In Case You Missed It: Top Cardiology Stories of the Week

Don’t Jump to Conclusions Based on JUPITER Results

The European Society of Cardiology (ESC) released a statement last week expressing concern that an analysis of results from the JUPITER trial published in the Lancet could “act to deter ongoing research efforts into developing new therapeutic strategies to increase high density lipoprotein (HDL) cholesterol.” According to the ESC, the Lancet study found that “if a normal, healthy individual has level of low density lipoprotein (LDL), known as “bad cholesterol”, substantially lowered with a potent statin, then the level of HDL “good cholesterol” in that person no longer bears any relation to the remaining cardiovascular risk. An ESC spokesperson said that it could be misleading to interpret the study as showing that raising HDL levels produces no beneficial cardiovascular effects, adding that “If you’re looking at populations with a very low incidence of cardiovascular events, and then with an intervention of any kind you reduce the risk of events even further, it’s logical that you’ll washout the influence of any other effect. These patients already have achieved such low levels of LDL that no other marker will prevail as a predictor of the few remaining events.”

Stents: Health Risks for Patients, Legal Risks for Cardiologists?

Will placing a stent lead to a patient's survival or the doctor's indictment? That’s one of the questions asked in this interesting article from the Baltimore Sun that looked at the recent controversies surrounding the use of stents. In the article, William O'Neill, MD, executive dean of clinical affairs at the University of Miami's Miller School of Medicine, said that “Every interventional cardiologist is going to be afraid that some angry patient or angry attorney or disgruntled colleague or competitor is going to turn him in for doing unnecessary procedures… Though we kind of brought it on ourselves. Two or four years ago, [the field of interventional cardiology] became overly aggressive.”

FDA Approves First Generic Version of Enoxaparin Sodium Injection

The FDA last week approved the first generic version of Lovenox (enoxaparin sodium injection), an anti-coagulant drug used for multiple indications including prevention of deep vein thrombosis (DVT), a potentially deadly blood clotting condition. Prior to approval, the FDA received a citizen petition that “questioned the approval criteria for generic enoxaparin sodium injection.” The FDA reviewed the petition and “determined that current scientific evidence, precedent, and FDA's legal authority establish a sound basis for the approval of generic enoxaparin sodium injection.” The FDA’s response to the petition is available here.

Is Cardiac Care “A Cash Cow”?

An article published in the Albany Times Union notes that New Yorkers “get twice as many angioplasty and stenting procedures than people who live in Ontario,” despite the fact that there is “no apparent difference in the rate of heart disease” between patients in Ontario and New York. The article cites research conducted by Edward L. Hannan, PhD, dean for research at the University at Albany's School of Public Health, and colleagues that showed that although “medication or open heart surgery may be as effective or better for many patients,” financial incentives (for physicians and health systems) may push patients toward percutaneous coronary interventions (ie, stents and angioplasty). The research, was published in Circulation in June and concluded that the “market-oriented financing approach” to healthcare in New York State is “associated with markedly higher rates of PCI procedures for both discretionary indications (eg, PCI in nonacute myocardial infarction patients) and emergent indications (eg, primary PCI) compared with the government-funded single-payer system in Ontario.” An earlier study by Hannan and colleagues, published in Circulation in January, found that “patients with coronary artery disease receive more recommendations for PCI and fewer recommendations for [cardiac artery bypass graft] surgery than indicated in the American College of Cardiology/American Heart Association guidelines.”

Patient-centered Care Lowers Heart Attack Mortality Risk

A study published in the journal Health Services Research reveals that patient-centered healthcare can lower death rates from heart attacks. According to a news release, researchers examined medical records and patient survey results from more than 1,800 veterans hospitalized initial acute myocardial infarction. They evaluated “different components of patient-centered care, such as access to health care providers, courtesy, coordination of care, attention to patient preferences and whether patients were well prepared for discharge.” They also evaluated the “technical quality of care,” such as “whether patients received drugs or procedures recommended for the treatment of heart attacks by most cardiology experts.” They found that “patients who received better patient-centered care had a reduced risk of death of about 1 percent at one year after the heart attack.”