Long-Term Costs of Stroke Remain HIgh

A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, AustraliaMedicalResearch.com Interview with:
A/Prof Dominique Cadilhac, MPH PhD
Head: Translational Public Health Division
Stroke and Ageing Research Centre (STARC)
Department of Medicine,
School of Clinical Sciences at Monash Health, Monash University
Melbourne, Australia

Medical Research: What are the main findings of the study?

Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH).

243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on.

The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]).

The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because
a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and
b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event.

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Genes Beneficial To Our Ancestors, May Be Harmful Today

Dr. Toomas Kivsild PhD Department of Archaeology and Anthropology University of Cambridge, CambridgeMedicalResearch.com Interview with:
Dr. Toomas Kivsild PhD
Department of Archaeology and Anthropology
University of Cambridge, Cambridge

Medical Research: What is the background for this study? What are the main findings?

Dr. Kivsild: Native populations of Siberia are known to have certain physiological
characteristics such as high basal metabolic
rate, and high blood pressure and low levels of serum lipids, that have
been explained as traits that have evolved
as a consequence of the adaptation of Siberians to their cold
environment. Genetic basis of cold adaptation is still poorly understood.
In our previous study using genome-wide genotyping scans we detected a 3
Mbp region of high haplotype homozygosity in chromosome 11 as a
candidate of strong positive selection in Northeast Siberians.
There were 79 protein coding genes mapping to this homozygosity region
but we could not determine which of the genes
was driving the signal we observed.

In this forthcoming paper we have used high coverage whole genome
sequences from 25 individuals from Northeast Siberia and we were able
to determine the most likely SNP that is responsible for the high
haplotype homozygosity in the chromosome 11 in Northeast Siberians maps
to CPT1A gene which is a key regulator of long-chain fatty-acid
oxidation in mitochondria. What makes this finding most interesting is
that the same SNP had previously been found in Greenland and Canadian
Inuits in association with high infant mortality and hypoketotic
hypoglycemia. There are only a few other similar cases, like the sickle
cell and APOL1 alleles, where disease associated genetic variants may
have risen to high frequency in modern day populations due to the
adaptive advantage they have presented in the past populations.

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After Heart Attack: Women More Likely To Develop Anxiety and Depression

  MedicalResearch.com Interview with: Professor Pranas Serpytis Vilnius University Hospital Santariskiu Clinic Vilnius, Lithuania  Medical Research: What are the main findings of the study?  Professor Serpytis: The main findings of the study were that women are more likely to develop anxiety and depression after acute myocardial infarction. In our study depression was assessed by HADS scale: no depression (0-7 score), possible depression (8-10 score), definite depression (11+ score). The mean score of assessing depression were 6.87 (± 4.6) among men and 8.66 (± 3.7) among women (p <.05). Cardiovascular disease risk factors such as smoking increases patients anxiety levels, and low physical activity is associated with an increased risk to suffer from depression.  Medical Research: What was most surprising about the results?  Professor Serpytis: Most surprising about the results were that for women it is indeed more difficult to cope with the disease rather than for men. Women’s anxiety and depression rates are higher.  Medical Research: What should clinicians and patients take away from your report?  Professor Serpytis: Clinicians and patients should look after the possible symptoms and if needed refer the patients for psychologist or psychiatrist consultation in order get proper timely treatment. This could possibly improve the long-term treatment results.  Medical Research: What recommendations do you have for future research as a result of this study?  Professor Serpytis: Most definitely more research is needed in this field. Most importantly it is crucial to look for the impact of depression on the long-term effects on survival and general well-being.   Citation:   Women more likely to develop anxiety and depression after heart attack Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) and takes place 18-20 October in Geneva, Switzerland.MedicalResearch.com Interview with:
Professor Pranas Serpytis
Vilnius University Hospital Santariskiu Clinic
Vilnius, Lithuania

Medical Research: What are the main findings of the study?

Professor Serpytis: The main findings of the study were that women are more likely to develop anxiety and depression after acute myocardial infarction. In our study depression was assessed by HADS scale: no depression (0-7 score), possible depression (8-10 score), definite depression (11+ score). The mean score of assessing depression were 6.87 (± 4.6) among men and 8.66 (± 3.7) among women (p <.05). Cardiovascular disease risk factors such as smoking increases patients anxiety levels, and low physical activity is associated with an increased risk to suffer from depression.
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Familial Pancreatic Cancer Linked To Increased Melanoma and Endometrial Cancer Risk

MedicalResearch.com Interview with:
Jeremy L. Humphris MBBS

The Kinghorn Cancer Center, Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia and

Andrew V. Biankin
Regius Professor of Surgery
Director, Wolfson Wohl Cancer Research Centre,
University of Glasgow
Garscube Estate, Switchback Road, Bearsden, Glasgow Scotland
United Kingdom

Medical Research: What are the main findings of the study?

Response: Familial pancreatic cancer (FPC) is a family with at least 2 first degree (parent-child or siblings) with pancreatic cancer. We found these patients represent nearly 9% of our cohort. In addition we found those with familial pancreatic cancer were more likely to have other first degree relatives with a history of extra-pancreatic cancer, in particular melanoma and endometrial cancer. Patients with familial pancreatic cancer had more high grade precursor lesions in the pancreas adjacent to the tumour but the outcome was similar. Smoking was more prevalent in sporadic pancreatic cancer and active smoking was associated with significantly younger age at diagnosis in both groups. Long-standing diabetes mellitus (> 2 years duration) was associated with poorer survival in both groups.
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25% Infants Do Not Receive Vaccinations On Recommended Schedule

MedicalResearch.com Interview with:

Louise-Anne McNutt, PhD Associate Director, Institute for Health and the Environment University at Albany, State University of New YorkLouise-Anne McNutt, PhD
Associate Director, Institute for Health and the Environment
University at Albany, State University of New York

Jessica Nadeau, PhD Epidemiologist, University at Albany, State University of New YorkJessica Nadeau, PhD
Epidemiologist, University at Albany, State University of New York

Medical Research: What are the main findings of the study?


Response:
The study found that about 25% of infants consistently deviated from the routine vaccine schedule recommended by the American Academy of Pediatrics (AAP).  Alterations included either consistently refusing a recommended vaccine or reducing the number of vaccines given at each visit.

These deviations are generally associated with intent to use an alternative vaccination schedule.

Infants who did not follow the AAP recommended schedule were more likely to be unprotected against vaccine preventable diseases for a longer period of time. Only 1 in10 infants vaccinated on an alternative schedule were up-to-date at 9 months of age.
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Physicians Frustrated By Administrative Burdens of Medical Practice

Dr. Steffie Woolhandler MD MPH Professor of Public Health and City University of New York, Lecturer (formerly Professor of Medicine) at Harvard Medical School Primary Care Physician Practicing in the South BronxMedicalResearch.com Interview with:
Dr. Steffie Woolhandler MD MPH
Professor of Public Health and City University of
New York, Lecturer (formerly Professor of
Medicine) at Harvard Medical School
Primary Care Physician Practicing in the South Bronx

Medical Research: What is the background for this study?

Dr. Woolhandler: Physicians like myself are extremely frustrated
by the administrative burdens of medical
practice. Many hours of physicians’ time each
week go to administrative work completely
unrelated to good patient care, but mandated by
private insurers and other payers. Colleagues
often tell me that they love seeing patients but
are getting burned out by the paperwork.
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Pathology Reveals Overlap Between Schizophrenia and Bipolar Disorder

Glenn T. Konopaske, MD McLean Hospital, Belmont, Massachusetts Department of Psychiatry, Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with:
Glenn T. Konopaske, MD
McLean Hospital, Belmont, Massachusetts
Department of Psychiatry, Harvard Medical School
Boston, Massachusetts


Medical Research: What are the main findings of the study?

Dr. Konopaske: Using postmortem human brain tissue this study did reconstructions of basilar dendrites localized to pyramidal cells in the deep layer III of the dorsolateral prefrontal cortex. Tissue from individuals with schizophrenia, bipolar disorder or controls was examined. Dendritic spine density (number of spines per μm dendrite) was significantly reduced in bipolar disorder and also reduced in schizophrenia at a trend level. The number of dendritic spines per dendrite and dendrite length were significantly reduced in subjects with schizophrenia and bipolar disorder.

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Racial and Ethnic Disparities Continue In Asthma Rates

Nandita Bhan, ScD MSc MA Research Scientist & Adjunct Assistant Professor Public Health Foundation of India (PHFI)MedicalResearch.com Interview with:
Nandita Bhan, ScD MSc MA
Research Scientist & Adjunct Assistant Professor
Public Health Foundation of India (PHFI)

Medical Research: What are the main findings of the study?

Dr. Bhan: We found that the last decade in the US has seen a rise in racial/ethnic disparities in asthma. Compared to Non-Hispanic White populations, greater rates of asthma were seen among African Americans and lower rates among Hispanic populations. But more importantly, we found that it is not just a question of who you are, but where you live. Results showed heterogeneity by region and place of origin – highlighting that it will be simplistic to assume that asthma rates for Hispanic populations are the same across all states in the US.

While data is unable to explore further granularity by ethnicity, our results add to the developing evidence that state policies and politics have impacts on socioeconomic and racial/ethnic inequalities manifesting in health disparities in the US.
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Faster Weight Gain in Infancy Predicts Adult Obesity

Dr Ken Ong, Programme Leader & Paediatric Endocrinologist MRC Epidemiology Unit, University of Cambridge Box 285 Institute of Metabolic Science Cambridge Biomedical Campus, Cambridge  MedicalResearch.com Interview Invitation
Dr Ken Ong, Programme Leader & Paediatric Endocrinologist
MRC Epidemiology Unit, University of Cambridge
Box 285 Institute of Metabolic Science
Cambridge Biomedical Campus, Cambridge


Medical Research: What are the main findings of this report?

Dr. Ong: We found that genetic factors that predict adult obesity were associated with faster weight gain and growth during infancy – the findings indicate that the biological mechanisms that predispose to later obesity are already active from birth.

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Analgesics May Enhance Depression Treatment

Karl Ole Köhler, Research assistant  Department of Clinical Medicine The Department of General Psychiatry Aarhus UniversityMedicalResearch.com Interview with:
Karl Ole Köhler, Research assistant
Department of Clinical Medicine
The Department of General Psychiatry
Aarhus University

 
Medical Research: What are the main findings of the study?

Response:  We found that anti-inflammatory drugs and ordinary analgesics, which mainly are used against physical disorders, may have treatment effects against depression when used in combination with antidepressants. Thereby, our results furthermore support the hypothesis regarding a comorbidity between inflammatory diseases and depression, i.e. a connection between somatic and mental disorders.

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Trans and Saturated Fat Intake Declining, Still Room for Improvement

Mary Ann Honors, Ph.D. Postdoctoral Research Fellow Division of Epidemiology and Community Health University of MinnesotaMedicalResearch.com Interview with:
Mary Ann Honors, Ph.D.
Postdoctoral Research Fellow
Division of Epidemiology and Community Health
University of Minnesota


Medical Research:
What are the main findings of the study?

Dr. Honors: The American Heart Association and USDA have made recommendations on what we should and should not eat in order in reduce our cardiovascular disease risk. We wanted to know whether Americans are currently meeting these recommendations, as well as how our diets have changed over time. In particular, we were interested in several specific nutrients, including trans fats, saturated fats, and the omega-3 fatty acids, DHA and EPA. We examined trends in fatty acid intake in participants from the Minnesota Heart Survey. The Minnesota Heart Survey is a an ongoing, cross-sectional study of adults in the Minneapolis-St. Paul metro area that was designed to monitor cardiovascular disease risk factors, including diet.

We found that intake of trans fats and saturated fats has declined substantially over the last 30 years. However, intake levels are still above current recommendations. With DHA and EPA, we found that levels of intake were pretty steady over time and below what is recommended. Overall, while we saw some encourage trends, there is still some room for improvement in our diets. Continue reading

Bile Acid Diarrhea May Be Helped By New Drug Class

Julian Walters Professor of Gastroenterology Section of Hepatology & Gastroenterology | Imperial College London Consultant Gastroenterologist Imperial College Healthcare Hammersmith Hospital London W12 0HS | UKMedicalResearch.com Interview Invitation
Julian Walters

Professor of Gastroenterology
Section of Hepatology & Gastroenterology | Imperial College London
Consultant Gastroenterologist
Imperial College Healthcare Hammersmith Hospital
London W12 0HS | UK

Medical Research: What is the background for this study?  What is Bile acid diarrhoea (BAD)?

Dr. Walters: Bile acid diarrhoea accounts for about a third of the patients who would otherwise be diagnosed as IBS-D (irritable bowel syndrome – diarrhoea predominant).  We estimate about 1% of the adult population have this primary disorder; others may have it secondary to previous surgery such as ileal resection in Crohn’s disease or post-cholecystectomy.  There are unmet needs to improve diagnosis rates and to improve the current treatment with bile acid sequestrants which can be poorly tolerated and do not address the primary pathology.  We have shown that primary BAD patients have reduced levels of Fibroblast Growth Factor 19 (FGF19) the ileal hormone that regulates bile acid synthesis.
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Internalized Fat Bias Impacts Bariatric Surgery Success

Dr. Michelle Lent PhD Geisinger Health SystemMedicalResearch.com Interview with
Dr. Michelle Lent PhD
Geisinger Health System

Medical Research: What is the background for this study?

Dr. Lent: Previous study findings indicate that weight bias relates to a number of adverse outcomes in overweight and obese populations, including binge eating, psychological disorders and body image issues. In this study, we measured the degree to which people undergoing weight-loss surgery translate “anti-fat” attitudes into negative beliefs about themselves before surgery (known as “internalized weight bias”) and if this influences weight loss outcomes after surgery. Continue reading

Hospital Workers Besieged By Alarms

Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco, CA 94143-0610 MedicalResearch.com: Interview
Barbara J. Drew, RN, PhD, FAAN, FAHA
David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology
University of California, San Francisco (UCSF)
Department of Physiological Nursing
San Francisco, CA 94143-0610

Medical Research: What is the background for this study?

Dr. Drew: Physiologic monitors used in hospital intensive care units (ICUs) are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue.” Alarm fatigue occurs when clinicians are desensitized by numerous alarms, many of which are false or clinically irrelevant. As a result, the cacophony of alarm sounds becomes “background noise” that is perceived as the normal working environment in the ICU. Importantly, alarms may be silenced at the central station without checking the patient or permanently disabled by clinicians who find the constant audible or textual messages bothersome. Disabling alarms creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload.

To date, there has not been a comprehensive investigation of the frequency, types, and accuracy of physiologic monitor alarms collected in a “real-world” ICU setting. For this reason, nurse and engineer scientists in the ECG Monitoring Research Laboratory at the University of California, San Francisco (UCSF) designed a study to provide complete data on monitor alarms.
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Skin Cells Converted Into Neurons That Affect Huntington’s Disease

MedicalResearch.com Interview with:
Matheus Victorm PhD candidate
Dr. Andrew Yoo’s Lab
Graduate Program in Neuroscience
Washington University School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Answer: We have described a way to convert human skin cells directly into a specific type of brain cell called medium spiny neurons that is affected by Huntington’s disease, an ultimately fatal neurodegenerative disorder. Unlike other techniques that turn one cell type into another, this new process does not pass through a stem cell phase. Furthermore, we demonstrated that these converted cells survived at least six months after injection into the brains of mice and behaved similarly to native cells in the brain. Not only did these transplanted cells survive in the mouse brain, they showed functional properties similar to those of native cells. These cells are known to extend projections into certain brain regions and we found the human transplanted cells also connected to these distant targets in the mouse brain.

Medical Research: What should clinicians and patients take away from your report? What recommendations do you have for future research as a result of this study?

Answer:  The generation of a highly enriched population of medium spiny neurons allows the possibility of dissecting the pathogenesis of Huntington’s disease in a dish. This will enable researchers to investigate potential new drugs or small molecules that could be used to treat patients suffering from this disorder.To study the cellular properties associated with the disease, we are now taking skin cells from patients with Huntington’s disease and reprogramming them into medium spiny neurons using the approach described in the new paper. We also plan to inject healthy  reprogrammed human cells into mice with a model of Huntington’s disease to see if this has any effect on the symptoms.

Citation:

Generation of Human Striatal Neurons by MicroRNA-Dependent Direct Conversion of Fibroblasts

Matheus B. Victor,Michelle Richner, Tracey O. Hermanstyne, Joseph L. Ransdell, Courtney Sobieski, Pan-Yue Deng, Vitaly A. Klyachko, Jeanne M. Nerbonne, Andrew S. Yoo

Neuron DOI: http://dx.doi.org/10.1016/j.neuron.2014.10.016

 

 

Mortality From Acute Respiratory Distress Syndrome Drops Dramatically

MedicalResearch.com Interview with:
Jared Radbel MD
Staten Island, New York

Medical Research: What are the main findings of the study?

Dr. Radbel: Using ICD 9 coding from the largest all-payer inpatient health care database in the United States, the National Inpatient Sample (NIS) database we identified 174,180 patients with Acute Respiratory Distress Syndrome (ARDS) from 1996-2011.  When expanded to estimate country-wide discharges, our data represents 856,293 patients.  We found a decrease in case fatality rate from 46.8% in 1996 to 32.2% in 2011. This corresponds to an absolute mortality reduction of 14.6% and relative reduction of 31%.
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Metastatic Colon Cancer: Survival Improved With FOLFOXIRI and Bevacizumab

Alfredo Falcone MD Chiara Cremolini Fotios Loupakis University of Pisa and Azienda-Ospedaliero Universitaria Pisana ItalyMedicalResearch.com Interview with:
Alfredo Falcone MD
Chiara Cremolini Fotios Loupakis
University of Pisa and Azienda-Ospedaliero Universitaria Pisana
Italy

Medical Research: What are the main findings of the study?

Dr. Falcone: In the TRIBE study the main findings are that the use of an initial more intensive therapy with a triplet of cytotoxics (FOLFOXIRI) plus bevacizumab vs a doublet (FOLFIRI) + bevacizumab improves the outcome of metastatic colorectal cancer patients with unresectable metastases. In particular FOLFOXIRI + bevacizumab vs FOLFIRI+bevacizumab improved RECIST response-rate (65% vs 53%, p=0.006), progression-free survival which was the primary endpoint (median 12,1 vs 9,7 months, HR=0,75, p=0.003) and overall survival (median 31,0 vs 25,8 months, HR=0.79, p=0.054). These results, also compared to those reported in previous phase III studies in molecularly unselected patients, represent an important advance in the treatment of this disease.
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CHEST 2014: Electronic Stethoscope For Evaluation of Lung and Heart Disease

MedicalResearch.com Interview with: Ilina and Medha KrishenMedicalResearch.com Interview with:
Ilina and Medha Krishen
Michigan high school students and sisters Ilina and Medha Krishen, have developed screening tools using electronic stethoscopes to detect lung and heart disease. Their research was presented at the 2014 CHEST national meeting. Ilina and Medha have kindly agreed to discuss their work for the MedicalResearch.com audience.

Medical Research: Ilina, please tell us a little about you and the background for your study.

Ilina: I am a senior at Port Huron Northern High School in Fort Gratiot, Michigan. I was exploring the effects of air pollutants on lungs using frequency analysis of lung recordings.  My goal was to see if I could pick up early changes in healthy smokers and firefighters.

Dr. Sridhar Reddy, a local pulmonologist and occupational medicine expert mentored me.  He lent me his electronic stethoscope.  I am a violinist and a clarinet player, so initially had a lot of fun analyzing music frequencies. Later, I moved to lung sounds (a little more difficult!).

I used a Thinklabs Electronic Stethoscope for recording lung sounds. The inventor, Mr. Clive Smith, helped me understand the stethoscope.

I used the MATLAB program for analyzing frequencies.  Mr. Charles Munson, a graduate student at the University of Michigan, helped me write the software program for it.
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Cow’s Milk May Be Protective Against Childhood Infections

MedicalResearch.com Interview with:
Georg Loss, PhD
Dr. von Hauner Children’s Hospital
Ludwig Maximilians University of Munich
Munich, Germany

Medical Research: What are the main findings of the study?

Dr. Loss: In this large population based cohort study we observed that consumption of fresh unprocessed cow’s milk protected from respiratory infections, febrile illness and inflammation of the middle ear during the first year of life. The risk of developing these conditions was reduced by up to 30%, and the effect was diminished if the milk was heated at home before consumption. Conventionally pasteurized milk retained the ability to reduce the risk of febrile illness, while exposure to the higher temperatures used in UHT (Ultra-heat-treatment) processing eliminated the effect altogether. Importantly, the positive impact of fresh milk could be clearly separated from the confounding effects of other elements of the children’s nutrition. Furthermore, infants fed on unprocessed milk were found to have lower levels of the C-reactive protein, which is a measure of inflammation status.

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CT Angiograms Improve Outcomes and Save Lives

Dr. Matthew Budoff, M.D. Los Angeles Biomedical Research Institute Torrance CaliforniaMedicalResearch.com Interview with:
Dr. Matthew Budoff, M.D.
Los Angeles Biomedical Research Institute
Torrance California

Medical Research: What are the main findings of the study?

Dr. Budoff: We evaluated whether patients undergoing coronary CT angiography (non-invasive angiography) had better outcomes than those treated without the test.  We found survival was better with CT angiography.    Finding atherosclerosis allows cardiologists and primary care doctors to treat the patient better, including more statin therapy, more anti-platelet therapy, more lifestyle modifications.  Several small studies showed similar results, but this was by far the most significant and largest study of it’s kind.
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