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Heart Disease Blog
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By Richard N. Fogoros, M.D., About.com Guide to Heart Disease since 2000
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The Strange History of Amiodarone
Monday April 21, 2008
Amiodarone (Cordarone) is both the most effective and the most toxic antiarrhythmic drug ever developed. It's range of toxicities is so odd and potentially so harmful that one might wonder how a drug like this ever got approved. As it turns out, the history of amiodarone - its development, its usage, and how the drug came to be used in the United States - is as strange as the drug itself. Click here for the whole, strange history of amiodarone.
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Drug-Eluting Stents - How Long on Plavix?
Thursday April 17, 2008
The importance of taking Plavix (clopidogrel - a drug that helps prevent blood clotting) after receiving drug-eluting stents (DES) has received a lot of attention over the past few years. Not long after DES came into common usage, reports surfaced indicating that there is a long-term risk of sudden occlusion of the coronary artery with these stents, produced by the sudden formation of blood clots at the site of the stent. Sudden blockage of a coronary artery, of course, can have catastrophic results including heart attack and sudden death. The long-term use of Plavix is thought to substantially decrease this risk.
Unfortunately, long-term Plavix therapy is not benign. Indeed, trauma or surgery while on Plavix can have devastating consequences. Some cardiologists refuse to allow their DES patients to stop Plavix even long enough to have elective surgery - placing the patient in an untenable position. So a major remaining question with the use of DES is: How long should Plavix therapy be maintained?
In an extraordinary hearing of the FDA in late 2006, the recommendation was to continue Plavix therapy for at least 12 months after DES. But recognizing that there was little data on which to base this recommendation, a strong plea was made to conduct a randomized clinical trial as rapidly as possible to answer the Plavix question once and for all.
Unfortunately, as reported by Shelley Wood for theHeart.org, nearly a year and a half after this FDA hearing that study is not even close to getting off the ground, let alone yielding useful results. (Wood's report is linked here, but registration is required.) Wood describes continued difficult "negotiations" (some might call it squabbling) between researchers at the Cardiovascular Safety and Research Consortium (located at Duke University), various government agencies, and manufacturers of DES, over the goals, design, size and duration of the proposed study. From the sounds of it, the study that everybody's waiting for won't be providing anything like definitive answers, for many years to come, on how long DES patients need to remain on Plavix.
This means that if your doctor is recommending DES, for the foreseeable future you're still going to need a long talk with your doctor about Plavix - specifically, how long will the doctor want you to take it, and what is to be done if it turns out you need surgery 8 months from now? Unfortunately, it appears the Plavix question will be looming over the use of DES for a long time to come.
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Palpitations
Monday April 7, 2008
Palpitations - an unusual awareness of the heart beats - are a common symptom. Here's a discussion of what causes palpitations, and how they should be evaluated.
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Some Positive News on the Statin Front
Friday April 4, 2008
In the wake of the continuing soap opera (featuring congressional hearings and the publication of hot corporate e-mails) over Vytorin that has resulted from publication of the ENHANCE trial, here's some positive news on the cholesterol-therapy front.
This week, Astra-Zeneca announced they were closing the JUPITER trial because the study drug, Crestor (rosuvastatin), showed unequivocal benefit. JUPITER had enrolled over 15,000 men and women with no evidence of heart disease and normal-to-low LDL cholesterol levels, but whose CRP levels were elevated. (CRP, a marker of inflammation, has been associated with increased cardiac risk. The statin drugs have been shown to reduce CRP levels.) The participants were then randomized to receive either Crestor or placebo.
The JUPITER trial