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

"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

"I don’t believe that a good guideline should be hidebound by unduly restrictive ‘evidence rules’ that ignore all but a tiny fraction of the available scientific information. A good guideline must synthesize complex data in a clear and concise way and must address the kinds of questions that real doctors need answered every day."

Joseph L. Izzo, Jr., 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

"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

"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

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

“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

“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

"Patients and physicians may be attracted to a less invasive angioplasty and stenting approach for suitable coronary lesions, however, there are issues with the recommended anticoagulation regimens, which could include two antiplatelet drugs and another anticoagulant if the patient is in atrial fibrillation."
~ William Frishman, 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

“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

“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

"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

"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

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

“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

“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

“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 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

"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

"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

“...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

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

“I think thiazides offer the advantage of an anti-calciuric effect, so that women will tend to retain calcium, which has been demonstrated to facilitate bone mineralization with older age.”
~ Matthew Weir, 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

"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

“…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

“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

"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

“Most of the time we’re talking about an absolute difference in diabetes incidence within these trials of a couple percent.”
~ Bill Cushman, 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

"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

“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

"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

"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

“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

“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

“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

“... 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

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

"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

“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

"The key point that we found is …that interpreting the treadmill test on the basis of the ST segment alone is obsolete and should be abandoned…I think an important point we need to make to clinicians is that the most important prognostic indicator is functional capacity."
~ Ezra A. Amsterdam, 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

“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

“Even if people developed diabetes, they would still benefit from statin therapy, so the [JUPITER] panel concluded that the cardiovascular benefit outweighed the increase in the risk of diabetes.”
-Antonio Gotto, MD

“…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

"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

“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

"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

"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

"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

“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

“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

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

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

“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

“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

“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

"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

“…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

“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

"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 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

"[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

"Mitral valve repair has been the gold standard for patients with mitral regurgitation (MR) for approximately 30 years. What is the likelihood that percutaneous procedures will be able to achieve the same sort of efficacy for MR in the future?"
~ Michael A. Borger, MD