December 27th, 2010 by John Mandrola, M.D. in Better Health Network, News, Opinion, Research
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The end of the year marks a time for list-intensive posts. Recently Larry Husten from CardioExchange and CardioBrief asked for my opinion on the three most important cardiology-related news stories of 2010. Additionally, he wanted three predictions for 2011. Here goes:
Top Cardiology Stories Of 2010:
1. By far, the #1 heart story of 2010 was the release of the novel blood-thinning drug dabigatran (Pradaxa) for the prevention of stroke in atrial fibrillation. Until this October, the only way to reduce stroke risk in AF was warfarin, the active ingredient in rat poison. Assuming that there aren’t any post-market surprises, Pradaxa figures to be a true blockbuster. Doctors and patients have waited a long time to say goodbye to warfarin.
2. The Dr. Mark Midei stent story: Whether Dr. Midei is guilty or innocent of implanting hundreds of unnecessary stents isn’t really the big story. The real impact of this well-chronicled saga is the attention that it brings to the therapeutic misconceptions of coronary stenting. The problem with squishing and stenting is that although they improve the physics (of bloodflow), they do not change the biology of arterial disease — a hard concept to grasp when staring at a picture of a partial blockage. The vast press coverage of Dr. Midei’s alleged transgressions has served to educate many about heart disease, the nation’s #1 killer. Read more »
*This blog post was originally published at Dr John M*
November 24th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Tips, News, Research
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New clinical trials and published research are giving us information on how to improve health in elderly patients. Here are some brief points from the Cleveland Journal of Medicine that were surprising to me:
— Each year 30 percent of people age 65 or older fall and sustain serious injuries so preventing falls and fractures is important. Vitamin D prevents both falls and fractures, but mega doses of Vitamin D (50,000 mg) might cause more falls. A better dose is 1,000mg a day in people who consume a low-calcium diet.
— Exercise boosts the effect of influenza vaccine.
— The benefits of dialysis in older patients is uncertain, as it does not improve function in people over age 80. We don’t even know if it improves survival. Older patients who receive dialysis for kidney failure had a decline in function (eating, bed mobility, ambulation, toileting, hygiene, and dressing) after starting treatment.
— Colinesterase inhibitors (Aricept, Razadyne and Exelon) are commonly used to treat Alzheimer disease, but they all can have serious side effects. Syncope (fainting), hip fractures, slow heart rate, and the need for permanent pacemaker insertion were more frequent in people taking these drugs. The benefits of these drugs on cognition is modest.
— A new drug called Pradaxa (dabigatran) will likely prove to be safer than Coumadin (warfarin). Over two million adults have atrial fibrillation and the median age is 75. The blood thinner warfarin is critical for prevention of strokes but it caries a high risk of bleeding and drug levels have to be monitored frequently. Dabigatran will probably replace warfarin, but it will probably also be a lot more expensive.
As I often say, medicine and science are constantly changing and evolving. As new evidence comes forth, physicians and patients need to re-evaluate they way we do things.
*This blog post was originally published at EverythingHealth*
November 12th, 2010 by John Mandrola, M.D. in Better Health Network, Humor, Opinion, True Stories
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I loved my old status. Perhaps, reveled in it would be a better description. I was a crotchety, generic medicine-only doctor.** Sadly, my status changed today. Dabigatran (brand name Pradaxa) was the culprit.
It was a little nerve racking. I wrote the order, looked at it, thought it out again, talking to myself: “John, are you sure you don’t want to do it the old way? [pause to think] No, I am embracing the new.” And then, I closed the chart and handed it to the nurse.
“What’s that? Pradaxa?” asked the nurse. “Stop the Lovenox? You sure?” My face must have told the story.
Eight days had passed since dabigatran’s approval. “That’s plenty of time to mourn warfarin’s demise,” I thought. Enough studies, enough blogs — it was time for the rubber to hit the road. Read more »
*This blog post was originally published at Dr John M*
