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Preventive Medicine

The JUPITER Study and Your Cardiovascular Risk

By Heart Disease, Preventive Medicine One Comment

The JUPITER study (just published in the New England Journal of Medicine) solidly demonstrates that treatment of healthy middle-age and older people with low cholesterol values but elevated levels of an inflammatory marker (high-sensitivity CRP) with a powerful statin (Crestor) can substantially reduce the incidence of heart attacks, strokes and death. We need to reconsider our use of this test and its place in our approach to cardiovascular risk evaluation and treatment in each of our patients.

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HPV Vaccine: Cause for Concern?

By Preventive Medicine No Comments

An article and editorial in the New England Journal of Medicine of August 21, 2008 questioned the efficacy and appropriateness of the HPV (human papilloma virus) vaccine in young women, which concerned many parents in our practice. The article actually focused on the cost and health care policy implications of the vaccine rather than its safety and effectiveness in individuals. Both Dr. Kanner and Dr. Isselbacher believe the public policy concerns that were raised in that article do not trump the HPV vaccine’s continued usefulness for our young women.

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Cardiac CTA v. Cardiac Calcium Score

By Heart Disease, Preventive Medicine No Comments

The NYTimes today had an excellent and long piece on the use and probable overuse of the cardiac CT angiogram. The essence of the argument was that the CT angiogram of the heart was only occasionally helpful while costly in money and radiation exposure. The cardiac calcium score, which I have and continue to recommend frequently, differs in important ways, including much lower radiation and lower cost. Most important, we use it primarily to reaffirm the negative, that healthy “risk factors” really are accurate, because the cholesterol and blood pressure predictors of cardiovascular health are good but hardly infallible. Even the Framingham Heart Study is incorporating cardiac calcium scores in their risk evaluations.

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