Although the two drugs lowered central pulse pressure in the brachial artery to the same degree, nebivolol lowered central pulse pressure more than atenolol.
-John Cockcroft, MD

“...the value of performing a Valsalva procedure cannot be underestimated when using agitated saline for the detection of a right to left shunt.”
~ Michael Main, MD

"HIV clinicians often spend more time addressing comorbid chronic illnesses such as diabetes, cardiovascular disease, mental health and substance disorders, liver disease, and cancer than managing antiretrovirals or opportunistic infections."

Todd Korthuis

"We now know that sleep and the sleep/wake cycle are intertwined with most of our bodily systems, so sleep problems can lead to pathologies in many different physiological systems, possibly causing acute and chronic effects."

David Neubauer

“Certain activities like racquet sports, skiing, and basketball seem to be associated with a greater incidence of acute cardiovascular events. Many of these victims, especially those younger than 35, often have underlying structural cardiovascular abnormalities, most notably hypertrophic cardiomyopathy.”
~ Barry Franklin

"African Americans, and in particular African American women … carry the highest risk in the United States for having [CAD, MI, and CV morbidity and mortality]. Unfortunately African Americans, Hispanics and women of all ethnicities suffer from a disparity in access to life saving technologies and pharmacologic therapies."
Christopher Leggett, MD

“If you look at the rates, for instance, of preloading that occur in the United States, they are quite low, even though guidelines recommend preloading with antiplatelet agents (eg, P2Y12 inhibitors) prior to PCI in ACS patients.¹"

~ Ajay J. Kirtane, MD, SM

"HF [heart failure] is slightly more common in women—just over half of the HF population—and they certainly have more hypertension than we ever expected."

W. Frank Peacock, MD

"I think one of the things that is important for physicians to understand is that … we’ve had a long history of using a very complicated drug, warfarin. The new drugs are a significant advance, but they’re not necessarily going to be a cakewalk."
Peter Kowey, MD

"Cholesteryl ester transfer protein has been an important target for the management of risk for cardiovascular disease. It began a number of years ago when it was noted that this protein transfers cholesteryl ester in exchange for triglyceride from different lipoproteins specifically, apoB-lipoproteins to HDL lipoproteins."
~ Michael Davidson, MD

“... only about 10% of the patients in RALES were on a beta blocker, but those who were ... seemed to have just as good, if not a better, result from spironolactone."
~ Bertram Pitt, MD

"These are guidelines created to guide people in decision making, but there is latitude based on patients’ underlying medical conditions, underlying psychiatric conditions, and other issues that may come into play, and all of these things need to be considered."
~ John D. Fisher, MD

“It could be tremendous for prevention in children. After being followed, maybe they will come back to have fewer drug problems, smoking issues.”
~ James Dalen

"We have evidence of various properties of HDL [high-density lipoprotein] that might be theoretically useful for describing its potential benefit, but we don’t have either a clinical trial or other prospective evidence indicating that any of these properties are explanatory."

John LaRosa, MD

“It is very common for these patients to report New York Heart Association functional class 1 after myectomy—that is, they can do virtually anything…”
-Barry Maron, MD

“…it’s difficult for me to think that FAIR-HF proves that giving iron in any form would necessarily be beneficial.”
-Stephen S. Gottlieb, MD

“Because of socioeconomic limitations [our patients] are not always compliant about their medicines and follow-up, so we tend to err on the side of implanting sooner.”
-Richard Trohman, MD

"Many clinicians for years have prescribed niacin for people with low HDL ... so we recently had a shock… when AIM-HIGH was stopped because [there was] no evidence of benefit."
~ Daniel Rader, MD

“…this is an exciting new frontier for hypertension research and management. Masked hypertension is not just not a curiosity.”
~ Robert Phillips, MD

“Are we ready to make clinical decisions based on the presence of a scar in a patient with dilated cardiomyopathy and no coronary disease?”
~ Javier Sanz, MD

"There are a lot of… small studies that have evaluated whether or not the addition of a thiazide such as metolazone to a loop diuretic augments sodium excretion and urine output."
~ Tien Ng, PharmD

“That implies that the percutaneous-inserted prosthesis implanted inside the existing native valve without excising that valve has hemodynamics after implantation that are nearly as good as a stented bioprosthetic valve replacement. That was surprising to me…”
~ Paul Grayburn, MD

“I think it’s been an evolving process and I think it’s a good one. Moreover, transparently acknowledging a medical writer’s contributions clearly highlights the fact that this is a legitimate area of scientific endeavor.”
-Carol Sanes-Miller

"Osteoporosis is a very common problem that primary care practitioners encounter every day, not only with patients who come in with osteoporosis but also with those with a variety of other diseases."

Eric Gall

"One thing that I notice…is the lack of attention to IBS compared to Crohn’s disease and other GI disorders.…The unpredictability of IBS and its symptoms really affects the quality of life more than we give it credit for, in comparison to diseases that may have a greater impression on the doctor because they are associated with inflammation."

Mark Pimentel

“In essence, there can be some disconnect between what one’s heart function is at baseline and the precipitant that leads to acute decompensation.”
~ Phillip Levy, MD

“Investigations from those centers have shown a two- to three-fold rise in the occurrence of aneurysm disease compared to three to four decades ago. So, this appears to be bona fide, based on pretty comprehensive epidemiologic data from these isolated localities.”
~ John Elefteriades, MD

"Narcolepsy is a disorder that’s interesting because it typically does get missed. Although patients may present with complaints of tiredness and fatigue, very often people don’t think of narcolepsy as being a possible cause."
~Michael Thorpy

“We need to differentiate real life from what goes on in the clinical trials, because so often in the clinical trials patients with a history of myopathy … are excluded from the trials.”
~ Peter Toth, MD

“I believe there are some recent data that this increase [in obesity] seems to have leveled off, but at a rate that is still very unhealthy, with two thirds of the adult population being overweight and one third being obese.”
~ Jerome Fleg, MD

"I think one of the challenges we deal with is how to handle patients who don’t have a high enough blood pressure to get all the evidence-based therapies we want them on. In many patients with MI, at least in the early phase, blood pressure is tenuous."

James de Lemos, MD

"According to the ACC/AHA guidelines, routine exercise testing in the asymptomatic patient is a class III indication and therefore not recommended because the information you get is going to be more confusing and may lead to unnecessary further testing that could lead to complications."

Joseph Alpert

"With the improved respiratory flow monitoring that we have nowadays using a pressure transducer technique, the accuracy of detecting obstructive events— particularly when we speak about apneas— really has improved."
~ Ana Krieger, MD, MPH

“The NIH State-of-the-Science Conference concluded that [antipsychotics and barbituates] have significant risks and cannot be recommended for the treatment of insomnia. So I think that’s important for clinicians to remember.”
~ Sonia Ancoli-Israel

“…it’s been bandied about that the classic risk factors account for only 50% of the risk of atherosclerotic vascular disease. … We refer to this as the ‘50% myth’ and we need to refute it.”
~ Ezra Amsterdam MD

"Scientific advances in acupuncture research, coupled with the side effects of treating pain by conventional drugs, have promoted the use of acupuncture dramatically in the past 20 years. It is estimated that over 1 million practitioners outside China administer acupuncture treatments for chronic pain. Of these practitioners, over 300000 are physicians."

Brian Berman

“Patients with MetS and high triglycerides are the most likely to develop diabetes in the relatively near future. All patients with MetS, especially those with high triglycerides, need to be treated aggressively with TLCs and adjunctive drug therapies of proven benefit.”
~ Charles Hennekens

“…many of our clinicians get caught up in the diagnosis of coronary disease... I strongly believe that this is not the purpose of the ED evaluation.”
-Michael Farkouh, MD, MSc

“Ezetimibe has a role for LDL cholesterol lowering when other options have been exhausted. A change in this approach will require compelling evidence from a clinical events trial.”
~ Robert S. Rosenson, MD

“The data is pretty convincing that adding an aldosterone blocker on top of standard therapy is effective and an important strategy.”
~ Bertram Pitt, MD

“We have two studies, the randomized trial and the observational study that suggest that ACE inhibitors and ARBs … may not be useful, [and] may actually be harmful in patients with AR…”
~ Jeffrey Borer, MD

"Atherosclerosis is a systemic disease, not a regional disease. If one has plaques in the coronary arteries, they also have plaques in the peripheral arteries including the carotid arteries."
~William C. Roberts

“[Redistribution of abdominal fat is] one of the most rewarding things that we can see, as physicians caring for these patients, because we know that ... means we’re going to see gradual improvements in the HDL and triglycerides over time.”
~ Malissa Wood, MD

"Currently there are thousands of practices and millions of patients being served by medical homes across the country, and it is incumbent upon us to understand where this model has come from, and where it is going."
~Asaf Bitton

"When I put a patient on an NSAID, …. I’m careful to ask the patients about bleeding and to warn them about the signs of GI bleeding, and I do periodic blood counts to look at hemoglobin and creatinine levels. I also do a urinalysis to rule out silent GI or renal effects of these drugs, but I do use NSAIDs frequently."

Eric Gall

“I try to avoid the term ‘vulnerable plaque’ because it implies that we possess a crystal ball that can tell the future of a particular lesion based solely on its morphology.”
~ Peter Libby, MD

“The Lyon Mediterranean Diet Study had a 70% reduction in cardiac events—a benefit that exceeded that of most drug trials.”
~ Stephen Devries

"Investigators and clinicians alike have realized that the pragmatic approach, using the presence or absence of constipation as a symptom of IBS, may lend itself to the subsequent evaluation and management of the disorder."

Brooks Cash

“We have substantial outcomes data with spironolactone and eplerenone; eplerenone in the post-MI patient, spironolactone more so in the Class III or Class IV heart failure patient. Clearly there has been a renaissance for the drugs.”
~ Bill Frishman, MD

"I believe there has been a natural progression to spiraling costs. Despite what has or has not been achieved up to this point with reform, we have reached a crisis regarding out-of-control costs, and something must be done about it."

Christopher Pastore, MD

“There is controversy over whether patients with chronic hypertension who have compensated concentric ventricular hypertrophy ever evolve into more dilated HF.”
~ David Kass, MD

"Guidelines [for heart failure with preserved ejection fraction] don’t have much to say…Treatment remains relatively empiric, and different clinicians have different biases that affect the treatment that they provide…Several small studies have shown that some agents seem to work…[but] there hasn’t been a lot of evidence of benefit."

Barry Massie, MD

“I would say we probably need to define another category for severe MR, which is regurgitant volume above 100 mL, which would be a massive degree of MR.”
-Maurice Sarano, MD

“There is no question that these drugs have a major role to play in therapy. In every clinical trial over the past 50 years, where they have been used as monotherapy or in combination with other therapies they not only effectively lowered blood pressure, but morbidity and mortality were reduced not just from stroke, but from heart failure, progression of kidney disease, and coronary disease.”
~ Marvin Moser, MD

So in other words, for coronary artery disease, a clear J-shaped curve; for stroke there was no J-shaped curve.
-Franz Messerli, MD

“Atrial fibrillation always looks essentially the same on the ECG, but it’s certainly not one disorder.”
~ James Reiffel, MD

"The average person is gaining weight every year. So I get discouraged when people see that information and feel like everybody gains it back."
~Sherry Pagoto

"I would like to say there are many patients who get treated with clopidogrel. This applies to the PLATO trial as well. Since 46% of patients in the PLATO trial had already received clopidogrel administered in-hospital before getting randomized,² a clinician can still safely load with ticagrelor 180 mg followed by 90 mg twice daily."

Carl J. Lavie, MD

"When untreated or unsuccessfully treated, these attacks typically last 4 to 72 hours. Migraine varies widely in frequency, severity, and impact on the patient’s quality of life."
~Brian Grosberg

"We know the younger the patient is with thoracic aortic disease, the more likely there is to be an underlying genetic cause for the disease. The older the patient is … the less likely they are to have genetic risk factors and the more likely they are to have chronic wear and tear on the aorta over a lifetime causing the thoracic aortic disease."
~Dianna Milewicz

"This is a growing population and these patients are at risk of going on and developing more symptomatic advanced HF in the future, ... I think there is a substantial need for developing new therapies and new approaches using novel strategies for the management of these patients."
Barry Greenberg, MD

"...we all agree that one of our strong recommendations from this particular discussion is going to be that every institution should have a protocol for the basic framework of applying these treatments for ACS."

Christopher B. Granger, MD

"The difference in clinical practice is that individuals may not be as stringent at monitoring, and so I think hyperkalemia gets captured potentially a lot sooner in clinical trials as opposed to in clinical practice."
Orly Vardeny, PharmD

"There are mechanistic studies that indicate that the effect of ezetimibe on LDL is really not so much on the production side; turnover studies show that hepatic catabolism of LDL particles is important, and that is remote from the enterocyte and the whole supply side mechanism."
Robert Hegele, MD

“When you say the word fitness to people it often confuses them; they’ll think about flexibility, they’ll think about muscular strength, and they’ll of course think about how easily they get out of shape. Today we’re specifically talking about cardiorespiratory fitness, which is really your maximal aerobic capacity.”
~ Timothy Church

“I am greatly concerned that, instead of supplementing what we learn at the bedside, we’re replacing it with modern imaging technology.”
~ John Michael Criley, MD

“As we entered this era of drug-eluting stents, we obtained some evidence that we are decreasing the need for repeat procedures, but the question remains, is it really as safe as surgery?”
~ Spencer King, MD

“Alzheimer’s disease is really much more than a memory impairment, … an older adult who is having changes in their mood, their interests, their patience, their behavior, their personality; these may all herald the beginning of Alzheimer’s disease.”
~ James E. Galvin, MD

"[There] is a group of migraineurs who have increased frequency and some change in quality. The treatment effects are perhaps important for them…Does analgesic use drive or follow the problem?"

Peter Goadsby

“I always worry that we haven’t had the patients in there long enough to finally tidy up their drugs, particularly the diuretics, to make sure they understand instructions.”
~ Ileana Piña, MD