ASPREE: Another Warning Bell for Aspirin, “Wonder Drug”Fails to Work Wonders Results of Aspirin in Reducing Events in the Elderly (ASPREE trial)

The results of the Aspirin in Reducing Events in the Elderly (ASPREE) trial published in the New England Journal of Medicine showcase higher all-cause mortality among apparently healthy older adults receiving daily aspirin as compared to placebo, coupled with the shocking finding of mortality being attributed primarily to cancer, thereby painting a bleak picture of Aspirin (ASA) and heralding an end to its use in primary prevention. Continue reading

Do Valsartan Contaminants NDMA and NDEA Bear A Potential Cancer Risk? Danish nationwide cohort study on N-nitrosodimethylamine (NDMA) contaminated valsartan products and risk of cancer, FDA notes second contaminant

The discovery of Valsartan products that were contaminated with NDMA, in July 2018, in drug products manufactured in China, triggered the withdrawal of all affected products by medical agencies across Europe and the United States. Being one of the most well characterized and potent animal carcinogens known, Pottegard and his colleagues conducted an expedited observational cohort study using the nationwide Danish healthcare registry. They aimed to quantify the potential effects of NDMA contaminated valsartan products in terms of increased cancer risk, in order to provide timely information for regulatory bodies evaluating its carcinogenic effects. Results from this Danish cohort study, published in the BMJ, however, failed to show a significant increase in overall short-term cancer risk due to consumption of NDMA contaminated valsartan. Continue reading

Aspirin Vs Placebo In Cardiovascular Event Reduction In Diabetes ESC 2018: ASCEND trial

A randomized 15,480 patient strong UK based trial comparing Aspirin (ASA) versus placebo in diabetics has shown that the absolute reduction in cardiovascular events from aspirin is offset by a similar absolute increase in major bleeding. Continue reading

High LDL Levels Can Increase Cardiovascular Mortality Even in Low Risk Population Results From the Cooper Center Longitudinal Study

A recent study published in Circulation found that higher levels of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDLC) increased the relative risk of long-term cardiovascular disease (CVD) mortality by 50% to 80%, in healthy participants that were considered to be at a low 10-year risk prior to the beginning of the study. Continue reading

‘Lowest is best’ when it comes to blood LDL cholesterol levels A meta-analysis shows lower blood LDL cholesterol levels may be efficacious and safe

Hypercholesterolemia is a major modifiable risk factor for coronary heart disease (CHD). Studies have consistently shown that atherosclerotic cardiovascular disease (ASCVD) risk is correlated to the levels of low-density lipoproteins (LDL) in the body. The lower the LDL levels, the lower the risk of ASCVD; but a key question remains to be answered, how low can you go without being unsafe? It has been several years since the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) published updated guidelines for the management of hypercholesterolemia. The more current American College of Endocrinology (AACE) guidelines make an attempt to update clinicians on clinical profile-based management in 2017. One of the most striking differences between the 2013 ACC/AHA guidelines and the AACE/ESC/EAS guidelines is the latter’s focus on specific target LDL-C levels. While there is little doubt that higher statin intensity lowers ASCVD risk, a new meta-analysis has now shown based upon the IMPROVE-IT (Examining Outcomes in Subjects With Acute Coronary Syndrome: Vytorin vs Simvastatin), FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) and REVEAL trials that, lower is better when it comes to LDL-Cholesterol (LDL-C). Continue reading

Modifiable risk factor control can eliminate excess cardiovascular risk in Type 2 Diabetes

A Swedish study has found that type 2 diabetics who have five risk-factor variables within the target ranges have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. Assessment of risk is based on the presence of five modifiable risk factors: smoking, elevated glycated hemoglobin, elevated low-density lipoprotein cholesterol level, elevated blood pressure and albuminuria. Continue reading

Greater Cholesterol Variability Is a Predictor for Atheroma Progression

“The variation in cholesterol levels is associated with an increase in the percentage of atheroma volume and worse clinical outcomes,” says a new meta-analysis in the European Heart Journal. Continue reading

EAGLES- A Randomized Clinical Trial Showing No Evidence of Smoking Cessation Treatments Association with MACE

EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study), a randomized clinical trial, published in the Journal of the American Medical Association, provides evidence that smoking cessation medications do not increase the risk of serious cardiovascular events in the general population of smokers. Continue reading

Preventing Heart Attack, Stroke, and Major Adverse Limb Events in Patients with Stable Atherosclerotic Vascular Disease

Dr. John Eikelboom Speaks at Brigham and Women’s Hospital

Video Augmented Information Delivery to Patients Undergoing Elective PCI Enhances Patient Awareness and Satisfaction

A new multi-center prospective randomized trial published in the American Heart Journal was able to show that a video presentation may be better at helping patients to understand the procedure and risks associated with percutaneous coronary intervention (PCI) compared to standard patient education pamphlets. Continue reading

Intervention in Barbershops Improved Blood Pressure Control

The results of a cluster-randomized trial conducted in black barbershops have been published in the New England Journal of Medicine and were presented by Dr Ronald G. Victor from Los Angeles, California at the ACC 2018 Conference in Orlando. The study showed that health promotion by barbers along with medication management in barbershops by pharmacists, resulted in a larger blood pressure reduction in black male barbershop patrons with uncontrolled hypertension as compared to lifestyle modifications and doctor appointments.

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Is Sodium Bicarbonate or N-Acetyl-Cysteine Effective in Preventing Contrast-Induced Nephropathy?

In a recent study published in the New England Journal of Medicine, it was found that amongst patients undergoing angiography, sodium bicarbonate is not better than sodium chloride  and neither is acetylcysteine better than oral placebo in the prevention of a composite outcome of death, need for dialysis, or persistent kidney injury. The treatment was also ineffective in reducing the risk of contrast-associated acute kidney injury.

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CANTOS subanalysis: Effect of Canakinumab on New Onset Diabetes in Pre-Diabetic Patients

Dr. Everett and Dr. Gibson Discuss

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Does Magnitude of CRP Level Reduction Correlate With Cardiovascular Mortality?

In a recent study published in The Lancet, it has been found that the magnitude of reduction in C Reactive Protein (CRP) levels due to treatment with Canakinumab, an interleukin 1β targeting monoclonal antibody, may directly correlate with a decrease in major cardiovascular events in post-myocardial infarction (MI) patients, even in the absence of an alteration in LDL levels. Continue reading

Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection

In a recent retrospective cohort study published in the New England Journal Medicine, a significant association was found between acute respiratory infections, particularly influenza, and the occurrence of acute myocardial infarction (MI) in the following week. The study also highlights the increased risk in older patients and in those who are hospitalized for the first time for an MI. Continue reading

D-dimer Level is Associated With Increased Long-term Cancer Incidence and All-cause Mortality

According to a recently published article in Circulation, it was found that D-dimer level is an independent predictor of the long-term (up to 16 years) risk of arterial and venous events, cause-specific mortality, and the incidence of new cancers. The results of the study are based on a  subanalysis of the LIPID trial. Continue reading

Does Marijuana Use Impact Cardiovascular Health?

With the increasing use and the legalization of marijuana in several states of USA, there is a need to evaluate its impact on the health. To explore this, a systematic review was recently published in Annals of Internal Medicine by Ravi et al. In the study, the investigators studied the association between marijuana use and cardiovascular outcomes. The authors concluded, “Evidence examining the effect of marijuana on cardiovascular risk factors and outcomes, including stroke and myocardial infarction, is insufficient”. Continue reading

Silent MI: A Risk Factor for Heart Failure? Link between silent myocardial infarction and heart failure

In a recent analysis published in the Journal of the American College of Cardiology, a link between silent myocardial infarction and subsequent heart failure has been demonstrated, revealing a novel potential marker for heart failure. Continue reading

Novel Echo Markers In Stroke Risk Stratification In AFib

The assessment of left atrial reservoir strain and P-wave to A’ duration on tissue Doppler imaging provides additional risk stratification for stroke after initial CHA2DS2-VASc scoring, according to a study published in the European Heart Journal, and may prove helpful in guiding decisions about anticoagulation for patients after the diagnosis of atrial fibrillation. Continue reading