Two press releases were issued about the SHARP trial : one from Merck, the much-maligned and criticized manufacturer of Vytorin (the combination of ezetimibe and simvastatin), and one from the group running the trial, the highly-respected Clinical Trials Service Unit (CTSU) at Oxford. Here’s the surprise: compared to the Oxford press release, the Merck release is a paragon, fully disclosing important details about the trial. The Oxford release is also a paragon, but of a different type. It’s a model of a press release that tries to manipulate the reader to adopt its… Continue Reading

In a Journal Watch Clinical Conversations podcast, Editor Harlan Krumholz discusses CardioExchange and what he thinks of the top research presented at AHA 2010. Hear what Harlan has to say about anacetrapib, rivaroxaban, Tele-HF, and more. Also, see Harlan’s posts at Forbes on remote patient monitoring (including his own Tele-HF study) and on the DEFINE study.

For a long time, HDL has been called the “good cholesterol.” Are we now entering the HDL decade? Two HDL-related trials were presented Wednesday at the AHA, and an array of additional trials are planned or underway, prompting the lead investigator of one of those trials, Chris Cannon, to speculate that this decade may be the HDL decade. Whether or not the 2010s turn out to be the HDL decade, there can be no question that the last day of AHA was HDL day. In addition to the excitement generated… Continue Reading

This week, JAMA published a commentary that Harlan Krumholz and I wrote about the growing use of ad hoc PCI and its implications for decision making about coronary revascularization. To cut to the chase, we believe that ad hoc PCI — the performance of a diagnostic cath and PCI in the same setting — makes it challenging to incorporate findings from landmark studies like the COURAGE and SYNTAX trials into routine clinical practice. As a solution, we suggest that in stable patients, interventionalists consider “pausing” for a few days between… Continue Reading

Well-known science journalist Mary Knudson is the author of HeartSense, a blog about heart failure, from which the following post is taken. In this post, she questions the aptness of the designation “heart failure.” For the last week, I have been mulling over the term heart failure, questioning how the collective conditions that bear this label ever got such a name, and looking into the very murky area of heart failure death statistics.  Many, many of us who were shocked to get the frightening diagnosis heart failure do not have hearts that have failed.  We… Continue Reading

From time to time, a sales representative visits my office promoting clopidogrel (Plavix) as a drug that patients who present with unstable angina/non–ST-segment-elevation MI (UA/NSTEMI) should start immediately as an up-front load. That strategy hasn’t been uniformly accepted in my clinician community because of concern about using an irreversible antiplatelet agent to treat patients who might need coronary artery bypass graft (CABG) surgery. Yet, this notion of clopidogrel pretreatment before cardiac catheterization is widely viewed as a given. Like most busy practitioners, I can be a fast-food consumer of the… Continue Reading

John Mandrola is a cardiac electrophysiologist and blogger on matters medical and general. Here is a recent post from his blog Dr John M. In response to my story on how physician consolidation and hospital ownership of doctors is affecting patient referral patterns, I received an email with this attached PDF file.  (Smudges mine) It is from a cardiac surgeon who doggedly chooses to remain independent. This document appears on his website and also ran in the local newspaper as an advertisement. Hopefully, the employer of your doctor has also… Continue Reading

We recently posted a blog that described the experience of a Fellow whose assessment of a patient and the need for a test was not seemingly given the fullest attention by the attending physician. Many of us remember such experiences in our training and the sense that there were issues beyond the patient that were influencing the decisions. We posted the blog to bring up issues of test ordering and the experience of Fellowship. The blog was written from the viewpoint of the Fellow and our belief was that the… Continue Reading

You’ve heard a lot lately about so-called “clopidogrel resistance.” That sounds straightforward, but the underlying reason can be complex, possibly related to how the drug is metabolized by subjects with a certain genetic profile. We seek here to provide some perspective about clopidogrel’s metabolic and gene-related complexities. First, some brief background: Clopidogrel, a thienopyridine, is a “prodrug” that is metabolized to its active form via the cytochrome P450 enzyme system — specifically, enzyme CYP2C19. A patient with certain genetic variants, or polymorphisms, can have diminished CYP2C19 activity (so-called “loss of… Continue Reading

I recently read an article in the journal Circulation that contained an alarming finding about patients who receive drug-eluting stents. Apparently, 1 in 6 did not fill their clopidogrel prescriptions immediately after discharge from a hospital in one of three large integrated health care systems. The median delay was 3 days. Furthermore, during a median follow-up of 22 months, the risk for death or myocardial infarction was significantly higher among patients with any delay in filling their clopidogrel prescriptions than among those with no delay (raw incidence, 14.2% vs. 7.9%)…. Continue Reading