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'Bendopnea': A New Symptom to Help Spot Sicker HF Patients? Marlene Busko March 24, 2014

DALLAS, TX — Cardiologists in Texas have identified a new symptom to look for in patients with advanced heart failure—"bendopnea," which they define as "shortness of breath when bending forward."Nearly a third of patients with advanced heart failure who were referred to their cardiac catheterization lab had bendopnea, according to a study published February 1, 2014 in the Journal of the American College of Cardiology: Heart Failure heartwire . These are heart-failure patients who are...

MAL-Adaptive Do We Avoid Metformin Unnecessarily? Chris Terpening, PhD, PharmD, BCACPDisclosures J Am Board Fam Med. 2014;27(1):136-141.

Abstract Convention holds that the use of metformin is contraindicated in many patients secondary to concerns about lactic acidosis. However, current evidence suggests that metformin-associated lactic acidosis is at most idiosyncratic. Awareness of the current evidence should permit broader use of this valuable medication. Conclusions and Recommendations While there are cases of metformin overdose resulting in lactic acidosis in the absence of confounders, even these situations seem to be idio...

New Data Linking Bisphosphonates and Atrial Fib: Should FDA Revisit?

BROOKLYN, NY — Authors of a new analysis say the US Food and Drug Administration (FDA) should consider revisiting its investigation of the atrial-fibrillation (AF) risk with certain osteoporosis drugs, in the wake of new studiesheartwire . And this meta-analysis suggests that they should be continued as a first-line therapy for osteoporosis and osteopenia, "but we should be very careful in selecting our patients." In particular, patients at high risk for AF—those who are older or hav...

Low-dose Aspirin in Primary Prevention Cardioprotection, Chemoprevention, Both, or Neither? Carlo Patrono Disclosures Eur Heart J. 2013;34(44):3403-3411.

Balance of Benefits and Risks While the balance of vascular benefits and risk of major GI bleeding due to aspirin is clearly favourable in patients with established coronary or cerebrovascular disease and at average haemorrhagic risk ( Table 3), such a balance is substantially uncertain in middle-aged people without symptomatic vascular disease, and will depend on the estimated annual risk of vascular vs. bleeding complications in the individual patient. It is important to consider that the two ...

A Pill a Day to Keep Breast Cancer Away Linda Brookes, MSc, Kala Visvanathan, MD, MHS Disclosures February 14, 2014

Weighing the Individual Risk for Breast Cancer Editor's Note: The American Society of Clinical Oncology (ASCO®) issued the latest update to its guideline on pharmacologic interventions for breast cancer risk reduction in July 2013. [1,2] The guideline focused on the risks/benefits of pharmacologic intervention vs no pharmacologic intervention, the comparative efficacy of breast cancer chemoprevention agents, and how physicians should communicate issues regarding breast cancer risk reduction in ...

Diagnosing and Managing Celiac Disease in Primary Care: Application of Current Guidelines An Expert Interview With Joseph A. Murray, MD Linda Brookes, MSc, Joseph A. Murray, MD Disclosures February 13, 2014

Background to the Interview Celiac disease is recognized to be an inflammatory disorder of the small intestine with an autoimmune component and strong heritability. Once viewed primarily as a disease of childhood, occurring mainly in white persons, it is now understood to occur in people of any age and in populations outside Europe and North America. Previously considered a rare disease, the prevalence of celiac disease is currently estimated at 1 in 100-300 in most parts of the world, [1] and...

Heartwire New Cholesterol Guidelines Abandon LDL Targets Michael O'Riordan November 14, 2013

Gone are the recommended LDL- and non-HDL–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL.According to the expert panel, there is simply no evidence from randomized, controlled clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prev...

Cardiovascular Risk and Cholesterol: Making Sense of the New Guidelines Sandra Adamson Fryhofer, MD Disclosures February 07, 2014

Heart disease is the leading killer of men and women in this country. That is why the details of this new prevention package addressing risk assessment, lipids, obesity, and lifestyle are so important. One major change is a new and somewhat controversial cardiovascular risk calculator. Although some experts have criticized this new calculator, saying it could overpredict risk by as much as 75%-150%, the AHA and ACC still stand in support of this new tool. It uses pooled cohort equations and inco...

Lower dose opioids are not associated with increased admissions or deaths in patients with COPD and might be safe for symptom reduction in severe respiratory disease.

British Medical Journal Safety of Benzodiazepines and Opioids in Very Severe Respiratory Disease: National Prospective Study Magnus P Ekström, Anna Bornefalk-Hermansson, Amy P Abernethy, David C Currow DisclosuresBMJ Introduction Breathlessness is a major cause of impaired activity and quality of life, affecting as many as a fifth of people aged over 65. [1,2] Chronic obstructive pulmonary disease (COPD) is a major cause of breathlessness, morbidity, and mortality. Worldwide, more than...

Cardiovascular Risk and Cholesterol: Making Sense of the New Guidelines Sandra Adamson Fryhofer, MD Disclosures February 07, 2014

It uses pooled cohort equations and incorporates age, sex, race, total and high-density lipoprotein cholesterol (HDL-C), systolic blood pressure, use of blood pressure-lowering medications, and smoking status. It applies to African American and non-Hispanic white men and women aged 40-79 years. The new guidelines say that patients with an estimated 10-year risk for cardiovascular disease of 7.5% or higher should be placed on moderate- to high-dose statin therapy. The same-intensity statin recomm...

Guidelines Ease Up on BP Thresholds, Drug Choices

CHICAGO, IL — At long last, the Eighth Joint National Committee (JNC 8) has released its new guidelines on the management of adult hypertension, which contain two key departures from JNC 7 that the authors say will simplify careheartwire . "We wanted to make the message very simple for physicians: treat to 150/90 mm Hg in patients over age 60 and 140/90 for everybody else. And we simplified the drug regimen as well, to say that any of these [four] choices are good, just get people to goal....

ACE + ARB = Adverse Events

I call to your attention a paper just published in the New England Journal of Medicine, with Linda Fried as the first author.[1] This was an excellent randomized controlled trial among US veterans, almost all men, with type 2 diabetes, a urinary albumin/creatinine ratio greater than 300 mg/g creatinine, and an estimated glomerular filtration rate (GFR) between 30 and 89.9 mL/min/1.73 m2. After participants with elevated serum potassium levels at baseline were excluded, the subjects were placed o...

ACOG Revises Guidelines on Treating Menopause Symptoms

The recommendations are listed in 3 tiers: Level A ("good or consistent scientific evidence"): Systemic HT, with just estrogen or estrogen plus progestin, is the most effective approach for treating vasomotor symptoms. Low-dose and ultra-low systemic doses of estrogen have a more favorable adverse effect profile than standard doses. Healthcare providers should individualize care and use the lowest effective dose for the shortest duration. Thromboembolic disease and breast cancer are ...

Vitamin-D Deficiency Linked to Fatal CVD Miriam E. Tucker December 23, 2013

Vitamin-D deficiency is much more strongly linked to fatal than nonfatal CV events, results of a large prospective study suggest. "Although our results were able to confirm an approximately 27% increased total CV risk in subjects with vitamin D deficiency, they indicate that the risk is much stronger for (and possibly even confined to) fatal CVD events," write the researchers, led by co–first authors Laura Perna, PhD, and Ben Schottker, PhD, from the German Cancer Research Center, Heidelberg. ...

Low-dose Aspirin in Primary Prevention Cardioprotection, Chemoprevention, Both, or Neither? Carlo PatronoDisclosures Eur Heart J. 2013;34(44):3403-3411.

Abstract and Introduction Abstract Low-dose aspirin has been shown to be effective in preventing about one-fifth of atherothrombotic vascular complications (non-fatal myocardial infarction, non-fatal stroke, or vascular death) in a meta-analysis of 16 secondary prevention trials in patients with previous myocardial infarction, stroke, or transient cerebral ischaemia. This corresponds to an absolute reduction of about 10–20 per 1000 patients in the yearly incidence of non-fatal events, and to a...

Prostate PSA Screening Does More Harm Than Good?

Medscape Medical News > Conference News PSA Screening Does More Harm Than Good, Says New Analysis Roxanne NelsonSep 29, 2013 MSTERDAM — To the ongoing debate over whether routine screening for prostate cancer reduces prostate cancer mortality comes a new analysis that suggests that it does more harm than good. The total harms that men experience in terms of impotence, incontinence, and other side effects from prostate cancer treatment can severely affect their quality of life, lead au...

Perils and Pitfalls of Long-term Effects of Proton Pump Inhibitors

Abstract This review summarizes the literature regarding long-term adverse effects of proton pump inhibitors (PPIs). A PubMed search (1966 to February 2013) for English language studies was conducted using key terms PPI: omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprazole, rabeprazole, pneumonia, Clostridium difficile, osteoporosis, risk of fractures, thrombocytopenia, rhabdomyolysis, anemia, iron deficiency, hypomagnesemia, vitamin B12 and nephritis. The risk of pneumonia w...

Heavy Coffee Consumption Linked With Increased Risk of All-Cause Death Michael O'Riordan Aug 15, 2013

COLUMBIA, South Carolina— Drinking more than four cups of coffee per day does more than increase the risk of the jitters, a new study suggests[1]. Researchers report that heavy coffee consumption, defined as more than 28 cups of coffee per week, is associated with an increased risk of all-cause mortality among men. For men and women 55 years of age and younger, the association between heavy coffee consumption and all-cause mortality is more pronounced In a multivariate analysis, men who dran...

Can Diet Soft Drinks Make You Fat? D. Eric Walters, PhDDisclosures Sep 16, 2013

Interpreting the Data Although Dr. Swithers focuses on the observation that consumption of artificially sweetened beverages correlates with risk for the metabolic syndrome, type 2 diabetes, hypertension, and coronary heart disease, the fact is that the correlation also exists with sugar-sweetened beverages. This argues against the premise of the article title. It is obvious (and pointed out in Dr. Swithers' article) that correlation is not the same as causation. People who have type 2 diabetes o...

Old drug, High risk..

BARCELONA, Spain (updated September 27, 2013) — First-line therapy with sulfonylureas significantly increases the risk for death in patients with type 2 diabetes when compared with treatment with metformin, a new study shows. Additional research showed that the combination of metformin and a sulfonylurea was also associated with a significantly increased risk for death when compared with combination therapy with metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor (or "gliptin")....

Anti-Hypertensive medicine & Breast Cancer

The first observational study of long-term antihypertensive use and breast cancer risk has found that calcium-channel blockers are associated with a more than 2-fold increased risk and that angiotensin-converting-enzyme (ACE) inhibitors are associated with a reduced risk. Women who had taken calcium-channel blockers for 10 years or more had more than double the usual risk for invasive ductal breast carcinoma (IDC) (odds ratio [OR], 2.4) and for invasive lobular breast carcinoma (ILC) (OR, 2.6)...