Coronary angioplasty is a technical marvel. A thin tube is threaded from an artery in the groin to the heart. Through this tube a tiny balloon is threaded into a narrowed coronary artery. The balloon is inflated to open the artery, and then a stent (a metal mesh tube) is placed in the newly open artery to keep it open. About a million coronary angioplasties are done in the United States annually.
The procedure was initially developed with the hopes that opening narrow arteries would prevent...
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What We Don’t Know About Diabetes – Part 2
In February I wrote about the results of the ACCORD trial, a study designed to test whether strict glucose control in patients with diabetes helps prevent strokes and heart attacks and prolongs life. The startling results were that the patients with diabetes who were randomized to have their glucose lowered to normal levels died sooner than those with more lax sugar control.
This week the New England Journal of Medicine published the results of another study, the ADVANCE trial, which ...
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Home Defibrillators Less Helpful than Hoped
Automatic external defibrillators (AEDs) are machines that are designed to be used by non-medical personnel in the event of a witnessed sudden collapse. The AED is connected to the chest of the patient and automatically detects the patient's heart rhythm. If the AED detects a rhythm that requires an electric shock, the AED delivers the shock and monitors the rhythm until paramedics arrive. The time between collapse and delivery of the first shock is critical to survival. So it was hoped that...
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It’s Never Too Late to Treat High Blood Pressure
New Feature Ask the Doctor
I've read a lot in the news in the last two weeks scary stuff about Singulair. Should I stop taking it? -- Jeff K.
About two weeks ago the FDA released a communication that it was investigating the incidence of suicidal thinking and mood changes in patients taking Singulair, a medication used to treat asthma and nasal allergies. No connection between Singulair and these symptoms has been est...American Heart Association Recommends Hands-Only CPR
Despite many encouraging advances in the prevention, diagnosis and treatment of heart disease, heart attacks remain the largest cause of death in the US. Many of those heart attacks happen suddenly and cause a life-threatening abnormal heart rhythm called ventricular fibrillation. Patients frequently suddenly collapse, and without prompt restoration of a normal heart rhythm, survival is unlikely.
There are two critical factors that determine whether the patient will survive without serious br...
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In Event of a Heart Attack Let the Paramedics Come to You
Yesterday's LA Times health section had an important article about what to do in the event of a heart attack. In the last decade our understanding and treatment of heart attacks has improved dramatically. The best treatment for a heart attack is immediate angioplasty, a procedure that inserts a tiny balloon in the closed artery, opens it and leaves a metal stent to keep the vessel open...
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How Much Good Do Cholesterol Drugs Do?
Last month BusinessWeek had a fascinating article about cholesterol-lowering medications. The article also teaches us how we should calculate a specific medication's benefit and harm, and how pharmaceutical companies manipulate our opinions by reporting benefits in percentages but side effects in absolute numbers. If you want an interesting lesson in evidence-based medicine, or just in cholester...
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What We Don’t Know About Diabetes
This week we learned something very important about diabetes. We learned that we don't know something we thought we knew. (Regular readers will note that this keeps happening in medicine. For a generation everyone assumes something. Then we check and discover it isn't so.)
We've always assumed that in type 2 diabetes, the closer to normal that blood sugar is lowered the fewer complications of diabetes patients would have. Why? Because diabetes is known to be a major cause of kidney diseas...
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More Bad News for Zetia and Vytorin
Regular readers will remember that I wrote about Zetia back in November. That post had some important background for this week's news, and a handy lesson about the difference between clinical and intermediate outcomes in medical studies. If you missed it, you may want to check it out. This week, Merck released the data from a study comparing the growth of cholesterol plaques in the arteries of patients taking Zocor (a cholestero...
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Taking Blood Pressure Seriously
I've written many times about the U.S. Preventive Services Task Force (USPSTF), the most unbiased and authoritative group that reviews the literature on preventive healthcare.
Their latest recommendation is not surprising; it's just a good reminder. This week's Annals of Internal Medicine has a USPSTF recommendation statement ...
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