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A short take of the big stories in cardiology in 2015

Here is my most recent column on | Medscape Cardiology: Mandrola’s Top 10 Cardiology Stories 2015

What follows below is a short-writing summary of my ten picks. The hyperlinks go to earlier columns I wrote on the topic.

1. The FDA approved two new (injectable) cholesterol drugs. The problem with the PCSK9-inhibitors: the study to determine whether or not the $14,500-per-year drugs prevent heart attack or death finishes in 2017. I wished the FDA had waited.

2.  The Sprint Trial studied the effects of lowering BP to 120 versus 140 in high-risk adults. The lower-BP target won. The differences were small, and there were tradeoffs: more pills and more adverse events in the lower-BP group. The challenge will be applying these results to the real world–where patients aren’t as uniform or closely followed as they are during a trial.

3. In 2015 we relearned that coffee, fat and cholesterol are not baddies. Refined sugars are. This made my list because it was a huge reversal; not a single trial backed the 1970s-era advice to cut fat consumption. And, I love coffee.

4. Three discoveries dominated the news in atrial fibrillation. I listed them in the Medscape story.

5. When a researcher presented results of a study of a diabetes drug (one already approved, and in use), he received a round of applause. Why? It was the first time a drug for Type 2 diabetes had been shown to lower death rates. Of course, concerns arose; later in the year, FDA released warnings about adverse effects with this class of drugs.

6. One of the worries with the new oral anticoagulant drugs (NOACs) is a lack of reversal agent. That changed in 2015–at least for dabigatran (Pradaxa). Reversal agents for the other three drugs (Factor-Xa inhibitors) performed well in studies, and will likely be available in 2016.

7. I love pacemakers because they are so pure. Pacemakers don’t treat risk factors; they treat disease. 2015 brought a wireless revolution. Pacemakers without leads performed well in studies. This is the beginning of a new era.

8. Like heart attacks are, strokes are often caused by blood clots that abruptly occlude a blood vessel to the brain. Five studies this year showed that stroke patients did better if they were treated with rapid intervention to open the blocked artery in the brain. This is big because it will require revamping of EMS and hospital systems to treat stroke like heart attacks. E.g–faster.

9. Patients who take clot-preventing drugs (anticoagulants) often require procedures or surgeries. This means stopping the drug for a period of time before and after. In the past, doctors felt it was best to bridge them with IV or subQ anticoagulant drugs. Two big studies in 2015 showed that bridging made matters worse. There were caveats though. I listed them in the column.

10. When you board an airplane and look into the cockpit, you expect that the pilots have been well-trained. Great controversy erupted in 2015 on how best to train doctors. One non-profit organization had enjoyed a monopoly on the lucrative doctor-testing process. Powered by social media and a few vocal activists, a revolt among doctors occurred this year. The monopoly conceded a lot; the question as to how doctors certify in the future remains unknown.

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