theHeart.org - Lipid/Metabolic

EFFECT: Public reporting of hospital performance improves quality of care?

Thu, 19 Nov 2009 10:00:55 EST

Publicly released report cards based on hospital performance did not result in a measurably greater systemwide improvement in two composite AMI or CHF process-of-care indicators in a Canadian study. But they did appear to stimulate some important changes in delivery of care that could have led to some better outcomes.

BARI 2D cost-effectiveness analysis favors medication over PCI for less severe CVD in diabetic patients

Wed, 18 Nov 2009 15:45:07 EST

New data from the BARI 2D trial comparing medical therapy vs revascularization in diabetics shows higher up-front costs of revascularization are only partially offset by long-term savings.

Niacin not beneficial in patients at goal with statins: NIA Plaque

Wed, 18 Nov 2009 09:00:00 EST

The addition of niacin to statin therapy in secondary-prevention patients resulted in a significant improvement in lipids but failed to significantly alter atherosclerotic disease progression as measured by MRI. Researchers say it's a win for treating patients to target and suggest this trumps raising HDL.

Statins do not eliminate risk of low HDL-cholesterol levels

Tue, 17 Nov 2009 14:45:00 EST

Researchers say a new study shows that statins don't alter the risks associated with low HDL-cholesterol levels and that raising HDL cholesterol 10�mg/dL could prevent an additional eight MIs per 1000 patient-years.

ARBITER 6-HALTS: HDL raising with niacin superior to ezetimibe

Sun, 15 Nov 2009 18:00:00 EST

Extended-release niacin is superior to ezetimibe in its effect on carotid intima-media thickness. While experts say the trial tells clinicians little about ezetimibe, it is a big win for niacin given the substantial regression of atherosclerosis observed at eight and 14 months.

Canadian confusion: Primary-care docs lack knowledge of CVD risk factors, prevention

Sun, 15 Nov 2009 09:00:30 EST

Family doctors and general practitioners in Canada are confused about cardiovascular risk assessment in primary prevention, a new survey reveals.

SGR repair bill failure could cool physician support for healthcare reform

Thu, 12 Nov 2009 15:00:58 EST

Now that the US House of Representatives has passed a healthcare reform bill, organized medicine anticipates another vote—possibly next week—on a second bill that would rewrite Medicare's controversial sustainable-growth-rate formula for physician reimbursement.

Total- and HDL-cholesterol levels, not triglycerides, predict vascular risk

Thu, 12 Nov 2009 10:00:40 EST

Clinicians can simplify their existing risk-assessment tools by measuring either total- and HDL-cholesterol levels or apolipoproteins, and this assessment can effectively be done in patients who did not fast before the test.

What's going to be hot at AHA 2009?

Wed, 11 Nov 2009 09:00:54 EST

Anticipation is building for full trial results from ARBITER 6-HALTS, plus a better understanding of what went wrong with cangrelor in the CHAMPION trials. Also in the lineup are updates from PLATO, RE-LY, ALLHAT, BARI 2D, STICH, CASCADE, POPULAR, HEARTMATE II, and many more. Indeed, this year's "late-breaking" sessions include more than 30 trials over five days.

No benefits of aspirin for primary prevention in diabetics, meta-analysis suggests

Tue, 10 Nov 2009 17:15:54 EST

Most guideline documents recommend aspirin for primary prevention in people with diabetes, but a new meta-analysis has found no benefit of the widely used drug across a range of different cardiovascular end points. The results speak to the need for dedicated randomized trials, investigators say.

Low-cholesterol/cancer studies should "dispel lingering doubts" of causal link

Thu, 05 Nov 2009 14:15:24 EST

Two new papers should help put to rest concerns that low serum cholesterol levels may increase cancer risk.

Not all metabolic syndrome is created equal: Framingham Offspring analysis

Thu, 05 Nov 2009 11:45:03 EST

The syndrome (defined by ATP III criteria) can predict increased cardiovascular and mortality risk or not, depending on which three of five risk factors contributed to the diagnosis, a cohort study suggests; its investigators caution that their observations are only preliminary.

VELETI in print: Plaque sealing of SVGs a strategy "ahead of its time"?

Wed, 04 Nov 2009 15:30:23 EST

The imaging study was the first to show that stenting a non-flow-limiting stenosis of an SVG may help slow or halt the accelerated atherosclerosis that takes place in these vessels. An accompanying editorial cautions that the study does little more than "infer a trend toward anatomic benefit."

Adding fuel to the J-curve fire; debate is reignited

Wed, 04 Nov 2009 14:30:56 EST

More discussion about the J-curve in hypertension is published this week; one expert believes the undue attention being paid to this subject might discourage doctors from treating high blood pressure aggressively.

CAC scoring plus SPECT provide long and short view of cardiac risk

Tue, 03 Nov 2009 17:00:51 EST

UPDATED // An 1126-patient trial shows that SPECT and CAC scoring imaging tests are independent and complementary predictors of short- and long-term cardiac risk, respectively.

FDA expands exenatide use; warns of renal-failure risk

Tue, 03 Nov 2009 13:15:00 EST

The FDA has issued a warning about exenatide the same day the agency approved its first-line use along with diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.

CORONA analysis reopens door for statins in heart failure

Tue, 03 Nov 2009 10:45:33 EST

Statins for heart failure? After they failed to show much effect in two large randomized trials? Yes—maybe; at least in patients with ischemic heart failure who start the drugs early enough, suggests a post hoc analysis based on one of the trials.

Imaging study shows plaque regression with niacin vs placebo

Fri, 30 Oct 2009 16:00:00 EDT

Just weeks before ARBITER-HALTS�6 results come out at AHA 2009, an MRI study suggests that niacin is better than placebo in statin-treated patients with low HDL, at least for reducing carotid wall area. Experts say they'd also like to see insights into niacin effects on lipid-rich plaque volumes—the more commonly seen end point with MRI.

Lifestyle-based diabetes prevention seen to endure for at least a decade

Fri, 30 Oct 2009 10:00:00 EDT

The protective effects of diet modification, exercise, and other lifestyle changes against new-onset diabetes showcased in the three-year Diabetes Prevention Program continued out to 10 years in a follow-up analysis.

Combination drugs for weight loss

Thu, 29 Oct 2009 15:30:33 EDT

Two studies presented this week have shown positive effects on weight loss using a combination of agents.

CRP predicts mortality and MI, but not stroke

Thu, 29 Oct 2009 12:00:54 EDT

A new analysis from the Northern Manhattan Study finds that high-sensitivity C-reactive protein was modestly associated with mortality and MI but not ischemic stroke in this multiethnic population, suggesting the predictive value may depend on other factors.

Sex differences in changing MI prevalence, mortality challenge conventional wisdom

Thu, 29 Oct 2009 10:30:28 EDT

Two well-known observational registries highlight such changes in women and men over a decade or more: Do women younger than 55 still have an advantage over men in the same age group?

Schizophrenia plus diabetes linked with higher CAD yet lower revascularization rates

Wed, 28 Oct 2009 16:30:56 EDT

Individuals with schizophrenia and diabetes—as opposed to diabetes only—have a greater risk of CAD but a smaller likelihood of receiving CABG or PCI, a large cohort study suggests.

Lorcaserin passes weight-loss and valvular hurdles in BLOSSOM study

Tue, 27 Oct 2009 16:15:27 EDT

Among overweight patients, including those with preexisting echocardiographic valvulopathy, the average weight loss was approximately 5 kg with lorcaserin. Importantly, there were no concerns raised about new or worsening cardiac valve problems with the 5HT2C-receptor agonist.

ACCORD update: "One size fits all" may not be best glucose-lowering strategy

Tue, 27 Oct 2009 10:00:02 EDT

While post hoc analyses of ACCORD data suggest there are subgroups of diabetic patients who may not benefit from an aggressive glucose-lowering approach, similar analyses with ADVANCE data did not identify subgroup differences.

Experts weigh in on calorie lists on menus, despite "mixed" science

Mon, 26 Oct 2009 16:45:21 EDT

Results showing that people eat less when they know how many calories are in that Big Mac are mixed, but experts say that menu labeling provides only upside, with no public-health cost, and that over time results will show the information to have a positive effect on obesity rates in the US.

Distribution of body fat important in VTE

Mon, 26 Oct 2009 16:00:00 EDT

The distribution of body fat, as well as the amount, is important when it comes to the risk of venous thromboembolism, Danish researchers have discovered.

Less exposure to cardiovascular risk factors with intensive diabetes intervention: Look AHEAD

Mon, 26 Oct 2009 10:00:00 EDT

Intensive lifestyle intervention in the management of diabetes produces sustained weight loss and improvements in fitness, as well as improvements in glycemic control, systolic blood pressure, and HDL-cholesterol levels.

New MESA data: Pericardial fat a better predictor of CHD than BMI

Fri, 23 Oct 2009 17:00:00 EDT

Pericardial fat, which is found around the heart, predicts future CHD events and may even be a better predictor of these than conventional obesity measures, such as BMI and waist circumference, a new study of MESA participants shows.

Look at absolute event rates when interpreting trial results

Fri, 23 Oct 2009 13:30:19 EDT

The low event rate in the RECORD trial of rosiglitazone has led some to question the validity of the results.

GLP-1 analog liraglutide promising in obesity

Thu, 22 Oct 2009 18:30:00 EDT

A drug originally developed to treat diabetes may have promise as an obesity therapy, a new study shows. Those taking liraglutide, a GLP-1 analog, lost more weight than those on an established obesity medication, orlistat.

Glucose lowering in type 2 diabetes to prevent CVD remains controversial but still important

Thu, 22 Oct 2009 14:45:51 EDT

Although the case for intensive glucose lowering in diabetic patients to prevent CVD is not straightforward, glucose control is still important for other reasons, and blood pressure and lipid control should not be neglected, according to debaters at a diabetes meeting.

Current risk equations may overestimate CVD risk in diabetic patients

Wed, 21 Oct 2009 10:00:31 EDT

Researchers using different international databases report that the Framingham and UKPDS risk equations overestimate the probability of CV events in diabetic patients.

Omega-3s no help to SSRI-treated CHD patients

Tue, 20 Oct 2009 16:00:00 EDT

The researchers suggest further study is still needed, as it is unclear whether higher doses of omega-3 fatty acids or setraline, longer treatment, or a different ratio of EPA to DHA would produce favorable results.

Thiazolidinediones have a role for appropriate diabetic patients

Tue, 20 Oct 2009 12:45:38 EDT

After 10 years of clinical use of TZDs, "we are still at the beginning," and randomized controlled trials shed light on their use in appropriate diabetic patients, speakers at a diabetes symposium reported.

ACE inhibitors of benefit in ischemic heart disease patients with preserved LV function

Mon, 19 Oct 2009 17:00:00 EDT

Patients with ischemic heart disease and preserved LV function on standard therapy will gain additional benefit from taking ACE inhibitors, a new review concludes. The same cannot be said for ARBs, a drug class for which the evidence is much weaker, but these are a good substitute in those who cannot tolerate ACE inhibitors, the authors say.

Rosuvastatin cleared for pediatric FH

Fri, 16 Oct 2009 16:30:01 EDT

The FDA has approved rosuvastatin for use in children aged 10 to 17 years old with familial hypercholesterolemia.

Can statins prevent and treat infection?

Thu, 15 Oct 2009 14:45:36 EDT

Results from a new meta-analysis show the pleiotropic effects of statins are useful in the treatment and prevention of different infections, including bacteremia, pneumonia, and sepsis.

Racial background woefully underreported in CV trials

Thu, 15 Oct 2009 13:15:10 EDT

Two-thirds of the 156 trials considered by the AHA in preparing a recent guideline failed to even record the ethnic backgrounds of participants, a new study has found. The researchers call for the reporting of race/ethnicity to be mandatory in all clinical trials, and they suggest medical journals should enforce this policy.

A fish tale with merit: Omega-3 PUFAs underrated for heart failure

Wed, 14 Oct 2009 12:30:27 EDT

Are the data not shouting loud enough, or is cardiology hard of herring? Omega-3 fatty acids may have only a modest treatment effect in heart failure, but they've performed swimmingly in randomized and observational studies considering how few new HF drugs have been reeled in lately.

Genetic variant again linked with statin side effects

Mon, 12 Oct 2009 17:00:00 EDT

Carriers of the SLCO1B1*5 allele are at a twofold increased risk of mild statin-induced side effects, and the majority of these individuals had normal creatine-kinase levels.

Target HbA1c levels still the subject of much debate, but tailored therapy should be the aim

Fri, 09 Oct 2009 16:45:25 EDT

Diabetologists are trying to tease out the best message to convey when it comes to target HbA_1c levels for primary-care physicians and other nonspecialists who might be treating patients with type 2 diabetes.

EULAR: CV risk management in inflammatory arthritis

Fri, 09 Oct 2009 11:45:12 EDT

The European League Against Rheumatism has issued 10 recommendations for cardiovascular risk management in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.

FDA clears colesevelam for FH in kids

Fri, 09 Oct 2009 11:00:39 EDT

The FDA has approved an expanded indication for colesevelam tablets and a new powder for oral suspension as an adjunct to diet and exercise to reduce LDL-C levels in boys and postmenarchal girls aged 10 to 17 years with heterozygous familial hypercholesterolemia.

New joint statement streamlines definition of metabolic syndrome

Thu, 08 Oct 2009 16:45:46 EDT

The statement from the International Diabetes Federation, the National Heart, Lung, and Blood Institute, and the American Heart Association, among others, formalizes the definition of the metabolic disorder with the hope of eliminating some of the confusion regarding how to identify patients with the syndrome.

New review confirms homocysteine lowering does not prevent CVD events

Thu, 08 Oct 2009 15:30:45 EDT

The latest review to look at the effects of homocysteine lowering with vitamin-B supplementation has come to much the same conclusions as most other studies and analyses in this field.

Experts debate bariatric surgery as a cure for diabetes

Thu, 08 Oct 2009 13:15:54 EDT

Under the some-say-misguided term "metabolic" surgery, gastric bypass is now being used in some instances to treat diabetics who are not considered morbidly obese. Experts say the mostly circumstantial evidence on this is intriguing, but prospective data are desperately needed in this group of patients.

Mercury/blood-pressure link should guide fish choices

Tue, 06 Oct 2009 16:45:03 EDT

An association seen between mercury levels and blood pressure, even after considering omega-3s and selenium, has researchers warning about the need to weigh the risks and benefits of fish consumption and to steer clear of bigger predators.

China death toll due to hypertension worse than predicted

Tue, 06 Oct 2009 14:15:24 EDT

The first prospective study using real data to inform the number of people suffering from and dying due to high blood pressure in China finds the problem is much worse than previously thought. A number of initiatives are planned to try to tackle this crisis.

Thiazolidinediones once again linked to fracture risk

Tue, 06 Oct 2009 12:30:18 EDT

Risk appeared to be similar in men and women, with exposure to either rosiglitazone or pioglitazone, and across a range of fracture sites. The longer the duration of exposure to the drugs, the greater the risk.

Simple, fixed-dose drug bundle may lower MI and stroke risk

Tue, 06 Oct 2009 10:15:41 EDT

A bundle of medium doses of a statin and an ACE inhibitor appears to lower CV risk in high-risk individuals, an observational study suggests, but critics caution that these are early days.

Hypoglycemia associated with increased risk of MI among US veterans with diabetes

Mon, 05 Oct 2009 13:45:19 EDT

Close attention should be paid to diabetes patients who experience an episode of hypoglycemia, because a new case-control study suggests a 65% increased risk of MI in the immediate two-week aftermath of such an event. Doctors should tailor diabetes therapies to minimize the risk of hypoglycemia occurring, say the researchers.

Insulin glargine and cancer: Association, no causal link

Fri, 02 Oct 2009 15:00:18 EDT

That was the conclusion of a recent panel of experts, perhaps alleviating concerns raised by several recent studies. �

New "principles" on authorship and COI from PhRMA get mixed response

Fri, 02 Oct 2009 12:00:10 EDT

The "Principles on Conduct of Clinical Trials and Communication of Clinical Trial Results" echo recent standards set by medical journal editors, but some observers say the document, which has no penalty component, lacks real teeth.

Wealthy Americans more likely to benefit from statin therapy than poor

Thu, 01 Oct 2009 16:45:51 EDT

In the past 30 years, wealthier Americans, who were once more likely to have high total- and LDL-cholesterol levels than poorer individuals, now have a significantly better lipid profile. Statins, say researchers, may have contributed to the expanding social disparities in cardiovascular risk.

Time to act: Cardiologists, diabetes docs, and psychiatrists urged to work together to tackle CVD in the mentally ill

Wed, 30 Sep 2009 14:00:04 EDT

Doctors from across the specialties of cardiology, diabetes, and psychiatry are being urged to collaborate to improve care for the mentally ill, who are more likely to die from cardiovascular disease than any other cause.

Diabetes: An independent risk factor for AF

Tue, 29 Sep 2009 00:00:23 EDT

Atrial fibrillation was more likely to develop in diabetics than in nondiabetics in a new observational study, and the link was particularly strong in women.

Early statin therapy in ACS: What's the level of evidence?

Mon, 28 Sep 2009 17:00:00 EDT

The use of high-dose statin therapy early in the course of acute coronary syndrome currently has the highest possible (class IA) recommendation in US guidelines, but a group of experts argues that this is inaccurate based on current evidence. However, they stress, they are not saying statins should not be used in this indication.

Sitagliptin linked to acute pancreatitis, FDA warns

Mon, 28 Sep 2009 13:00:51 EDT

The FDA is revising prescribing information for sitagliptin and sitagliptin/metformin after cases of acute pancreatitis, some severe, surfaced in postmarketing reports.

COMPARE: "Real-world" randomized trial favors Xience V over Taxus Libert�

Fri, 25 Sep 2009 08:30:19 EDT

COMPARE is the second of two large randomized controlled trials comparing a Taxus stent with Xience V to show a clear benefit of the newer stent.

New Canadian lipid guidelines will recommend CRP testing for certain patients

Thu, 24 Sep 2009 13:45:07 EDT

New Canadian guidelines for the diagnosis and treatment of dyslipidemia and the prevention of cardiovascular disease will recommend the testing of hs-CRP for certain patients, most notably those at intermediate risk. However, the lead author stresses that the majority of patients will not require a CRP test and that recommending and promoting a healthy lifestyle must be the first port-of-call for doctors.