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The quest for ever-more effective drugs to decrease platelet aggregation and reduce the risk of thrombus formation, without unduly increasing the risk of bleeding, will always be a holy grail of cardiovascular disease research. With each new contender comes fresh excitement as well as more questions.
Long considered an essential agent for primary cardiovascular disease prevention, aspirin has been getting a second look. In recent years, a growing number of trials and meta-analyses are questioning whether an aspirin a day is a good idea for primary-prevention populations.
Proton-pump inhibitors have been prescribed to reduce the gastrointestinal risks of clopidogrel--until a range of small studies suggested that this combination might actually increase the risk of cardiovascular events. The FDA took the unusual step of issuing a warning about the combination, but many people believe the evidence simply doesn't warrant concerns about the combo and may even be putting patients at risk.
The presentation of the RE-LY results at the 2009 ESC meeting, showing that dabigatran safely and significantly cut the risk of stroke or peripheral embolic events compared with warfarin over two years, quickly let to speculation that a new era in anticoagulation therapy had arrived. The path to approval around the globe has not been entirely without controversy.
Heart disease still tops the charts as the number-one killer in most developed countries, while cancer deaths occupy the number-two position. But a close look at the numbers shows that cancer has had more new drugs approved in recent years than has heart disease, with even more novel therapies moving through the R&D pipeline. Some experts point to the vastly larger funding coffers cancer researchers have at their disposal, but other, less tangible public forces are also likely driving some of the disparities.
Years ago, Viagra made the unexpected transition from hypertension and angina drug contender to erectile-dysfunction blockbuster, only to journey back as a treatment for PAH. Recent years have seen a flurry of studies suggesting that erectile dysfunction and coronary disease are closer cousins than ever expected.
Low-carb diets like Atkins and South Beach have, in some studies, shown counterintuitive effects on the heart, garnering them support from an unlikely corner: cardiology. The debate over how low-carb diets stack up against the low-fat diets long recommended by heart experts has proved to be both lively and enduring.
Magnetic resonance imaging tests are increasingly being used for diagnosing forms of heart disease and for a wide range of other ailments, at the same time that more and more people are receiving ICDs and pacemakers. Just what are the risks to patients and to devices themselves?
For six decades, warfarin cemented its reputation as the world's most effective anticoagulant--and the most troublesome to dose appropriately. In recent years, a host of new agents have been vying to be the long-sought-after alternative to warfarin by posing fewer risks and doing away with the need for regular INR monitoring.
Randomized clinical trials dating back to the GISSI Prevenzione study have cemented a role for omega-3s in cardiovascular disease. But further studies have also pointed to populations in whom fish or supplements seem to have no added benefits.
The much-anticipated antiplatelet agent gained FDA approval on the basis of the pivotal TRITON-TIMI 38 trial, showing significantly reduced ischemic events as compared with clopidogrel, but at the expense of increased bleeding. The approval process, however, became news in and of itself, when a known critic of the drug was kept off the FDA's advisory panel.
A controversial 2007 meta-analysis questioning the cardiovascular safety of rosiglitazone opened a Pandora's box for what had been a blockbuster diabetes drug. The story has involved analyses and reanalyses of trial data, accusations of investigator intimidation, FDA and US Senate investigations, black-box warnings, leaked academic papers, accusations of missing data, and wiretapped discussions with the drug manufacturer--all culminating in calls to pull the drug from the market and stop the only trial that might decisively answer the questions that have dogged this drug.
Around the globe, public policy-makers, restaurateurs, and food manufacturers are asking what it would take to reduce the soaring sodium content of daily staples and whether the predicted drop in blood pressures at a societal level would translate into reduced cardiovascular events.
The new nonthienopyridine started making waves in cardiology circles in 2009, with the presentation of the PLATO trial. As excitement grows about the so-called "reversible" antiplatelet drug, experts still have questions about its twice-daily regimen, bleeding profile, and dyspnea among patients taking this drug in randomized trials.
In 2008, a heartwire investigation reported on a mitral annuloplasty ring, invented by a prominent surgeon, that one patient believed she'd received without giving informed consent. The device ultimately traveled an unusual path to FDA clearance, but not before attracting the attention of Congress.
Back in July 2006, some of the biggest names in cardiology signed their name to the controversial "SHAPE task-force report," which recommends screening of all "at-risk" men between the ages of 45 and 75 and all at-risk women age 55 to 75. Experts and representatives of the major cardiology societies have now spent years debating the so-called "guidelines," even as legislators in Texas moved ahead with a bill based on the report.
Athletes push their bodies to the max, but does that means their hearts are stronger or more at risk than regular folks? A wide range of studies looking at endurance and professional athletes provides some surprising and often counterintuitive insights.
Radial access for PCI, even for STEMI patients, can be performed with a low risk of adverse events, including bleeding, and, in experienced hands, takes no additional time. So why are some parts of the world lagging behind?
People are regularly taking vitamins and herbal remedies in higher quantities than ever before, often without mentioning these over-the-counter products to their doctors. Some agents have powerful effects on the cardiovascular system, while others can interact with heart medications to strengthen or weaken their effects.
