There have been many ongoing trials on this topic and they are finally starting to conclude that intervening early, even when the patient is asymptomatic, is beneficial once echocardiogram shows the patient has severe aortic stenosis. A meta-analysis of 4 randomized control trials on this topic recently showed that among 1,400 patients at 42-74 months of follow up, those who received TAVR or other valve replacement were significantly less likely to experience death, stroke, heart attacks and...

We get a lot of questions from women who would benefit from vaginal/topical estrogen but are appropriately concerned about increased risk for heart attack and stroke with estrogen supplementation. A new study in the journal Stroke suggests that even amongst women who would be high or above average risk for stroke, use of vaginal estradiol was not associated with excess risk for recurrent ischemic stroke in this population. And this was true at doses as high as > 50ug per week....

This is one of the most commonly asked questions that we get and probably one of the most difficult to manage as really >95% of it is behavioral and/or anxiety related and not truly a neurologic problem with sleep…   There was a really great recent New England Journal of Medicine review article on this topic that does a nice job of describing the evidence behind the thoughts on this subject. [1]   In brief, the majority of patient reported insomnia falls into one of (or a combination of) the...