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

"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

“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

“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

"We know that celiac disease is a genetic autoimmune disease, and we know that non-celiac gluten sensitivity is not considered an autoimmune disease… In order to obtain a diagnosis of non-celiac gluten sensitivity, celiac disease and a wheat allergy would both need to be ruled out."

Melinda Dennis

“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

"[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

“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

“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

“... 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

“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

I wrote … that the pen, and namely the prescription pad, may be mightier than the stent. I’ve gotten quite a reaction from that, being an interventional cardiologist.
-Spencer King, MD

"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

“[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

"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

“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

"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

“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

“So JNC 8 might say that home BPs will be helpful in determining what the pressure is over time, but presently there is no trial evidence that knowing home blood pressures will decrease events.”
~ Marvin Moser, 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

“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

"Most importantly, not everybody in the population with a migraine needs neuroimaging, but that depends on detailed clinical symptoms."

Tobias Kurth

"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

"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

"...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

"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

"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

"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

"Practitioners will certainly want to keep in mind that to make optimal decisions, you need systematic summaries of the best evidence."

Gordon Guyatt

“Some tend to use sildenafil as a starting agent since there is evidence of symptomatic and functional benefit. However, this remains controversial.”
-Patricia A. Uber, PharmD

“CPX testing has been a major component of research with heart failure patients and has migrated into the clinical care of heart failure patients.”
~ David Whellan, 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

"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

"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

"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

“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

"One of the more controversial issues in medicine has been that of hypertension in pregnant women. The guidelines have not changed much in the last 50 years, although some effort to update these guidelines has been made recently."

Marvin Moser, MD

"I recommend to people who want to take home BPs, do it with a protocol. They take their BP twice a day for two weeks and that’s recently been shown to be all you really need."
~ Henry Black, MD

“These therapies are now mainstream for the bridge-to-transplant population, as well as for patients who are ineligible for transplant … The outcomes in the destination therapy populations have been just as good in the transplant population—it’s certainly a leap forward, as compared to the previous generation of devices.”
~ Andrew Boyle, MD

“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

“…patients who are device candidates are far and away most interested in receiving a device that will make them feel better rather than live longer…”
~ Jonathan Steinberg, MD

"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

"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

“Aspirin is said to minimize the flushing that occurs with the niacin products. Many of the patients we would consider candidates for niacin need to be on aspirin anyway because they’re high-risk.”
~ Peter H. Jones, MD

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

"Behavioral interventions have yielded improvements on the order of 35% to 55% reductions in headache from pretreatment to post-treatment indicating that they're viable interventions. Those observed outcomes are approximately equivalent to the best prophylactic medications for primary headache."
Donald B. Penzien

“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

"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

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

“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

"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 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

"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

"In general, if someone has an indication for revascularization, the stenting or an angioplasty approach is more commonly used in single- or double-vessel disease. More extensive multivessel disease and left main disease historically have been more often treated with bypass surgery."
Jeffrey Snell, 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] 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

"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

"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

“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

“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

“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

“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 think the field has begun to move away from looking at percent inhibition with respect to a given drug, and toward looking at the residual platelet reactivity during treatment, and how we can associate that with outcomes in patients. Certainly, there have been ample studies demonstrating that high on-treatment platelet reactivity is associated with a greater risk of subsequent cardiovascular events.1–3"

~ David J. Schneider, MD

"The standard of therapy is not known, so that’s why if you select a patient who we don’t want to operate on, there is no competition there."
~ Saibal Kar, 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

"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