June 20th, 2011 by DrRich in Opinion, Research
Tags: ACS, Acute Coronary Syndromes, Artery Blockage, Blockage, CAD, Cardiologist, Cardiology, Coronary Artery Disease, COURAGE Trial, Guidelines, Heart Attacks, JAMA, Plaques, Rupture, Statins, Stent, TheHeart.org
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In 2007, when the results were published from the COURAGE trial, all the experts agreed that this study would fundamentally change the way cardiologists managed patients with stable coronary artery disease (CAD).*
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*”Stable” CAD simply means that a patient with CAD is not suffering from one of the acute coronary syndromes – ACS, an acute heart attack or unstable angina. At any given time, the large majority of patients with CAD are in a stable condition.
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But a new study tells us that hasn’t happened. The COURAGE trial has barely budged the way cardiologists treat patients with stable CAD.
Lots of people want to know why. As usual, DrRich is here to help.
The COURAGE trial compared the use of stents vs. drug therapy in patients with stable CAD. Over twenty-two hundred patients were randomized to receive either optimal drug therapy, or optimal drug therapy plus the insertion of stents. Patients were then followed for up to 7 years. Much to the surprise (and consternation) of the world’s cardiologists, there was no significant difference in the incidence of subsequent heart attack or death between the two groups. The addition of stents to optimal drug therapy made no difference in outcomes.
This, decidedly, was a result which was at variance with the Standard Operating Procedure of your average American cardiologist, whose scholarly analysis of the proper treatment of CAD has always distilled down to: “Blockage? Stent!”
But after spending some time trying unsuccessfully to explain away these results, even cardiologists finally had to admit that the COURAGE trial was legitimate, and that it was a game changer. (And to drive the point home, the results of COURAGE have since been reproduced in the BARI-2D trial.) Like it or not, drug therapy ought to be the default treatment for patients with stable CAD, and stents should be used only when drug therapy fails to adequately control symptoms.
When the COURAGE results were initially published they made a huge splash among not only cardiologists, but also the public in general. So cardiologists did not have the luxury of hiding behind (as doctors so often do when a study comes out the “wrong” way) the usual, relative obscurity of most clinical trials. Given the widespread publicity the study generated, it seemed inconceivable that the cardiology community could ignore these results and get away with it.
But a new study, published just last month in JAMA, reveals that ignore COURAGE they have. Read more »
*This blog post was originally published at The Covert Rationing Blog*
June 19th, 2011 by DeborahSchwarzRPA in Research
Tags: Amino acids, Blood Sugar Levels, BMI, Body Mass Index, Branched-Chain Amino Acids, Center for Metabolic and Weight Loss Surgery, Columbia University, Diabetes, Dr. Melissa Bagloo, Gastric Bypass Surgery, insulin, Science Translational Medicine, Surgical Weight Loss, Type 2 Diabetes, Weight Loss
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Science Translational Medicine
The April 27, 2011 issue of Science Translational Medicine included a study titled “Differential Metabolic Impact of Gastric Bypass Surgery Versus Dietary Intervention in Obese Diabetic Subjects Despite Identical Weight Loss.”
Melissa Bagloo, MD, Assistant Professor of Clinical Surgery at the Center for Metabolic and Weight Loss Surgery, NYP/Columbia, explains the context and importance of this study.
Q: What did this study find?
Dr. Bagloo: For years, surgeons have observed that gastric bypass surgery cures diabetes in over 80% of patients with diabetes. This improvement in blood sugar levels happens almost immediately after surgery, and far before any significant weight loss occurs. What’s more, studies have found that when patients lose the same amount of weight through diet as other patients lose after surgery, those who had surgery experience significantly better improvement in their diabetes than those who lost weight non-surgically. So we know surgery dramatically improves or resolves diabetes, but we do not know why this happens.
This recent study in Science Translational Medicine found an important clue as to why this effect may occur. The researchers found that Read more »
*This blog post was originally published at Columbia University Department of Surgery Blog*
June 19th, 2011 by ChristopherChangMD in Health Tips, Research
Tags: Allergic Sensitization, Allergy, Baby, Cat, Clinical and Experimental Allergy, Development, Dog, Indoor Cat, Risk
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There have been a number of studies in the past investigating whether it is healthy for a baby to be around pets and whether such exposure increases or decreases risk of becoming allergic to them later in life.
In a recent study (published online June 2011), the researchers found that among males, those with an indoor dog during the first year of life had half the risk of becoming allergic to dogs at age 18 compared with those who did not have an indoor dog in the first year of life regardless whether born by C-section or vaginally. Also, teens with an indoor cat in the first year of life also had a decreased risk of becoming allergic to cats. Neither cumulative exposure nor exposure at any other particular age was associated with either outcome. So it appears that Read more »
*This blog post was originally published at Fauquier ENT Blog*
June 19th, 2011 by GarySchwitzer in Opinion, Research
Tags: American Cancer Society, Diagnosed, Dr. Len Lichtenfeld, Education, Facts About Prostate Cancer, Father's Day, Follow Up, Men's Health, Men's Health Month, Men's Health Week, Promotion, Prostate Cancer, Prostate Screenings, U.S. Preventive Services Task Force
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This week has been proclaimed International Men’s Health Week – the week leading up to and including Father’s Day. And it’s part of what’s more broadly been proclaimed by some as Men’s Health Month.
The campaign offers a variety of men’s health “materials” – including the squeezy prostate stress ball pictured at left – if you’re into that kind of thing.
There are also brochures like the one below. The “Facts About Prostate Cancer” state that men at high risk should begin yearly screening at age 40 – all others at age 50. The “should begin (at 50)” recommendation crosses a line not supported by the US Preventive Services Task Force and the American Cancer Society, among other organizations.
The campaign also commits fear-mongering with these statistics: Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
June 17th, 2011 by RyanDuBosar in Health Tips, Research
Tags: Autism, CDC, Childhood Vaccinations, Epidemiology, Health Affairs, HealthStyles, National Immunization Survey, Patient Communication, Patient Education, Patient Safety, Public Health, Vaccinate, Vaccination, Vaccines
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Some parents remain unpersuaded that all childhood vaccines are safe or even necessary, a new survey published in Health Affairs shows.
While most parents vaccinate their children, they lack confidence in them, researchers pointed out. Parental education should include thorough explanations why infants should be fully immunized before age two.
Vaccination levels for most recommended vaccines were above 90% of national immunization goals in 2009, reported the CDC’s National Immunization Survey. But, researchers wrote, high immunization rates aren’t the same as high confidence in the vaccines.
Using data from the 2010 HealthStyles survey of 6,253 households (response rate 67%), researchers identified Read more »
*This blog post was originally published at ACP Internist*
