How Good Is the New ACC/AHA Risk Calculator?

Is the new calculator for assessing the 10-year risk of atherosclerotic cardiovascular disease flawed, as suggested by a recent news article, or does it work exactly as the committee members of the risk-assessment guidelines expected it to?

In an article published November 18, 2013 in the New York Times, two physicians testing the accuracy of the new risk calculator developed by the American College of Cardiology (ACC) and American Heart Association (AHA) found that it vastly overestimated patient risk. Drs. Paul Ridker and Nancy Cook (Brigham and Women’s Hospital, Boston, MA) calculated the 10-year risk of cardiovascular events in three large-scale primary prevention cohorts—the Women’s Health Study(WHS), the Physicians’ Health Study (PHS), and the Women’s Health Initiative Observational Study (WHI-OS) — and found the new algorithm overestimated the risk by 75% to 150%.

Read the full article.

New cardio guidelines change statin use, CVD risk assessment

The American Heart Association (AHA) and American College of Cardiology (ACC) issued 4 new cardiovascular disease prevention guidelines last week on cholesterol treatment, cardiovascular risk assessment, lifestyle management and management of overweight and obesity.

The cholesterol guideline made substantial changes to recommendations about statin use, moving away from specific cholesterol targets and likely increasing the number of patients taking the drugs, according to a press release.

See the full article

Heart Groups, CDC Issue New Algorithm for Hypertension Control

A science advisory from the American Heart Association, American College of Cardiology, and CDC — designed as a “call to action for broad-based efforts to improve hypertension awareness, treatment, and the proportion of patients treated and controlled” — includes a new, simple algorithm for controlling hypertension in adults.

The algorithm emphasizes the importance of lifestyle modification as first-line therapy for all patients with stage 1 or 2 hypertension. In addition, a thiazide may initially be considered in certain stage 1 patients (e.g., those with heart failure or diabetes), while two drugs (e.g., a thiazide plus ACE inhibitor) are preferred for stage 2 patients.

The algorithm can be found on page 14 of the free PDF linked below.

– See more at Journal Watch

Download this file

iPhone Medical Software Review

Today I’ll be reviewing four useful medical applications for the Apple iPhone: Eponyms, DxSaurus, Lab Values, and ECG Guide. Each of these are good applications in their own right, and each one serves a different purpose in the day to day practice of medicine. Continue reading

What’s your story?

Everyone has a story.

One of the things that really drew me to medicine were the stories. I’m convinced every patient has an incredible story to tell.

These are the stories that inspire and give purpose to this life long commitment to medicine we have all made.

I’m also convinced, all of us (physicians) have a story to tell.

Who better to inspire us, than each other.

The following link is to a blog site, by a friend  Philip Lederer. He’s an internist just like you and me.

He’s putting together stories. They are simply stories about physicians who are putting “Hope into Action”

Doctor Stories


“Of all the forms of inequality, injustice in health care is the most shocking and inhumane”        

– Dr. Martin Luther King, Jr.




The home page of has been redesigned to make getting around the site easier than ever. Using the popular Joomla CMS platform, the webpage is now responsive and can detect the device being used to change its interface accordingly. Why is this important? On the Internet today, 90% of websites are not ready for mobile traffic despite mobile traffic constituting 10% of all Internet traffic. 72% of Internet users say mobile support is very important and that they are five times more likely to abandon a task if the site does not have mobile support. In fact, 79% will go to another site to meet their needs. For repeat use, three out of four visitors are more likely to revisit a site if it’s mobile ready. – Using the latest web-based technologies to connect you to the innovators in medicine bringing you the best ideas in medicine.


What is the Patient Protection Affordable Care Act?

Everyone’s taking about it,

But as physicians, do we REALLY know what it is?

Can you explain it to your patients?

Can you explain it to your interns or medical students?

It’s one of the major healthcare policy decisions to happen in a generation, and it’s important as physicians, we all at least understand the basics.

Here’s a link to the Khan Academy video that breaks it down. It’s not an opinion piece for or against it. It just describes what it currently is.

Khan Academy PPACA


Dolutegravir Regimen Superior to Standard Combination ART for HIV

hivReplicationCycleAn HIV treatment regimen of dolutegravir plus abacavir-lamivudine is superior to a currently recommended combination pill, according to a phase III trial published in the New England Journal of Medicine.

In the manufacturer-conducted SINGLE study, roughly 850 treatment-naive patients were randomized to dolutegravir (an integrase inhibitor) plus abacavir-lamivudine or to efavirenz-tenofovir disoproxil fumarate-emtricitabine (EFV/TDF/FTC). After 48 weeks of treatment, the dolutegravir group had a higher percentage of patients with HIV-1 RNA levels under 50 copies per milliliter (88% vs. 81%). The number of adverse events was lower in the dolutegravir group.

In his blog HIV and ID Observations, Paul Sax writes: “Up until the SINGLE study, one could argue that EFV-based treatments — especially TDF/FTC/EFV — represented the gold standard against which all other regimens must compete. Has that now changed? I think it has.”

Abstract from the NEJM:

See also:


Stony Brook at the NYC Marathon

I’m a little biased, but our residents at Stony Brook are awesome.
Great work gang!

Helping out at the the NYC marathon.

Helping out at the the NYC marathon.

Afib May Spark MI

Atrial fibrillationAlthough myocardial infarction is a known risk factor for the development of atrial fibrillation, the relationship might work the other way around, too, researchers found.

Among patients without a history of coronary heart disease, those with atrial fibrillation were 70% more likely to have an MI through an average of about 7 years of follow-up after accounting for other potential risk factors (HR 1.70, 95% CI 1.26-2.30), according to Elsayed Soliman, MD, of Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues.

That risk was greatest among women (HR 2.16, 95% CI 1.41-3.31) and black individuals (HR 2.53, 95% CI 1.67-3.86), they reported online in JAMA Internal Medicine.

Full article:

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