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THE LEADERIN NEWSANDMEETINGCOVERAGE
Experts Split onEzetimibe’s Value
BY MITCHEL L.ZOLER
Philadelphia Bureau
W
hen results from thecontroversial studythat assessed ezetim-ibe’s ability to slow atheroscle-rotic progression when added toa high-dose statin regimen werereported via a press release on Jan. 14, cardiologists split onwhether the findings signaled aflawed study or a flawed drug.The results were “disappoint-ing, but not surprising because Ihad a lot ofconcern that thiswas not the right patient popula-tion and not the right methodol-ogy,” Dr. Michael Davidson, pro-fessor ofmedicine and director of preventive cardiology at the Uni-versity ofChicago, told C
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.But other experts tied thestudy’s negative result to limita-tions ofezetimibe itself.“It appears that this method forlowering LDL cholesterol is not beneficial,” commented Dr.Steven Nissen, chairman ofthedepartment ofcardiovascularmedicine at the Cleveland Clinic.“I was always worried that LDLlowering with ezetimibe might be less effective than LDL lower-ing with a statin. Statins do manyother things that ezetimibe doesnot do: Statins raise HDL cho-lesterol, lower triglycerides, andreduce inflammation,” he said inan interview.There are several possible ex-planations why the combinationofezetimibe plus simvastatinfailed to slow atherosclerotic pro-gression any better than an iden-tical dosage ofsimvastatin alone,Dr. Christie M. Ballantyne, pro-fessor ofmedicine at Baylor Col-lege ofMedicine, Houston, andchiefofthe section ofathero-sclerosis and vascular medicinetold C
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. “One ex-planation is that there are differ-ences in the drug effects [be-tween ezetimibe and statins] thatgo beyond their reduction of LDL. Another is that the trialhad technical issues.”
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The ENHANCE results were “disappointing, but not surprising”because of the study’s design, according to Dr. Michael Davidson.
A ShockingOmission
Few physicians talk about ICDshutoffat end oflife.
PAGE 19
Marrow Victory
Bone marrow cells improvedcontractile recovery after ST-elevation MI.
PAGE 7
ContrastingPositions
Cardiologists push the FDAto reconsider its black box warning on contrast agents.
PAGE 28
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page 20
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The Leading Independent Newspaper for the Cardiologist
F
EBRUARY
2008
www.ecardiologynews.com
BY DAMIAN M
C
NAMARA
Miami Bureau
C
alcium supplementation sig-nificantly increased the risk ofa myocardial infarction among healthy, postmenopausal women,compared with placebo, in a sec-ondary analysis ofan osteoporo-sis study.Physicians should consider thisincreased cardiovascular risk against other clinical benefits of calcium supplementation in old-er women until confirmatorystudies can be completed, the au-thors suggested.“It is an important finding be-cause so many women are pre-scribed calcium supplements,”Dr. Rita F. Redberg said in an in-terview. “I would not recom-mend calcium supplementation based on this finding. This raisesenough concern. With any sup-plement, you have to show evi-dence ofbenefit without risk,”said Dr. Redberg, who was notinvolved in the study.The HDL/LDL cholesterol ra-tios improved among the 732women who took daily calciumsupplementation, compared withthe 739 participants who took placebo. This suggests that a dif-
Rapid reperfusion is ultimate STEMIgoal.
New Data DriveGuideline ChangesFor PCI and STEMI
Calcium Supplements UpMI Risk in Older Women
BY ROBERT FINN
San Francisco Bureau
T
he pace ofresearch in car-diology is proceeding sorapidly that importantchanges have just been issued totwo guidelines initially promul-gated in the not-so-distant past. Announced in December, the“focused updates” involve thetreatment ofST-elevation my-ocardial infarction (STEMI) andthe technique ofpercutaneouscoronary intervention (PCI).While the updates maintainedmany ofthe recommendations inthe full guidelines, issued in 2004for STEMI and 2005 for PCI, theyeach included significant recom-mendations for practice changes.The STEMI updates, for ex-ample, reiterate that the overar-ching goal oftreatment remainsrapid reperfusion. But they statethat, with the exception ofas-pirin, NSAIDs and cyclooxyge-nase-2 inhibitors should be dis-continued immediately. And
β
-blockers should not be admin-istered to patients in certain high-risk groups.The PCI updates emphasizedthe importance ofensuring thatpatients will be able to complywith dual antiplatelet therapy fora full year after receiving a drug-eluting stent. Bare-metal stentsshould be substituted when thatcompliance can’t be ensured.This dual antiplatelet therapy is
See
Guideline
page 8See
Supplements
page 6
Presorted StandardU.S. PostagePAIDPermit No. 384Lebanon Jct. KY
C
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5635 Fishers Lane, Suite 6000Rockville, MD 20852
CHANGE SERVICE REQUESTED
National Health ExpendituresAs Percentage of Gross Domestic Product
Note: Based on data from the Centers for Medicare and MedicaidServices.Source: Health Affairs
20062005200420032000199019801970
7.2%9.1%12.3%13.8%15.8%15.9%15.9%16.0%
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