"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

"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

“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

“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

"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

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

“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

“…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

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

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

"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

"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

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

"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

“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

“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

“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

“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

“…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

“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

“...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

“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

"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

“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

"Knowing that efficacy is not 100% and that comorbidities can add to a poor response, we realize that some patients need to move on to second-line therapies."

Charles Butrick

"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

"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

"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

"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

“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

"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

"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

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

“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

“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

"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

“... 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

"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

"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

“If you show up in the ED and you have either an elevated troponin or an elevated adrenomedullin, your risk of death in the next two weeks is exceedingly high and you ought to get aggressive care.”
~ Alan Maisel, MD

“There are lots of reasons to be skeptical about the results of randomized trials ... There’s at least a collection of circumstances in which when they come head-to-head, it seems that you agree that the results of randomized trials would trump prior physiologic reasoning and clinical experience.”
~ Gordon Guyatt

"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

"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

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

“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

"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

"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

"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

"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

"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

“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

"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

"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

"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

“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 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

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

Tobias Kurth

“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

"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 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

"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