When the FDA put a black box warning on tofacitinib in 2021, the message was blunt: more heart attacks, more cancers, and more blood clots. The warning came from the ORAL Surveillance trial, which followed over 4,000 patients with rheumatoid arthritis already at high cardiovascular risk. Compared to TNF blockers, patients on tofacitinib had:
…
Everywhere in American medicine today, you hear the word leadership. Hospitals advertise leadership programs. AMCs hold leadership retreats. Colleagues are urged to “develop as leaders.” Yet when you talk to practicing doctors (the ones actually seeing patients), most will tell you all they want is to do their work, fairly scheduled, with decent colleagues, and without interference.
That is the paradox of the physician leader. Everyone talks about leadership, but almost …
During the COVID-19 pandemic, I cared for a patient in the intensive care unit whose condition was critical. When I asked how he was feeling, he said, “Doctor, I am not afraid. My family is praying for me, and I believe God will give me strength.” Despite receiving the best medical interventions available, it was clear that his faith, cultural practices, and the support of his family played an undeniable …
We have all been told the story: High cholesterol leads to heart disease, and statins are the magic bullet. The JUPITER trial, published in The New England Journal of Medicine in 2008, became one of the most heavily publicized pieces of “proof” supporting that belief. It claimed that rosuvastatin significantly reduced heart attacks, strokes, and cardiovascular events, even in people with normal LDL cholesterol levels.
But what if I told you …
Not long ago, a 36-year-old man came to the emergency room with crushing chest pain. He had no significant medical history, exercised occasionally, and thought heart disease was something he would only need to worry about decades from now. To his disbelief, he was having a heart attack.
Stories like his are no longer rare. Cardiologists and emergency physicians are increasingly seeing patients in their thirties and forties presenting with acute …
More than 400 amputations happen in the U.S. daily. Not from gun violence, shark attacks, or car crashes, but from a disease that is easily diagnosed, preventable, and treatable, if caught early. Peripheral artery disease, or PAD, is a circulation problem in which narrowed arteries reduce blood flow to the limbs, most often the legs. More than 200 million people suffer from PAD, yet many aren’t even aware they have …
He literally rolls into my office every three months, shoes still clipped to his carbon-fiber lifestyle. Lycra damp, Apple Watch buzzing, resting heart rate of 42. He is fit, smart, and tightly wound.
“Doc,” he begins, eyes wide, “I read that morning workouts burn more fat and lower clotting factors. Should I move my rides earlier? Or maybe late evening is better for heart rate variability?”
This is a man who, when …
I see it every week in my practice: Patients obsessed with their cholesterol numbers. LDL, HDL, triglycerides, the full alphabet soup. They have been trained to believe these numbers hold the keys to life and death.
But here is something I cannot stop thinking about: When you look under the microscope, an atherosclerotic plaque (the thing that clogs arteries and leads to heart attacks) looks an awful lot like a tuberculosis …
I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.
How it works
The cycle is simple:
As physicians, we are trained to prescribe, to fix, to optimize. Our patients expect it, and frankly, so do we. I built a career around lipid panels, trial data, and prescriptions meant to shave percentage points off cardiovascular risk. But lately, I find myself offering something far less high-tech and far more radical: a walk.
Walking is slow. Impractical. Rarely the efficient choice. Which is exactly why it matters.
Everywhere around us, …
As a practicing internist and lipidologist, I have long been trained to believe in the cholesterol hypothesis. Statins were not just recommended; they were the gospel. Lower LDL, save lives. That mantra was repeated at every lecture, every conference, every guideline committee.
But like many dogmas in medicine, the cracks are there if you dare to look. And some of the most damning cracks are found in a set of randomized …
In my practice, I care for many patients obsessed with longevity. They fast, they microdose, they meditate, they cold plunge, they gulp down supplements by the handful. They optimize their labs with the fervor of a hedge fund manager optimizing a portfolio. They read Peter Attia and Andrew Huberman like scripture.
And yet, they still die.
This is not cynicism; it is reality. Over the years, I have watched patients do everything …
As a physician, I spend most of my days telling patients to walk more, eat better, stress less, and maybe, just maybe, go to bed before midnight. So when I came across a piece on ancient Roman and Greek health habits, I had to laugh. Turns out, they were doing a lot of things right — without fitness trackers, $12 smoothies, or a trillion-dollar wellness industry.
We like to think of …
ADVERTISEMENT
A new gene-editing therapy just dropped LDL cholesterol by 69 percent — with a single injection. One shot, permanent effect. Cue the headlines: “Game-changer!” “End of statins!” “Revolution in heart disease!”
Here we go again.
Let’s be clear: I’m not anti-innovation. I’m not against gene therapy. I’m against making the same mistake again and again, just with better marketing and shinier tools.
VERVE-102 is the latest miracle-in-a-vial — a CRISPR base-editing therapy that …
As a cardiologist in New York City who treats a sizable Bangladeshi‑American community, I have witnessed otherwise healthy individuals exhibit concerning cardiovascular events, frequently in the absence of conventional risk markers. What unites them? Severe, protracted psychological stress brought on by prejudice, family court disputes, immigration problems, or financial instability.
The mechanisms of prolonged stress
Prolonged stress raises cortisol, adrenaline, and inflammatory cytokines via activating the sympathetic nervous system and hypothalamic‑pituitary‑adrenal (HPA) …
Coronary artery disease is still the world’s number-one killer.
That’s despite statins, PCSK9 inhibitors, stents, bypasses, and decades of lifestyle messaging.
We’ve gotten better at managing heart attacks, but we haven’t cured heart disease. Or prevented it. Or even figured out exactly what causes it.
As an internist and lipidologist (in recovery), I spent years chasing cholesterol numbers, especially HDL. I gave talks for Abbott. I pushed niacin like it was salvation. Then …
“Doctor, it’s not my portion. I don’t have hypertension,” she said confidently, shifting her wrapper and returning my gaze like I had just accused her of something terrible.
The blood pressure monitor read 170/120 mmHg. I had just measured it myself twice, yet here I was, facing a patient who flat-out refused to believe her numbers.
She was a middle-aged woman who came in complaining of a headache and body weakness. She …
For decades, you were told that whole milk was the devil in a glass. Doctors (including me), dietitians, and public health agencies told you to toss the red cap and grab the blue — skim, 1 percent, or 2 percent milk. Why? Because whole milk had fat. And fat, particularly saturated fat, was supposed to clog your arteries like grease in a kitchen drain.
Except we were wrong.
The fat in whole …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Cardiologist Monzur Morshed discusses the article, “Why South Asians in the U.S. face a silent heart disease crisis.” Drawing from his direct experience treating the Bangladeshi-American community in New York City, Monzur …
This story has been fictionalized.
Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306745014-K.
OK. Next.
Dorothy Klein. MRN 508291987. DOB 12/22/1962. Patient A-. Unit A-. Unit number W038306928906-K.
We finish checking the emergency release blood and wait. We know that whatever was coming up isn’t going to be pretty. A lung transplant gone bad, uncontrolled hemorrhaging, 14 hours on the table. So much blood transfused, an exploratory laparotomy was …
Get free updates delivered free to your inbox.
