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Tuesday, January 31, 2012


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Sandeep Aggarwal

Dear Dr Laird, first of all I would like to divert your focus towards the realm of preventive medicine and preventive cardiology, if you ever get a chance from cardiac interventions (which happen to produce no significant mortality benefit - Courage trial -N Engl J Med 2007; 356:1503-1516,) please read this another facinating NEJM article about how only 5% of total reduction of CV deaths were attributable to revascularization (Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. death from coronary disease, 1980-2000. N Engl J Med 356:2388-2398, 2007.) most of which were not PCI but - CABG. Also try reading Foley et al(American journal of kidney disease 1998) which tells us that a 20 yr old with ESRD has a CV risk of a 80 yr old without CKD, now while we know that traditional Framingham CV risk management has never worked in CKD 5 patients (eg 4D study) , do you really think its a cardiologist that is keeping a renal patient alive with their completely non evidence based love for beta blockers and Imdur/hydralazine combination (www.thelancet.com Vol366 October29,2005, and accomplish trial and ascot trial) no sir, with all due respect it's the nephrologist and its a much busier job than thought. Besides with the bundling I don't think nephrologists are in it for being the dialysis money sucking leaches. Thanks for your article, it was ... Interesting

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