Subscribe- Interventional cardiologist Donald Baim dies
Nov 06, 2009 18:22 EDT - Latest European and US STEMI guidelines compared and contrasted
Nov 06, 2009 17:15 EDT - Enrollment halts in randomized trial of CPR for out-of-hospital arrest
Nov 06, 2009 16:00 EDT - Medicaid access to smoking cessation falls short
Nov 05, 2009 17:30 EDT - Serum phosphorous, kidney function predict CAC
Nov 05, 2009 17:00 EDT
Are you "JUPITER-ed" out??
The Jupiter trial is a large well conducted study which has been exhaustively covered on theheart.org as well as other websites. The study has had very little impact on clinical practice now 3 months after presentation and publication of the data. There is little discussion amongst patients or primary care physicians about the use of CRP for the Jupiter to find patient subset.
The trial has validated CRP as a useful biomarker for patient’s in an intermediate risk range and having this "objective" criteria may help convince some patient’s to except statin therapy white otherwise have been reticent
This trial seems to demonstrate safety and efficacy of rosuvastatin that puts it solidly in the family of the other statin medications and gives me more confidence to use this therapy especially in patients who need 50% or more LDL lowering to achieve a desired goal.
Guidelines for application of this trial and CRP in general are eagarly awaited . (last updated in 2003)
References:
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ; JUPITER Study Group. N Engl J Med. 2008 Nov 20;359(21):2195-207.
Expanding the Orbit of Primary Precention: Moving beyond Jupiter. Hlatky, MA. N Engl J Med. 2008 Nov 20; 359(21): 2280-2282.
Glossy job listings in a hostile healthcare environment
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RE-LY: Patient preference based on the data
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DNR patient with STEMI = To PCI or not?
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Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.
Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
- Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
- Practice approaches to the extra clinical issues in dealing with managed care insurers
- Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
- Experiences with restrictions on testing and imaging
CommentsCommentaires
Dr. Ridker responded to these concerns on the NEJM website:
If the "protective" effect on diabetes incidence reported in WOSCOPS is treated as hypothesis-generating, then a summary of published hypothesis-testing trials demonstrates that all statins modestly increase the risk of diabetes, with no heterogeneity according to potency. In our study, many of the patients in whom diabetes developed were obese or had an impaired fasting glucose level, groups in which large reductions in vascular events were associated with rosuvastatin.
The independent data and safety monitoring board for our trial followed rigorous principles3 in its prespecification that early termination of the study because of an observed benefit would require proof beyond a reasonable doubt. Members of the board were experienced in monitoring publicly and privately funded trials and viewed the trial's prespecified statistical boundary as only one component required for proof. Although the formal statistical boundary was conservative and evaluated only after accrual of ample data, the board elected to continue the trial for an additional 6 months after the boundary was crossed. Data that were accrued thereafter independently confirmed both the magnitude and statistical significance of the apparent benefit. We thus respectfully disagree with Pierard and Davis. The board appropriately protected the interests of society and the trial participants and provided a valid estimate of the treatment effect.4
The evaluation by Koller et al. ignores the significant reduction in death from any cause that we observed. If death from any cause is added to our primary composite outcome (a standard approach to account for competing risks), then the absolute risk difference increases and the number needed to treat declines.