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

“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

"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

“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

“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 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

“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

“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

“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

“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

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

"[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

"It seems like the biggest change in the guidelines is the addition of ticagrelor, or BRILINTA®.… a new antiplatelet therapy that has been shown to be effective in ACS. Actually, based on the PLATO trial and the current [US FDA] rulings, it’s the only antiplatelet agent that is superior to clopidogrel for reducing cardiovascular death following ACS.…"

Carl J. Lavie, 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

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

"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

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

“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

“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

"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

"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

“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 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

"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

"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 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

"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

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

"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

"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

"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

"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

"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

“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

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

Gordon Guyatt

"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

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

“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

"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

“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

“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

"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

“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

“…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

"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

"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 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 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

"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

"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

"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

“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

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

"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

"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

"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

“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 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 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

"These trials have enrolled more than 50,000 patients, so we have a great foundation of information not only about AF but also about the drugs."
~Ken Mahaffey

"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