EvidenceUpdates + professional commentaries (numerous): Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women`s Health Initiative limited access dataset and meta-analysis

OBJECTIVES: To investigate the effects of personal calcium supplement use on cardiovascular risk in the Women`s Health Initiative Calcium/Vitamin D Supplementation Study (WHI CaD Study), using the WHI dataset, and to update the recent meta-analysis of calcium supplements and cardiovascular risk.

DESIGN: Reanalysis of WHI CaD Study limited access dataset and incorporation in meta-analysis with eight other studies.........

Conclusions: Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.

Author Insights: Erythropoietin and Cardiovascular Concerns « news@JAMA (Epogen, Procrit, Patient Safety, adverse events)

Is Heart Disease Inevitable for Women? Heart Health Tool Kit for Every Decade of a Woman's Life

Cardiology in Review:

March/April 2011

doi: 10.1097/CRD.0b013e318209a711

Genomics|Update|Current - Recommendation on Genetic Testing for Risk of Cardiovascular Disease

Recommendation on Genetic Testing for Risk of Cardiovascular Disease
 
This month the independent Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group has released a new evidence-based recommendation on the use of “cardiogenomic profiles” (or “heart health”) genetic tests. These tests are being marketed to physicians and the general public as a way to find out a person’s risk for cardiovascular disease, and some can be ordered online without the involvement of a physician. The EGAPP Working Group did not find enough evidence to indicate whether these tests should or should not be used to determine future cardiovascular risk in the general population, and currently discourages the use of this testing except in research settings. Access the EGAPP recommendation. Read more about the EGAPP recommendation.

How to Avoid a Heart Attack: Putting It All Together -Journal of the American Osteopathic Association

Note: this is not specific to treatment-related cardiovascular concerns

Conclusion
The central question posed in the letter to the editor by Juhl et al2 is whether supplements of vitamins E and C and the B vitamins have demonstrated an evidence-based reduction in patients' cardiovascular risk. Unfortunately, the authors' criticism of the perceived deficiencies of a previously published study1 does not constitute evidence to support their position; it serves only to point out those perceived flaws.

Multiple meta-analyses and reviews of published medical literature have convincingly established that there are few, if any, objective, evidence-based, well-designed trials to support the use of supplements of vitamins E or C or those in the B family to reduce risk of cardiovascular events. Furthermore, I am unaware of any study that advocates the use of these supplements to help patients or to rejuvenate our ailing medical delivery system.

If Dr Juhl and his coauthors2 seek to establish the medical value of these supplements, I would recommend that they design, participate in, and publish a study to establish their yet unproven hypothesis. Until such a goal is accomplished, my opinion (shared by researchers at the Mayo Clinic,3 the Cleveland Clinic,5 the AHRQ,12 and the American Heart Association19) is that published evidence clearly does not support the use of vitamins E, C, B6, B9, or B12 to improve patients' cardiovascular health.

Cardiovascular Safety of VEGF-Targeting Therapies: Current Evidence and Handling Strategies -- Girardi et al., 10.1634/theoncologist.2009-0235 -- The Oncologist

Abstract
Treatment with the angiogenesis inhibitors bevacizumab, sunitinib, and sorafenib as single agents or in combination with conventional chemotherapy is becoming a cornerstone of modern anticancer therapy. However, the potential toxicity of these drugs, mainly to the cardiovascular system, is still being investigated. Patient assessment at baseline, of crucial importance in candidates for treatment, involves the evaluation of risk factors and screening for past or present cardiovascular disease. Strict monitoring of treatment-related adverse effects must be conducted in order to allow the early detection of cardiovascular toxicities and their prompt medication. In the present paper, the most frequent cardiovascular toxicities and their underlying mechanisms are investigated, with a view to providing indications for effective patient management.