December 1st, 2011 by John Mandrola, M.D. in Health Tips, Research
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There was important news this month on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.
I’d like to tell you about a recently-published (Lancet) landmark study that should quell safety concerns over statin drugs.
The punch line after I tell you the study’s results are short and sweet. Scroll down if you wish. But first, statin drugs are misunderstood enough to warrant a little blog-like simplicity. Let’s start with some background.
A brief statin review:
Statin drugs are best known for their cholesterol-lowering properties. The notion is simple: Read more »
*This blog post was originally published at Dr John M*
October 8th, 2011 by John Mandrola, M.D. in Health Tips, Opinion
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I recently wrote about the incredible sensations that come with vigorous exercise. Perhaps it was the post ride cannabinoid flurry, but it’s possible that I went too far in suggesting that ‘we’ (doctors, patients, the whole of Western Society) default first to pills before healthy living.
Two commentors called me out on this snark. They wrote about valid points.
One comment focused on the fact that her AF medicines were causing side effects that made vigorous exercise difficult. The second objected to my inference that exercise alone could substitute for the many benefits of modern medicine.
To the idea that medicine Read more »
*This blog post was originally published at Dr John M*
September 20th, 2011 by John Mandrola, M.D. in Opinion
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Did you know September is AFib awareness month?
As a believer in education as the first, and best treatment of AF, I think it’s great to enhance the public knowledge of this highly-misunderstood disease.
By all means…
Tell people about AF’s risks: stroke and heart failure.
Tell them that their fatigue, poor exercise tolerance and breathlessness might not be old age; it might be AF.
Tell them about the importance of early intervention.
Tell them that obesity, inactivity, sleep disturbances, alcohol, and incessantly worrying about everything makes AF more likely to occur, and to stay.
Tell them that Read more »
*This blog post was originally published at Dr John M*
June 20th, 2011 by DrRich in Opinion, Research
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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 8th, 2011 by John Mandrola, M.D. in Health Tips
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When cyclists find out that I am a heart doctor, they most frequently ask about cholesterol numbers.
“…My cholesterol is this…What do you think?”
“…My doctor wants me to take a statin…But I read that these drugs might lower my functional threshold power 2.014 watts/40km.”
All this focus on numbers saddens me. Remember, I am a forest guy, not a tree guy. What’s more, as a doctor that revels in the adrenaline rush of ablating rogue circuits with technology that would impress even a twenty-something, I find questions about biochemistry dreary–like eating quinoa.
I wish folks would ask me about how to terminate AF with a catheter, or how an (evidenced-based) ICD saved a mom’s life, or perhaps even this: “Do you do heart surgery?”
But more often than not people want to know about cholesterol.
Okay. It just so happens that this week brought some very interesting news concerning the treatment of abnormal cholesterol lab values. News that big-picture docs have to like. Read more »
*This blog post was originally published at Dr John M*
