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Thursday, January 14, 2010

Most Americans overweight, and one-third are obese: NHANES

This is terrible. As a population, we must change our eating habits and be more active.

With all the talk of trying to reduce health care spending -- there's no way we will be able to control medical costs if we continue to live unhealthy lives

More than two-thirds of US adults are considered overweight or obese, while more than 10% of children and adolescents are also considered too heavy for their age. The good news, however, is that the...

For complete story visit theheart.org.


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Tuesday, January 12, 2010

Brits Not NICE to Dronedarone


The British National Institute for Clinical Excellence (NICE) has made a preliminary determination NOT to cover the new antiarrhythmic drug dronedarone (Multaq, Sanofi-Aventis) for British patients with atrial fibrillation (AF). Instead, NICE implies, patients should continue receiving amiodarone (Cordarone, Pacerone), which is more effective and cheaper.

Amiodarone is the most effective antiarrhythmic drug (drug that is supposed to stabilize the heart rhythm) available, but it unfortunately produces a bizarre array of side effects that are common, often dangerous or disabling, and difficult to treat. A suitable "replacement" for amiodarone has long been sought.
Amiodarone: A Uniquely Toxic Drug
Amiodarone's Strange History

For a long time, it was hoped that dronedarone (a compound related to amiodarone) would be that perfect replacement. It is not. While it appears to have much less toxicity than amiodarone, it is not as effective in treating AF.
Dronedarone Drug Information

And indeed, this was the very logic used by NICE to deny approval for dronedarone -- it is not as effective as amiodarone, and it is much more expensive. So it will not be made available for British patients.

DrRich Comments:

The dronedarone/NICE story illustrates how panels of "clinical excellence" (like NICE, or like the panels apparently being established in the United States under pending healthcare reforms), even when they strictly follow the results of randomized clinical trials, can make decisions that seem reasonable on the surface but ultimately are harmful to patients.

Consider that while the effectiveness of dronedarone in treating AF (effective in approximately 30% to 40% of patients) is substantially less than for amiodarone (which is effective in approximately 50% to 60%), this still means that a substantial minority of patients could potentially be treated effectively with dronedarone. So, for instance, if patients with AF were given a trial of dronedarone, potentially up to 40% of them could be spared exposure to the extravagant toxicity of amiodarone.

But because randomized trials tell us that, in a large population of patients, the average response to dronedarone is significantly lower than the average response to amiodarone, no patients (in Britain, at least) will have the opportunity to try dronedarone.

To my mind, this example succinctly illustrates a key problem with how our bureaucrats propose to use panels of experts. Such panels can be of immense help in providing guidance to clinicians. But when bureaucrats insist on converting such recommendations into strict, "up or down" coverage decisions, individual patients will lose their opportunity to receive the kind of individualized care most of us value -- care given by our chosen doctors, who judiciously apply expert-generated clinical guidelines, while still taking our individual circumstances into account.


National Institute of Health and Clinical Excellence. Atrial fibrillation - dronedarone: appraisal consultation document. http://www.nice.org.uk/guidance/index.jsp?action=articleo=46768 Accessed January 7, 2009.

Brits Not NICE to Dronedarone originally appeared on About.com Heart Disease on Monday, January 11th, 2010 at 07:21:31.

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Saturday, January 9, 2010

Obesity overtakes smoking as health burden in US

Data from 1993 to 2008 show quality-adjusted life-years lost from obesity recently surpassing those lost from smoking.

For complete story visit theheart.org.


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Thursday, January 7, 2010

Low vitamin D levels associated with increased heart risks in black patients.

Research News fro ACC:

The Los Angeles Times (1/6, Maugh) "Booster Shots" blog reported that "the disparity in rates of heart disease deaths between blacks and whites can be attributed in large part to low levels of vitamin D in a substantial portion of the black population," according to a study published in the Annals of Family Medicine. Altogether, investigators "found that the 25% of subjects in the study with the lowest blood levels of vitamin D had a 40% higher risk of dying from heart disease than those in the upper 75%." The researchers found that "blacks in the study had a 38% higher risk of dying from heart disease than whites...but low blood levels of vitamin D accounted for about two-thirds of the increased risk," with poverty responsible for the remainder. HealthDay (1/6, Edelson) and HeartWire (1/6, Hughes) also covered the story.

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Tuesday, January 5, 2010

Overweight, obesity up CV risk regardless of metabolic markers in long-term study

Investigators showed that overweight and obese individuals without the metabolic syndrome are also at an increased the risk of cardiovascular events and death, refuting the notion these are benign...

For complete story visit theheart.org.


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Obesity Rise Hurts Health More Than Smoking

America's obesity epidemic now poses an equal or greater threat to health-related quality of life than smoking, according to a new study.


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More positive data on the impressive power of cardiac rehab

Background-- For patients with coronary heart disease, exercise-based cardiac rehabilitation improves survival rate and has beneficial effects on risk factors for coronary artery disease. The relationship between the number of sessions attended and long-term outcomes is unknown.

Methods and Results-- ...

Conclusions-- Among Medicare beneficiaries, a strong doseresponse relationship existed between the number of cardiac rehabilitation sessions and long-term outcomes. Attending all 36 sessions reimbursed by Medicare was associated with lower risks of death and MI at 4 years compared with attending fewer sessions.


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