March 9th, 2010
Tuesday, March 9 News Roundup: Clopidogrel After DES, Obama’s Calcium Scan
Larry Husten, PHD
Clopidogrel After DES: In a retrospective analysis of more than 9,000 patients who received a drug-eluting stent, Petersen et al. found that at 12 months, high use of clopidogrel was associated with a significant reduction in the risk of death or nonfatal MI but at the cost of more bleeding. Low use of clopidogrel was associated with an increase in death and nonfatal MI but with less bleeding. In their paper in the American Heart Journal, the authors write that the optimal duration of dual antiplatelet therapy can only be determined by “a dedicated randomized controlled trial.” In the meantime, “the decision to use drug-eluting stents in percutaneous coronary intervention should be made after consideration of the risks of ischemic events and bleeding in addition to the risk of restenosis.”
Obama’s Calcium Scan: In an early-release editorial in Archives of Internal Medicine, Rita Redberg writes that although she was “pleased to learn” about the results of President Obama’s recent physical examination, she “was troubled to read that the President’s physical examination included an electron beam computed tomographic (CT) scan for coronary calcium.” She points out that this test is not recommended for men in Obama’s risk category, and that “the most powerful way for President Obama to reduce his cardiac risk is to stop smoking.”
One Response to “Tuesday, March 9 News Roundup: Clopidogrel After DES, Obama’s Calcium Scan”
NEJM Journal Watch — Recent Cardiology Articles- Do Lifestyle Factors Influence Diabetes Risk Associated with Statins?
- Transient Anticholinergic Exposure Tied to Cardiac Risk
- Look Carefully for Causes of Myocardial Infarction in Younger Patients
- What Is the Best Timing of Complete Revascularization in STEMI?
- Is Upper-Extremity Exercise a Reasonable Alternative for Older Patients with Lower-Extremity PAD?
Dr Redberg is dead wrong
When experts with an axe to grind such as Dr. Redberg write editorials and intentionally distort the facts, it makes me wonder how they reached their level of importance.
Let’s look at her facts”
1. She repeated the old EBT radiation lie that is frequently brought up to criticize EBT calcium imaging. She then referenced an article on helical calcium imaging (the high radiation alternative to EBT) to make her point. The truth is that EBT calcium imaging exposes the patient to 0.7msv of radiation (1/20th the radiation of a single nuclear stress test adn 12/28th the radiation of a 64 slice CTA using older machines), The 0.7 msv dose does not increase the risk of cancer by anyone’s estimate and she knows it.
2. She uses the USPTF to support her position. Remember, the USPTF is the group that recommended against routine mammography, does not recommend EKGs, stress tests, prostate cancer screening or even conventional colonoscopy (thy like FOCB). If we based medical screening on this nihilistic group, we would all just wait until we die; the most cost effective screen ever.
3. She goes beyond her level of biased expertise to criticize the virtual colonoscopy by misrepresenting USPTF guidelines and ignoring a Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the Am Col of Radiology that recommends ct colonography (virtual colonoscopy). Dr Redberg, you can’t keep making stuff up!
4. To say that these screening tests provided no benefit to his care is an amazing statement considering the peer reviewed DATA to the contrary. One study presented in Orlando last year demonstrated that EBT calcium imaging reclassifies 76% of patients considered “intermediate risk” by conventional risk factors prior to their EBT heart scan. A study the AHJ last January demonstrated that 77% of heart attacks occur in individuals with LDL cholesterol <130 and therefore unlikely to qualify for cholesterol lowering therapy under any guidelines.
5. A bit off subject, virtual colonoscopy in 2 different NEJM articles was found to be significantly more accurate than conventional colonoscopy for detecting large adenomas and cancers.
So the question that I have is: Does the Archives have a credible physician who can take another stab at reviewing Obama’s physicians? Dr. Redberg’s intentional misrepresentations leave her without credibility.
Competing Interests: I proudly have an ownership interest in a facility that can perform EBT calcium imaging and virtual colonoscopies. We find heart disease missed by conventional standards every day. The results motivate lifestyle changes and medication compliance which prevent heart attacks. The facility will likely never break even but that is OK because of the great service that it provides.
I am getting intollerant of fools.