sicker patients, confounding the issue. The authors hope the work will act as a catalyst to improve HF care.
SWITCH III: Bivalirudin is as safe as heparin after fondaparinux in PCI patients
Recent studies have shown that ACS patients on fondaparinux prior to PCI should switch to another anticoagulant prior to the procedure to avoid thrombus. The SWITCH III trial compares bivalirudin and unfractionated heparin in a small group of these patients.
TRA 2°P: Vorapaxar meets end point but ups bleeding
In its second phase 3 trial, Merck's novel antiplatelet agent reduced ischemic events but increased bleeding, including ICH. Results looked more promising in patients without a history of stroke.
CTO, even in non-infarct-related artery, bodes ill in NSTEMI patients
Swedish researchers examined SCAAR to determine the prognostic significance of a chronic total occlusion in an artery other than the infarct-related one of non-ST-elevation-MI patients.
ICDs charged with sex discrimination: Women get fewer shocks
Differences in appropriate-therapy and device-related complication rates in a prospective study question (once again) whether women and men should have the same ICD-eligibility criteria.
Fitness and fatness independently linked with CVD risk factors
Individuals should be aware that exercising can have positive health effects, even if the weight doesn't necessarily come off, as can losing weight alone, researchers say, although the ideal combination is to improve fitness and lose fat.
MI-shock proposal is cold comfort: Hypothermia might boost survival
Some data suggest therapeutic hypothermia might reduce the currently high mortality from cardiogenic shock; let's do the necessary clinical studies to see whether it might be true, urges a published viewpoint.
Dr Paolo Raggi joins University of Alberta
Dr Paolo Raggi has been named the academic director of the Mazankowski Alberta Heart Institute at the University of Alberta in Edmonton and chief of cardiology at Alberta Health Services.
Lower mortality in NFL players—if weight is kept in check
The reduction in mortality and cardiovascular disease was observed in the smaller players—defensive backs, quarterbacks, and wide receivers, as well as fullbacks, halfbacks, and running backs, among others. For the true giants of the gridiron, the linemen, cardiovascular disease mortality was not significantly reduced compared with the US population.
KEEP: Focus on CKD patients with highest SBP
A new, contemporary study in real-world patients with chronic kidney disease finds that those with systolic BPs of 140 mm Hg and higher are at the greatest risk of developing end-stage renal disease. Hence the current "goal" in CKD patients of 130 mm Hg should be revised upward, say the authors, making the target easier to achieve and allowing physicians to focus on other aspects of care.
"Irrational" choices stall adoption of new antiplatelets
Dr David Cohen points out some of physicians' potential "psychological" barriers to more rapid adoption of new antiplatelet agents, even though they may be the best choice for their patients.
Sitagliptin/metformin once-daily combo approved for diabetes
The extended-release combination of sitagliptin and metformin joins saxagliptin/metformin as a once-daily tablet for type 2 diabetes.
No recurrent stroke prevention seen with clopidogrel plus aspirin
A new study shows that the combination of clopidogrel and aspirin increases risk of hemorrhage and mortality, including nonvascular mortality, vs aspirin alone.
Heart failure linked to loss of brain gray matter
Heart failure is associated with a decline in mental function and loss of gray matter in the brain, which may make it more difficult for patients to follow instructions regarding their medication, a new Australian study has found.
Photos on school lunch trays boost veggie intake
A simple intervention, whereby photographs of green beans and carrots were placed in lunch trays in a school cafeteria, has had some success in boosting consumption of these vegetables among elementary schoolchildren.
Aspirin as effective as warfarin in heart failure: WARCEF
Although there was an edge for warfarin for those treated for four or more years, there is "no compelling" reason to anticoagulate these patients, researchers say.
"Tetherless" power-transmission technology could radically change LVAD therapy
New wireless technology used to power implantable ventricular assist devices has the potential to make them far safer than ever before and bring the therapy to patients at earlier stages of heart failure than are currently recommended.
CMS draft of proposed coverage for TAVI
The CMS has issued a draft of the conditions under which it will provide coverage for transcatheter aortic-valve replacements, as the technology begins to be rolled out in the US.
Severe anemia potent predictor of death poststroke
Study results should prompt physicians to take a closer look at what's causing anemia in stroke patients.
Cardiac telemetry identifies AF in cryptogenic stroke
Outpatient monitoring for 21 days detected atrial fibrillation in 17% of patients, and this could change management.
The flap over flavonoids
The field of flavonoids and polyphenols continues to attract a massive amount of interest, from researchers and the public alike. But can health really be improved by eating chocolate and drinking red wine?
Severe, rapid memory loss could herald stroke
A new study finds that victims of fatal stroke had sharp memory declines before the event.
Dr Mandeep Mehra leaves Baltimore for post at the Brigham
The accomplished specialist in advanced heart failure is taking on new challenges at the head of the Boston institution's Advanced Heart Disease Center.
"Cardiovascular health," new focus of the AHA, linked with reduced mortality
Individuals meeting five of seven cardiovascular health metrics outlined by the American Heart Association had a significantly lower risk of all-cause mortality and deaths from diseases of the circulatory system when compared with unhealthy individuals who met none of the cardiovascular health criteria.
US "roadmap" for TAVI rollout published
A new US expert-consensus document on transcatheter aortic-valve implantation aims to smooth the rollout of this new technology stateside.
Restenosis similar with carotid stenting or surgery: CREST
At two years, carotid restenosis is infrequent and appears similar whether patients were treated with carotid stenting or endarterectomy.
Stroke risk linked to infections in children
A new study finds the risk is highest closer to infection, then tapers off.
Combination type 2 diabetes pill gets FDA nod
The new treatment option combines linagliptin and metformin in a single tablet taken twice daily in adults with type 2 diabetes who require more than one medication to lower blood glucose.
Shifty and dangerous: Worsening diastolic dysfunction ups mortality
Actually, it was just as strong a mortality predictor as worsening systolic function in a retrospective series of patients followed with echocardiography.
"Valve-on-a-stick" transaortic TAVI offers alternative to transfemoral route
A growing number of centers, especially in Europe, are trying a third route for transcatheter valve implants in select patients. Instead of threading the device from the femoral artery or up through the left ventricular apex, they're deploying it directly through the aorta.
New data will shed light on cancer risk from imaging
Ongoing epidemiological studies in children who have undergone CT scans should help provide a better understanding of radiation-associated cancer risks from cardiac imaging over the next few years.
Dr Robert Harrington leaves DCRI for Stanford University
UPDATED // Dr Robert Harrington has been named the chair of the department of medicine at Stanford University and will be leaving Duke University, where he has worked for the past 22 years.
PARTNER CAP data show transapical outcomes improve with practice
Only 104 of the 799 high-risk patients in the PARTNER A trial of the Sapien transcatheter valve were treated with the transapical approach, so it can be considered to be only the preliminary experience with this technique. Now data from 822 patients in the continued-access protocol are available.
SYNTAX, FAME trials influence update to PCI/CABG appropriate-use criteria
The document somewhat expands the appropriateness of PCI in some patients with left main coronary disease, among other indications.
Once-weekly exenatide okayed by FDA for type 2 diabetes
The FDA approved the once-weekly version of exenatide for type 2 diabetes with a list of required postmarketing studies on the potential for cardiovascular events and medullary thyroid carcinoma.
Women do better after TAVI, hints small study
The first foray into possible gender differences in presentation and outcome among patients undergoing TAVI for severe aortic stenosis hints that women may fare better than men after this procedure.
Statins reduce cardiovascular events and all-cause mortality in women: Meta-analysis
Based on the meta-analysis, which included 18 clinical trials, investigators conclude that the benefits of statin therapy for the reduction of cardiovascular outcomes and all-cause mortality extend to both men and women.
ASCERT: Better survival for CABG vs PCI in some high-risk patients
The ASCERT study, a unique collaboration between the CMS, ACC, and STS, compares survival rates with bypass surgery and PCI in over 190 000 patients.
Interarm BP differences increase CVD risk
New research indicates that large differences in systolic blood pressure between the right and left arm of 15 mm Hg or more point to an increased risk of cardiovascular disease and death. The findings should add weight to guidelines, which already encourage doctors to measure BP in both arms, say the authors and editorialists.
3B or not 3B? Should patients get an LVAD before reaching end-stage HF?
Experts debated the evidence supporting the expansion of LVAD therapy to patients whose heart failure has not yet progressed to the so-called end stage.
Surgeons insist TAVI reimbursement rollout won't be repeat of carotid-stenting debacle
Now that the FDA has approved a transcatheter aortic valve, cardiac surgeons and cardiologists are working together to put all of their ducks in a row to secure national Medicare coverage for the procedure.
Don't routinely replace spent ICDs: Proposal
It may have little to offer and it might not be what the patient wants, argues a perspective in the New England Journal of Medicine.
Data mixed on role of parents and caregivers in combating childhood obesity
Despite the mixed data from the clinical trials, experts say there are some parenting strategies, such as monitoring unhealthy behaviors and positive reinforcement, that are helpful in getting children to change their behavior and lose weight.
More data needed on carotid atherosclerosis, CMS advisers agree
The Centers for Medicare & Medicaid Services' Medicare Evidence Development & Coverage Advisory Committee met to once again discuss the latest available evidence on different treatments of carotid atherosclerosis, and the only clear message was these questions remain a moving target.
Contaminated cardiac drugs kill more than 100 in Pakistan
More than 100 people have died in Pakistan and hundreds more have been hospitalized after having received contaminated cardiac drugs.
Riata Summit insights: Vigilance key to following functional but "recalled" ICD leads
UPDATED // Most attending the recent Riata ICD lead summit felt that fluoroscopic screening of Riata recipients was a reasonable thing to do, at odds with some recommendations; remote monitoring has its limits here, say VA data.
Proximal balloon superior to distal protection in carotid artery stenting
Proximal balloon-occlusion devices do not cross the lesion before it is stented, which helps to significantly reduce embolic load in the brain during the carotid procedure, according to researchers.
Dr Gary Roubin to resign as CV chair at Lenox Hill
The cardiologist is best known for his work in carotid stenting and as coinventor of the first FDA-approved coronary stent. He also made headlines when he was tasked with rebuilding the interventional cardiology department at Lenox Hill after the mass departure of some of the most prominent cardiologists in New York City.
Heart attack deaths plummet in three EU nations
New statistics from Denmark, England, and Poland show a roughly 50% drop in deaths due to acute AMI in recent decades.
Heart disease risk begins with middle-age risk factors
Risk-factor-reduction efforts are usually based on short-term risk scores, but most Americans at low risk for cardiovascular disease over the next 10 years are actually at much higher risk for heart problems over the rest of their lives.
Cardiologists flagging woeful patient care say they paid with their jobs
An echocardiographer and cardiac surgeon who say their jobs were axed in retaliation after they lodged numerous complaints of substandard patient care at a county hospital in Santa Clara are suing some of their former bosses, including two other cardiologists. The plaintiffs also claim they suffered severe harassment as a result of expressing their concerns. The defendants' attorney says the case "is hotly disputed."
Vytorin US label updated with SHARP results
But the FDA has not allowed an official indication for chronic-kidney-disease patients, which has concerned investigators who conducted the trial.
Pay for SGR repeal with war savings, say medical groups
A letter to Rep Dave Camp from 110 medical societies admits that war savings from military pullbacks are a "budget gimmick" but says they could retire SGR debt, another budget gimmick.
Black tea lowers blood pressure in small trial
Three daily cups, which provided approximately 400 mg/day of polyphenols, reduced systolic and diastolic blood pressure between 2 to 3 mm Hg, according to researchers.
PLATO: PPI analysis "raises flag" but should not change practice
A new analysis of the PLATO study has found that use of a proton-pump inhibitor was independently associated with a higher rate of cardiovascular events but that this was apparent in both the ticagrelor and clopidogrel arms. The finding is likely due to confounding and should not precipitate any change in advice on this subject, says the lead author.
Carotid images don't boost quit rates or cut CV risk factors in smokers
A new randomized controlled trial is the latest addition to a contentious field of research trying to establish whether "seeing is believing" when it comes to motivating cardiovascular risk reduction.
Cardiologists accused of defrauding Medicare by performing unnecessary cardiac procedures
A new whistle-blower lawsuit filed in US District Court claims that five cardiologists from two medical practices in Erie, PA defrauded Medicare by performing unnecessary cardiac and vascular surgeries and interventional procedures between 2001 and 2005.
Gifts, pep talks have some success post-PCI and in hypertension
Some of the first research showing that positive affect interventions—including phone calls to bolster self-affirming thoughts and small gifts—generate some success in post-PCI and hypertensive patients has been published. An editorialist describes the work as "innovative" and calls for many more studies of this kind.
To prescribe or not to prescribe: That is the statin question, experts debate
The two very different sides of the statin argument are debated today in the Wall Street Journal, with Dr Roger Blumenthal arguing the drugs prevent heart disease in patients with cardiovascular risk factors as well as in those who have already had a cardiovascular event. Dr Rita Redberg, on the other hand, argues against the current practice of prescribing statins to healthy patients with cardiovascular risk factors, including individuals with elevated cholesterol levels.
"Recalled" Riata ICD leads: Brainstorming conference aims for guidance
The lead failures can take years to manifest with inappropriate shocks or a variety of other issues, or they may not cause problems at all. There could be more agreement on how to manage the patients after today's Minnesota Heart Institute Riata ICD Lead Summit.
EMA investigating CV problems with fingolimod
Physicians are being advised to intensify cardiovascular monitoring after the first dose of the new oral agent for multiple sclerosis.
Dapagliflozin declined by FDA
The US Food and Drug Administration has denied approval for the novel diabetes drug dapagliflozin, asking codevelopers Bristol-Myers Squibb and AstraZeneca to provide more studies.
Lower mortality rates at two years with transradial PCI, Italian registry shows
In a propensity-score-matching analysis, the mortality rate at two years was 8.8% among patients treated via the radial artery and 11.4% in the femoral-PCI patients, a statistically significance difference. Transradial PCI was also associated with a significantly reduced need for vascular surgery and blood transfusions.
Pillow talk: First AHA advice on sex and CVD
The first-ever guidance on sexual activity and cardiovascular disease from the AHA encourages doctors, patients, and their partners to discuss the subject during consultations. The majority of those with heart disease can safely engage in sex, which is important to quality of life, it concludes.
Treat risk and not LDL-cholesterol targets, new perspective argues
In focusing on patient risk, rather than LDL-cholesterol treatment targets, doctors would improve patient outcomes and reduce adverse effects and costs that result from treating low-risk, low-benefit patients, say experts.
"High-normal" blood pressure linked to AF
Upper-normal levels of blood pressure in otherwise-healthy middle-aged men appear to predict a higher risk for the development of atrial fibrillation in older age, a new study suggests.
New AF ablation programs need time, money, and data
Starting up an atrial fibrillation ablation program takes more than just a couple of skilled electrophysiologists, Dr Rodney Horton explained at the Boston Atrial Fibrillation Symposium.
FFR shows benefit in FAME II; enrollment halted
An interim analysis of the FAME II study shows a significant benefit of fractional-flow-reserve-guided stenting plus optimal medical therapy over and above optimal medical therapy alone; as a result the data safety monitoring board has said no further patients should be randomized to medical therapy alone.
Mortality climbs with rising PA pressure in heart failure: Community-based study
The finding in a broad community-based HF population confirms and extends what is recognized in the hospital setting.
Contemporary look at VTE after joint surgery
One in 100 patients who have knee-replacement surgery and one in 200 who undergo hip replacement will have a venous thromboembolic event in the hospital, despite receiving modern anticoagulant prophylaxis, a new review shows. These numbers will help inform patients and clinicians, say the authors, but an editorialist notes that to get a better picture, it will be necessary to look at a longer postsurgery time frame.
BRIDGE study published: Cangrelor suited for important antiplatelet niche
The intravenous antiplatelet with a very short half-life is the ideal candidate for bridging patients on clopidogrel or other thienopyridines to surgery, the authors say.
NHANES: One in three adults, one in six children obese
Obesity continues to be a significant public health problem in the US, affecting more than one-third of US adults and 17% of children and adolescents, but 2009-2010 data suggest trends may have plateaued for most groups.
Dronedarone gets another chance to prove itself in ranolazine combo trial
Researchers of the beleaguered antiarrhythmic dronedarone believe the drug may still have a role to play in AF therapy for some patients and are testing it as a low-dose complement to another newer antiarrhythmic drug, ranolazine.
CCTA is less useful in patients with high calcium score
The diagnostic accuracy of any test depends largely on disease prevalence in the tested population. CORE-64 researchers looked at how calcium scores could help identify patients with such a high likelihood of disease that CCTA is not useful.
Thoracic endoprosthesis gets traumatic transection approval
The FDA has expanded approval for the Gore TAG Thoracic Endoprosthesis to include treatment of "life-threatening tears or ruptures of the aorta."
New AF ablation consensus doc previewed at Boston AF symposium
A group of 45 AF experts from North America and Europe will soon publish a major update to the 2007 international clinical consensus statement for the use of catheter and surgical ablation for the treatment of AF.
Resveratrol scientists react to Das fraud scandal: "Research will continue"
As the controversy over the research fraud allegations against Dr Dipak Das enters its third day, researchers told heartwire what the news means for the field of resveratrol research and, more pressingly, an upcoming scientific meeting.
Yoga therapy for AF yields insight into brain-heart axis
Yoga has shown to help some patients manage atrial fibrillation, so researchers are moving forward with investigations of yoga's influence on cardiac autonomics to better understand the biology of meditative practice.
FDA: CardioGen-82 problems site-specific
The generators, used in cardiac nuclear scans, were recalled by the manufacturer last summer, and the FDA previously found fault with manufacturing processes. Now the FDA says the excessive radiation cases appear to have occurred only at specific clinical sites and were unrelated to any manufacturing deficiencies.
Red-wine researcher charged with photo-editing fraud
A University of Connecticut investigation found Dr Dipak K Das guilty of falsifying and fabricating images that appeared in published research.
US bleeding ADRs higher with dabigatran than warfarin
There is particular concern over use of dabigatran in the elderly, in whom there has been a high number of bleeds, including intracranial hemorrhages, reported to the FDA.
Silent atrial fibrillation increases stroke risk
A new study finds device-detected atrial tachyarrhythmias occur frequently and are associated with a significant increase in risk for stroke and systemic embolism.
Very low risk of cardiac arrest and sudden death in long-distance running events
Despite the high-profile deaths of seemingly healthy runners at marathons in the past few years, new data show that the risk of cardiac arrest and sudden death during marathon and half-marathon running races is actually quite low.
Statins cost four times more in US than UK
UPDATED // Based on 2005 numbers, American private insurers paid as much as 400% more for statins than the UK government was paying over the same period. Even for statins sold as brand-name drugs in both countries, US costs were at least double.
Inactivity is a universal risk factor for heart attack
New findings from the INTERHEART study show that being physically active during leisure and work time protects against MI. The message is simple, say the authors: incorporate as much physical activity into daily life as is possible. Not surprisingly, those who own a TV and car have a higher risk of MI, they also show.
Pulmonary hypertension in kids differs from adult PAH
A new registry of children with pulmonary hypertension is helping to differentiate the pediatric population with this disease from the adult one and should aid in better diagnosis and treatment of this condition in kids, say the authors.
Venous thrombosis, pulmonary embolism raise mortality risk
First-time venous thrombosis or pulmonary embolism dramatically increases the long-term mortality rate in individuals with and without malignancy, according to a recent study.
GWTG improves AMI care in Asian Americans
The new data suggest that among participating hospitals in the GWTG program, equitable quality care for many performance measures can be attained across racial and ethnic groups, including Asian Americans, say researchers.
Serum potassium targets in acute MI need rethink, analysis suggests
Recommendations to routinely raise serum potassium levels when ventricular arrhythmias are a concern may be based on outmoded data, according to authors of one of the largest analyses of its kind.
New DES best older stents for deaths, restenosis in latest SCAAR data
The latest data from the Swedish registry that launched the international furor over stent thrombosis with drug-eluting stents is now providing reassuring data about the safety and efficacy of the latest generation of the devices.
Aspirin in primary prevention: New meta-analysis finds bleeding outweighs benefits for most
But there may be a case for aspirin treatment in certain individuals at high risk of heart disease or with a family history of cancer.
New guidelines suggest blood glucose testing for all inpatients
New clinical-practice guidelines from the Endocrine Society say all patients should have a glucose test on admission to the hospital and describe optimal management of hyperglycemia in patients who do not require intensive care.
Aortic stenosis grading system misses rare, high-risk group
A new study has examined the clinical outcomes of asymptomatic aortic-stenosis patients classified by valve area plus flow-gradient patterns instead of the older, inherently inconsistent system based on separate area, gradient, and flow measurements.
Dabigatran: New data on MI and ischemic events
The question of MI risk with dabigatran is in the spotlight once again, with two new papers on the subject published within the last few days.
Statin use associated with significantly increased risk of diabetes: WHI analysis
New data from the Women's Health Initiative hint that the risk of diabetes is higher than suggested by previous studies, with investigators reporting a 48% increased risk of diabetes among women taking the lipid-lowering medications.
Bereavement triggers MI, new study finds
Bereaved people are 21 times more likely to suffer an MI the day after the death of a significant other, and this heightened risk remains for as long as a month afterward, new research finds. Healthcare providers, the bereaved themselves, and their family and friends need to recognize this heightened risk, say the authors.
UK's NICE wants more data on rivaroxaban in AF
The UK drugs cost-efficacy watchdog, NICE, has asked for more data from Bayer before it will sanction use of rivaroxaban for stroke prevention in atrial-fibrillation patients.
Informed consent questioned in Florida patient's death after stem-cell treatment
A Florida cardiologist is accused of malpractice after a patient treated with a novel stem-cell therapy died of a brain infarct.
MitraClip: Encouraging results in nonsurgical patients
While the clip did appear to reduce mitral regurgitation and improve remodeling in patients unsuitable for surgery in the EVEREST II trial, problems with the comparator group make the results difficult to interpret.
Complications, rehospitalizations not uncommon post-AF ablation
Little is known about the complication rates for atrial fibrillation outside of academic hospitals and Medicare data, so researchers in California analyzed data from a state database to estimate the complication risk of AF ablation in the contemporary community setting.
Novel LDL-gene-targeted agent promising
Suppressing the activity of PCSK9, a gene known to mediate low-density-lipoprotein cholesterol metabolism, cut LDL-C levels in a small dose-ranging study.
Excess calories, not proportion of dietary protein, key in causing obesity
Excessive food intake, rather than the mix of protein, fat, and carbohydrates, has been implicated in causing obesity and is key in treating it.
RESPECT PFO/stroke trial completes enrollment
After eight years of sluggish patient accrual, the RESPECT trial looking at the Amplatzer device for the prevention of cryptogenic stroke has finally collected enough events for the trial to be stopped.
Public Citizen requests recall of the Wingspan stent
A consumer-advocacy group argues that the Wingspan Stent System provides less benefit and causes more harm than aggressive medical treatment alone.
BRCA1 cancer gene affects cardiac function
Canadian researchers have discovered that the BRCA1 gene is implicated in cardiac function, at least in mice. The findings may also have implications for cancer sufferers who have mutations in this gene: they may be at increased risk of heart disease and more likely to suffer cardiotoxicity from chemotherapy.
Rivaroxaban filed for ACS in US and EU
The factor Xa inhibitor rivaroxaban has been filed for approval for the additional indication of secondary prevention in acute coronary syndrome in both the US and EU.
Type 2 diabetes adds risk to tissue valves
Type 2 diabetes is a known determinant of degeneration of both native and prosthetic valve implants, so a group of Italian researchers investigated whether bioprosthetic valves also degenerate faster in diabetic patients vs nondiabetic patients.
US leads in shorter hospital stays, early readmission after STEMI
Patients with ST-segment-elevation MI were more likely to be hospitalized again within a month if they had been treated in the US, and American patients had the shortest initial hospitalization, in a retrospective study of data from an international trial. The work identifies national differences in this measure of care—30-day-readmission—and it should help guide future investigations, the authors say.
Bariatric surgery reduces CV events, but mechanisms remain a mystery
The latest data from the Swedish Obese Subjects study show that bariatric surgery reduces the risk of cardiovascular events and CV death among obese individuals, compared with usual care. But weight loss is not the reason behind this reduced risk, meaning that guidelines that use BMI to determine who will get such surgery need updating, say the authors and an editorialist.
Enoxaparin prophylaxis doesn't cut mortality in acute-care setting
Antithrombotic prophylaxis remains important in this group for other reasons, but don't expect it to necessarily prevent death, according to researchers.
Mayo report: It takes docs about 30 TAVIs to achieve proficiency
Two new single-center studies shed light on the contemporary experience with new transcatheter aortic-valve systems. One looks at the "learning curve" required for operators to become proficient with the devices, and the other investigates how patient selection for these procedures has changed over time.
Analysis slams use of clopidogrel loss-of-function gene test; proponents fire back
A new meta-analysis and especially an accompanying editorial argue against current use of CYP2C19 genotyping to define risk of subsequent CV events in patients considered for clopidogrel. Proponents of the test defend its use and describe what they see as flaws in the study.
Troponins at admission and three hours allow MI diagnosis or rule-out
Troponin levels measured using a sensitive or highly sensitive assay can help with early MI rule-out, suggests a study that makes a case supporting the possible approval of the high-sensitivity assay in the US.