"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

"Low back pain is a perfect example of how complexity based on biopsychosocial-spiritual influences can influence the severity of pain as well as suffering."

David Rakel

“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

“Unfortunately I think the level of understanding of the complexity of degenerative mitral valve disease, while increasing, is not at a high level among many imaging cardiologists.”
~ Randy Martin, 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

"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

"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

Some people also have been advocating echocardiograms, but I don’t think I’ll be out of line with this audience to say that including echocardiograms is a bit on the fringe of what we’re talking about, and really the argument centers more on using the ECG as a primary screening tool.
-Ben Levine, 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

"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

“...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

"Fibromyalgia is undoubtedly a valid condition characterized by widespread body pain as well as variable other symptoms, which can include fatigue; sleep disturbance; mood disorders; and other somatic symptoms such as headache, abdominal pain, and hypersensitivity to external stimuli. Fibromyalgia remains a clinical challenge as there is no defining test, symptoms are subjective with variable patient presentation, and ideal treatment is elusive."

Mary-Ann Fitzcharles

"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

“Various studies have shown that [with complementary and alternative therapies] the patient’s satisfaction is markedly increased, and there is a shortening of the length of the hospital stay.”
~ Gulshan Sethi, MD

“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

“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

“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

"We are now seeing many such patients [with heart failure with preserved ejection fraction]. They’re often elderly women with many comorbid conditions, and they’re sometimes admitted with atrial fibrillation, which makes the estimation of diastolic function problematic."

Gary Francis, MD

“The use of the plasma aldo to renin ratio is a source of considerable confusion …the ratio is irrelevant as a screening test for primary aldosteronism.”
~ Norman Kaplan, MD

“So, do you think that ED is caused by HF or do you think it's just an association of two conditions with identical risk factors?”
~ Ernst R. Schwarz, MD, PhD

“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

"Obstructive sleep apnea (OSA) is increasingly recognized as a significant public health problem. Recent research has shown that it is related to a number of common medical illnesses such as hypertension, cardiovascular disease, and diabetes."

Stuart F. Quan

"So in someone who’s in his 70s, do you think we are where we can say that one really ought to turn to destination therapy VADs?"
~ James Young, MD

“You discuss with your patient what the available knowledge is, even though it’s limited, and you make the decision together.”
~ David Callans, 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

"Provided that we currently use only second- or, maybe in Europe, third-generation drug-eluting stents, I would prescribe a minimum of 6 months of DAPT, and I don’t make a strong effort to prolong DAPT over 6 months."

~ Antonio Colombo, 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

"I completely agree that we should avoid this kind of storm during the dialysis session. There are so many changes in the different ions that could trigger some arrhythmia. I completely agree that we should avoid important gradients, whether the ion is calcium or potassium."

Pieter Evenepoel

"...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

“… digoxin is even more pertinent in the context of the increasing prevalence of heart failure with preserved ejection fraction.”
~ Michael White, MD

"[One of the important questions that the results of galectin-3 testing raises is ‘should we be starting aldosterone blockers immediately in the patient presenting with acute heart failure and preserved ejection fraction?’]"

Frank Peacock, MD

“[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

"In my opinion, any patient who has had a history of episodic migraine and then has headaches on more than 15 days a month or more than half the time, should be considered for onabotulinum toxin A."

Sheena K. Aurora

"This technology helps to facilitate a conversation with the patient to say, 'Maybe there are different changes in either your medication therapy or self-care that we could help you implement.'"

Pamela R. Kushner, 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

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

"FH [familial hypercholesterolemia] is associated with an increased risk of premature CVD [cardiovascular disease], and its prevalence is increased in certain founder populations."

~James Underberg, 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

“In depression care … we are increasingly calling for the use of standardized instruments and repeated measures.”
~ Alan Gelenberg

“There are a lot of patients who can’t tolerate the higher dose of a statin, and maybe even ... on an every-other-day basis. Then we have to use the other agents that are at our disposal, whether it’s extended release niacin, ezetimibe, a resin, and/or fenofibrate.”
~ Roger S. Blumenthal, MD

“Troponin was a pretty good test when it was a crappy assay, but now that it’s a good assay, it’s a crappy test.”
-Bob Jesse, MD, Chairman of Medicine, Veteran's Administration, as quoted by W. Frank Peacock, MD

"That’s ... one way of using what appears to be an unsophisticated maneuver to gain fairly sophisticated insight into the volume status of the patients."
~ Douglas Schocken, MD

"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

“I really feel conceptually, and, I guess, philosophically, that ablation can have major favorable effects on peoples’ lives, even in addition to symptom control.”
~ David Callans, MD

"The difference between a prevalence of disease in patients with normal results or normal testing was in the order of 15% to 20%, which really questions how much better testing is than just flipping a coin and whether it might be just as well to proceed with angiography."
~ Mario Garcia, MD

"The [recently published new] guidelines incorporate other risk factors that can further identify those at intermediate risk—patients who would benefit from oral anticoagulation instead of aspirin."
~ Annabelle Volgman, MD

“Another critical step in the selection of patients is the assessment of aortic valve anatomy of the vascular accesses, and the presence of comorbidities. The main cause of mortality within the first year after TAVR are the comorbidities.”
~ Gian Paolo Ussia, MD

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

“I think what’s difficult is to take observational data and to say, well, because there’s a relationship … then lower the levels of all these things … but I really think that to decide whether to treat those particular risk factors, and how low to go with those, we … need clinical trial data.”
-William Cushman, MD

"If you look at the curve of the decrease in mortality from heart disease for the past 50 years in this country, there is a steady downtrend. But when we break up the data … it indicated that women did not benefit until the last decade."
Ezra A. Amsterdam, MD

"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

"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

“All the registry data indicate that the ICD is extremely effective in not only treating fast VT or VF, but also in preventing sudden cardiac death.”
~ Mark Estes, MD

“So I think one key modification of ATP IV will be to focus on non-HDL cholesterol as a treatment target equal to that of LDL cholesterol.”
~ Michael Davidson, 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

“Moderate-intensity activity is something that you can do while … talking comfortably, but you cannot sing.”
~ I-Min Lee, MD

"Over the last 2 decades, professional organizations have issued a number of screening guidelines. Initially, the AUA and ACS were very pro-screening. However, over time, they have acknowledged the fact that screening decisions are complicated, involving tradeoffs between benefits and harms, and that we need to help men make informed decisions."

Richard Hoffman

“There’s no question that aspirin decreases non-fatal MI in randomized trials of primary prevention and their meta-analyses, probably by about 20% … Because the number of deaths is not decreased, people assume that there’s no merit in preventing nonfatal MI. I don’t agree with that.”
~ James Dalen

"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

"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

"I think everyone knows that there are chronic risk factors such as high blood pressure, dyslipidemia, diabetes, smoking, lack of exercise, and others that contribute to coronary artery disease. We’ve only become aware recently of the issue that there are other kinds of risk factors, including what might be called acute risk factors."
~ Robert A. Kloner, MD, PhD

“The new finding was that an elevated heart rate above 70 beats per minute was also associated with an increase in hospitalization for fatal and non-fatal myocardial infarction.”
~ Kim Fox, MD

“Reversing obesity prevalence in the United States to that of a decade ago has been estimated to save US adults 111,206 total knee replacements."
~ Gary Williams, MD

"Diastolic function might also help you identify further people who have systolic impairment by providing additional information regarding the loading condition of the patient, ie, the LV [left ventricular] filling pressure. It also provides valuable prognostic information beyond EF [ejection fraction]."

Rami Doukky, MD

But for now, I would agree that this intermediate or low-to-intermediate risk group is the best group to target for coronary CT scanning.
-Allen Taylor, MD

"Hypertension continues to be a major contributor of cardiovascular events, and there is sufficient evidence to indicate that adequate blood pressure (BP) control is associated with marked reductions in the risk of not only target organ damage but also cardiovascular events such as stroke, myocardial infarction, and chronic renal failure."

Carlos M. Ferrario, 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

"Certainly, the procedure is performed safely in this study. There were no significant adverse events... In fact, there were fewer events, albeit ... significant in terms of the overall mortality."
~ Vivek Reddy, 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