Jan 5, 2018

We’ve all seen and used the American College of Cardiology 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator. There are several modifiable risk factors such as blood pressure, cholesterol, and smoking status that, if addressed, can lower ASCVD risk. But are there other modifiable risk factors that we are failing to account for and address? New evidence suggests systemic inflammation may be one.


Comments: 4
Dec 8, 2017

Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. Specifically, the potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest.

Comments: 0
Aug 25, 2017

Statins reduce atherosclerotic cardiovascular disease (ASCVD) risk.1,2 However, the utility of statin therapy in older adults — particularly in those age 75 years and older — remains controversial. The 2013 ACC/AHA Cholesterol Guideline does not provide specific recommendations for older adults citing a lack of evidence.3 Furthermore, the Pooled Cohort Equations estimates 10-year and lifetime ASCVD risk in adults between 40 and 75 years of age.

Comments: 0
Jul 27, 2017

Although statins have a proven benefit and are widely used, ASCVD continues to be the leading cause of death in the US.1-3  There is documented residual CV risk apparent even in patients treated with optimally-dosed statins.1,3 However, the 2013 ACC/AHA guidelines recommend against the routine use of statin add-on therapies.1 In 2015, two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab (Praluent®) and evolocumab (Repatha®), were ap

Comments: 2
Apr 14, 2017

More than 15 million Americans have coronary heart disease and most should be taking aspirin daily.1  Given aspirin’s ubiquity in cardiovascular medicine and patients’ pill boxes, it is shocking that there are still so many unanswered questions about aspirin use.  Which dose and dosage forms should be prescribed?  How common is aspirin resistance?  What is the relationship between platelet inhibition and clinical outcomes?


Comments: 0
Mar 24, 2017

Many patients with atrial fibrillation (AF) received triple antithrombotic therapy after undergoing a percutaneous coronary intervention (PCI) and receiving cardiac stent. Triple therapy consists of warfarin plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and low-dose aspirin. But is triple therapy the best approach? This practice, while widely employed, is not entirely evidence-based.

Comments: 0
Sep 15, 2016

Primary prevention is rooted at the foundation of public health by promoting interventions to decrease healthcare utilization and disease burden.

Comments: 1
Apr 22, 2016

After cardiovascular (CV) safety concerns emerged with rosiglitazone use, the Food and Drug Administration (FDA) now requires outcome studies to be performed for all new diabetes medications.1-3  Naturally, we’d prefer to use medications to treat diabetes that actually reduce CV risk – but, at a minimum, they shouldn’t be harmful.  The first CV safety study (ELIXA) for a drug in the glucagon-like peptide 1-receptor agonist (GLP-1 RA) class – lixisenatide - was recently pub

Comments: 0
Feb 28, 2016

With over 75% of people using mobile phones worldwide, text messaging might be a simple, cost-effective platform to encourage lifestyle changes.1  mHealth involves the use of mobile and wireless devices (e.g., wearable sensor technology) to provide health services and information.2,3  Such technologies have the potential to fundamentally change health practices.  Indeed, several healthcare-related applications and mobile phone text messaging systems have already been des

Comments: 0
Nov 19, 2015

When deciding which medications to use to treat a patient with type 2 diabetes, there are many options after initial treatment with metformin. The selection of a second-line agent is based on many factors including efficacy, cost, adverse effects, effect on weight, comorbidities, hypoglycemia risk, and patient preference.1  No clear consensus exists.  One characteristic that would truly help differentiate agents is their effect on cardiovascular events.


Comments: 3
Sep 5, 2015

Monoclonal antibodies (mAb) are used to treat many disorders — from cancer to age related macular degeneration.

Comments: 1
Jul 28, 2015

Clinical practitioners have used calculators such as the Framingham Risk Score to assess the probability that a patient will develop coronary heart disease (CHD) and to guide primary prevention therapy for decades.1  In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated risk calculator which has been widely criticized and may lead to over-prescribing of cholesterol-lowering agents (namely statins), aspirin, and antihypertensi

Comments: 7
Jun 17, 2015

The appropriate duration of dual antiplatelet therapy (DAPT) for patients following placement of a drug-eluting stent (DES) remains controversial.1 Many clinicians have pushed for prolonged DAPT — beyond 12 months — on the assumption that extended therapy reduces recurrent cardiovascular (CV) events.  However, the benefits and harms of extended DAPT therapy are unclear and many health systems won’t authorize it.  Does the Dual Antiplatelet Therapy (DAPT) study provide sufficient ev

Comments: 0
Feb 16, 2015

Current cholesterol guidelines promote the use of statins as first line therapy in primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events. Despite the impressive risk reduction associated with statins, a 60% to 80% residual risk of vascular events remains. Does adding niacin to statin treatment reduce residual risk?  Or does statin therapy alone offer optimal benefit?

Comments: 2
Nov 4, 2014

Have you ever had difficulty convincing some of your patients that generic medications work just as well as their brand-name counterparts?  While there is little evidence to suggest that generic medications aren’t therapeutically equivalent, a more subtle and perhaps more vexing problem is now emerging.

Comments: 0
Feb 5, 2014

In the United States, nearly 70% of adults are overweight or obese.1  Excess adipose tissue increases the likelihood of developing sleep apnea, type 2 diabetes mellitus (T2DM), dyslipidemia, and hypertension. The rate of all-cause mortality in obese individuals is higher when compared to normal weight individuals.2 Its imperative that we address body weight with all patients in all health care settings – but particularly in primary care settings.

Comments: 1
Dec 6, 2013

We’ve all encountered patients who’ve had difficulty taking their medications as prescribed.  Many of our patients don’t achieve the recommended treatment goals or derive much benefit their medications.  There are many reasons why patients don’t take their medications in an ideal manner — including cost barriers, unpleasant side effects, treatment complexity, and forgetfulness.  

Comments: 1
Dec 7, 2010

If you are like me, you probably received a lot of phone calls from patients and prescribers when the news hit about the potential interaction between clopidogrel and proton pump inhibitors (PPIs).  In January 2009, the Food and Drug Administration (FDA) published data from an ongoing safety review of clopidogrel effectiveness, which resulted in a November 2009 Public Health Advisory that recommended avoiding of the combination of clopidogrel and any PPIs excep

Comments: 3
Nov 5, 2010

The ARBITER-6 HALTS study examined the benefits of statin add-on therapy with either ezetimibe or niacin. Although not intended to be an outcome study, a significant difference between exetimibe and niacin in terms of cardiovascular events was observed in this study. How much weight should we give to this surprising finding?

Comments: 0