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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.
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.
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.
Administration of blood products to stable patients post-cardiac surgery increases their risk of death, renal failure, and sepsis, according to new research.
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.
Researchers using different international databases report that the Framingham and UKPDS risk equations overestimate the probability of CV events in diabetic patients.
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.
Heart-failure patients with ejection fractions >35% aren't necessarily excluded from the clinical and reverse-remodeling benefits of cardiac resynchronization therapy, suggests yet another study questioning the limits of CRT's current eligibility criteria.
Can an intrathoracic fluid-status monitor, added to an already-indicated ICD or CRT-D device in patients with heart failure, serve as the decompensation early-warning system now providedunreliably but as recommended in the guidelinesby the bathroom scale?
Rates of cardiac death and MI actually statistically favor the Endeavor stent at three years, new data show. Stent thrombosis occurred just once after one year for Endeavor, as compared with 11 cases after the one-year mark in the Taxus-treated patients.
Three-year target vessel failure remained statistically lower for the everolimus-eluting Xience V stent (which is also marketed as the Promus) than for the paclitaxel-eluting Taxus stent.
UPDATED // Compared with a 1996 survey by JAMA editors, a 2008 survey indicates that the practice of having ghost writers pen papers, then not appear as authors, is down to 8%, from 12% in 1996. The practice of inviting a prominent name to appear in the list of authors, without requiring that person to contribute to the research, has held steady at roughly 20%.
Results of a new survey showed that a surprising 15% of textbooks had one or more drug or device sponsors and, in two cases, those sponsors had tried to influence the content of the textbooks.
Dr Valentin Fuster returns to the city where he was born for a scintillating discussion with Drs Fox, Gershlick, Marrouche, Messerli, Spaulding, Vergheugt, Virmani, and Yancy about the miracle of RE-LY and the striking success of ticagrelor in the PLATO study.
UPDATED WITH COMMENTARY // A new nonthienopyridine antiplatelet agent, ticagrelor, has trumped clopidogrel in a phase 3 pivotal trial comparing the two agents and appears not to have the bleeding risks associated with prasugrel. But ticagrelor, which has the advantage of being reversible, has some unique side effects that could prove problematic.
The lead investigator for a controversial new analysis of hydrochlorothiazide says the drug is a "paltry" antihypertensive at the usual doses prescribed (12.5 mg-25 mg/per day) and should not be used as initial therapy. Others, however, offered plenty of caveats for the "provocative" conclusions.
The European Society of Hypertension is set to stir up the field of BP guidelines later this year, when it publishes an update to its 2007 recommendations. One key change is the recognition of a level of blood pressure below which could be dangerous to high-risk individuals, the so-called J-curve phenomenon. And the new guidelines will advise tailoring therapy to individual patients, rather than recommending a first-, second- and third-line drug therapy approach.
The trial concluded with the rosiglitazone being "noninferior" to metformin/sulfonylurea therapy with respect to CV death or hospitalization as adverse events over a follow-up of about five years. Researchers and observers disagree sharply, however, over what those results and other findings in the trial mean for diabetes therapy.
Overall rates of major CV events also were no different between revascularization and medical therapy, although CABG alonebut not PCIwas associated with a reduction in the risk of cardiovascular events, particularly nonfatal MI, compared with medical therapy, investigators note.
Although most patients receive more than one drug for high blood pressure, two new meta-analyses show that, in terms of initial drug therapy, only angiotensin receptor blockers were not significantly better than placebo or no treatment for the prevention of coronary heart disease events, while all antihypertensive drugs were better than placebo for the prevention of stroke.
In a group of patients with coronary artery disease, despite substantial lowering of LDL-cholesterol levels, a J-curve relationship exists between systolic and diastolic blood pressure and cardiovascular events, suggesting that low blood pressure can be harmful.
UPDATED // One-year risk of cardiovascular events is 50% higher in patients taking a proton-pump inhibitor on top of clopidogrel and similar for four PPIs, according to a retrospective cohort study of more than 16 700 patients who received clopidogrel poststenting.
The regional study highlights the need for studies addressing whether stent-thrombosis-STEMI patients should be treated the same as other STEMI patients.
The findings should help quell fears of a late catch-up phenomenon with a stent some have referred to as "DES-lite" and dispel concerns raised in meeting presentations last year about increased adverse events with this device.
Early results for the novel stent are reviving hopes for a concept that many people agreed was a good idea to begin withreservoir-based elution of an antiproliferative drug, using a bioerodable polymer.
Physicians trained in lead extraction should extract a minimum of 40 leads as the primary operator under the supervision of a qualified training physician and should extract a minimum of 20 leads annually as the lead operator. These numbers, however, are a "bare-bones" minimum, say researchers, stressing that patient care should always be individualized.
One crucial goal of the newly minted document is to foster realistic expectations for lead capabilities among regulators, industry, clinicians, and even patients.
JUPITER still burns brightly, if this year's ACC program is any indication. Program chairs for the ACC and i2 Summit programs say there are a range of other important trials that may prove "disruptive" to the status quo.
UPDATED WITH COMMENTARY // CABG-treated patients have more angina relief at one year, but PCI is the more cost-effective strategy, at least in low- and moderate-risk patients. During the first month, quality-of-life analyses clearly favor PCI, but these differences evaporate over the first year. In high-risk patients, CABG remains the clear winner.
Investigators caution that the data are preliminary, but the 30-day risk of stroke and death observed in clinical trials is lower when more experienced operators perform the procedure. (TCT 2008.)
Leaders of some of the more provocative DES studies in recent years seem to agree that other factors may be contributing to the apparent survival benefit with DES seen in recent registries but that it is at least safe to conclude that risk of death or MI is not increased with their use. But many also argue for a bigger role for bare-metal stents. (TCT 2008.)
There are a number of adjectives being thrown at the JUPITER studygroundbreaking and paradigm shifting are just twobut many experts believe the study, which showed significant cardiovascular risk reduction among healthy individuals with elevated CRP levels, is likely going to shake up the field of primary prevention. (Ridker PM et al. New Engl J Med; published online before print November 9, 2008. American Heart Association 2008 Scientific Sessions.)