Mortality Rate Increases With Each Sugary Drink Interview with:
Jean A. Welsh, RN, MPH, PhD
Departments of Epidemiology and Pediatrics
Emory University
Wellness Department, Children’s Healthcare of Atlanta
Atlanta, Georgia What is the background for this study?

Response: As the evidence has accumulated regarding the health risks associated with sugar-sweetened beverages, I’ve wondered about fruit juices.  Though they have a kind of healthy halo, their main ingredients are the same as sugar-sweetened beverages, sugar and water.  We know that young children drink a lot of fruit juice, and I’ve wondered if older children and adults might switch to drinking more as concern grows about soft drinks and other sugar-sweetened beverages.

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Grapefruit Juice Can Cause an EKG Change, Prolonged Q-T Interval, Aggravated by Some Medications Interview with:

Electrocardiogram showing QT interval calculated by tangent method Wikipedia image

Electrocardiogram showing QT interval calculated by tangent method – Wikipedia image

Sami Viskin MD
Tel-Aviv Medical Cente
Sackler School of Medicine
Tel-Aviv University, Israel. What is the background for this study? What are the main findings? 

Response: There are >200 medications with reported QT-prolonging risk. The majority of these medications do not even have cardiac indications, yet cause unintended QT-prolongation because they block IKr potassium channels in myocardial cells. With so many drugs, of such varied composition, blocking the IKr channel, it is reasonable to assume that food compounds also have IKr-channel-blocker properties, raising the possibility that proarrhythmic food exists.

We tested the effects of grapefruit on the QT interval with the rigorous methodology used by the pharmaceutical industry to test new medications before they are released to the market.

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Caffeine and Heart Disease: Is There a Right Amount of Daily Coffee? Interview with:
Professor Elina Hypponen
Professor in Nutritional and Genetic Epidemiology
Director: Australian Centre for Precision Health
 Australian Centre for Precision Health|
University of South Australia Cancer Research Institute |
South Australian Health & Medical Research Institute What is the background for this study?

Response: In Randomised controlled trials caffeine, which is a key constituent of coffee, has been shown to increase blood pressure. There is also some past evidence to suggest that higher coffee consumption may increase the risk of cardiovascular disease, but only in individuals who are slow caffeine metabolisers.

We used information from about 350,000 individuals from the UK, to look at the association between patterns of  habitual of coffee consumption and the subsequent risk of cardiovascular disease. As we also know that people are genetically different with respect to their ability to metabolise caffeine, a further aim for our study was to look at whether those people who are able to metabolise caffeine effectively, may also be more resistant to possible cardiovascular effects of coffee, compared to those who metabolise caffeine more slowly.  Continue reading

COPD: Aclidinium Bromide (Tudorza Pressair) Has Favorable Safety Profile in Patients with CVD Interview with:

Robert A. Wise, M.D.Professor of MedicinePulmonary and Critical CareJohns Hopkins University School of MedicineBaltimore, MD 

Dr. Wise

Robert A. Wise, M.D.
Professor of Medicine
Pulmonary and Critical Care
Johns Hopkins University School of Medicine
Baltimore, MD What is the background for this study? What are the main findings?

Response: There has been a lingering controversy about the safety of long-acting anti-muscarinic agents (LAMA) as maintenance treatment for COPD in patients who have increased cardiovascular risk.  This study enrolled participants with COPD who also had increased cardiovascular risk or known cardiovascular disease.  Participants were randomly treated with either aclidinium bromide (Tudorza Pressair) or placebo.

Over 3 years of follow up there was no increased risk of adverse cardiovascular events.  Moreover, the medication had a significant benefit in terms of reducing exacerbations and COPD hospitalizations. Continue reading

Higher Risk of Cardiovascular Disease Linked to Long Term Antibiotic Use in Women Interview with:
Dr. Lu Qi MD PhD
Department of Epidemiology, School of Public Health and Tropical Medicine
Tulane University New Orleans, LA 70112
Department of Nutrition, Harvard T.H. Chan School of Public Health,
Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
Boston, MA 02115

Yoriko Heianza RD, PhD
Department of Epidemiology, School of Public Health and Tropical Medicine,
Tulane University
New Orleans, LA What is the background for this study? What are the main findings? 

Response: Growing data suggest that antibiotic exposure is associated with a long-lasting alteration in gut microbiota, and may be related to subsequent cardiovascular disease (CVD). We investigated associations of duration of antibiotic use in different phases of adulthood (young, middle and late adulthood) with the CVD incidence among women at usual risk.

This new analysis from the Nurses’ Health Study shows that women who take antibiotics for long periods, especially during more recent adulthood (such as  in middle- and late adulthood) had a higher risk of CVD in later life.  Continue reading

Elevated PCBs Associated with Increased Risk of Cardiovascular Disease Interview with:

Monica Lind, PhD, Professor, Environmental toxicologistOccupational and Environmental MedicineUppsala University HospitalVisiting adress: Dag Hammarskjölds väg 60Uppsala Sweden 

Dr. Lind

Monica Lind, PhD,
Professor, Environmental toxicologist
Occupational and Environmental Medicine
Uppsala University Hospital
Visiting adress: Dag Hammarskjölds väg 60
Uppsala Sweden What is the background for this study?

Response: Previous studies in workers exposed to very high levels of polychlorinated biphenyls (PCBs) have suggested hazardous health effects. However, circulating PCB levels are detected in almost all indivuduals in industrialized countries, but the health effects of moderately elevated levels as seen in the general population are not well established.

We investigated levels of PCBs in around 1,000 individuals, all aged 70 years, randomly chosen from the City of Uppsala, Sweden.

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Genetic Studies Can Help Determine How Low LDL Should Go With Treatment

Florian Kronenberg

Dr. Kronenberg Interview with:
Florian Kronenberg, MD
Division of Genetic Epidemiology
Department of Medical Genetics, Molecular and Clinical Pharmacology
Medical University of Innsbruck, Innsbruck, Austria What is the background for this study?

Response: Lp(a) is one of the most prevalent lipoprotein risk factors for cardiovascular disease. Roughly 20% of the general Caucasian population have concentrations above 50 mg/dL and the 10% with the highest concentrations have a 2 to 3-fold increased risk for myocardial infarction.

There is strong evidence from genetic studies that high Lp(a) concentrations are causally related to cardiovascular outcomes. Until recently there was no drug available which lowers Lp(a) without any effects on other lipoproteins. This has recently changed by the development of drugs that block the production of Lp(a) in an impressive way. These drugs have to be studied in randomized controlled trials whether they not only lower Lp(a) concentrations but also cardiovascular outcomes. For the planning of such studies it is crucial to estimate the amount of Lp(a) lowering required to show a clinical benefit.

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It’s Not Just Avoiding Red Meat, It’s the Substitute Diet That Influences Heart Health Interview with:

Marta Guasch-Ferre, PhD Research Scientist, Dept of Nutrition, Harvard TH Chan School of Public Health Instructor of Medicine, Channing Division of Network Medicine, Harvard Medical School Boston, MA, 02115

Dr. Guasch-Ferré

Marta Guasch-Ferre, PhD
Research Scientist, Dept of Nutrition
Harvard TH Chan School of Public Health
Instructor of Medicine, Channing Division of Network Medicin
Harvard Medical School
Boston, MA, 02115 What is the background for this study? What are the main findings? 

Response: Previous findings from randomized controlled trials evaluating the effects of red meat on cardiovascular disease risk factors have been inconsistent.

But our new study, which makes specific comparisons between diets high in red meat versus diets high in other types of foods, shows that substituting red meat with high-quality protein sources lead to more favorable changes in cardiovascular risk factors. That is, to properly understand the health effects of red meat, it’s important to pay attention to the comparison diet. People do not simply eat more or less meat – it will almost always be in substitution with other foods. 

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Stroke: Experimental Antiplatelet Antibody Only Attacks Clots, Without Increasing Bleeding Risk Interview with: Interview with:Martine Jandrot-Perrus MD, PhD.Emeritus Research ProfessorInserm University Paris DiderotActicor BiotechHôpital BichatFrance

Dr. Jandrot-Perrus

Martine Jandrot-Perrus MD, PhD.
Emeritus Research Professor
Inserm University Paris Diderot
Acticor Biotech
Hôpital Bichat
France What is the background for this study? What are the main findings?

Response: Blood platelets are key actors in thrombosis a leading cause of global mortality estimated to account for 1 in 4 death worldwide in 2010.

Thrombosis is associated with cardiovascular diseases (myocardial infarction, stroke, lower limb ischemia, venous thromboembolism), and with numerous pathologies such as cancer, infections or inflammatory diseases. Currently available antiplatelet drugs are the cornerstone of therapy for patients with acute coronary syndromes. However, these drugs all carry an inherent risk of bleeding that restricts their use in sensitive populations and when arterial thrombosis occurs in the cerebral territory. At present the only acute treatment option available for ischemic stroke consists in revascularization by thrombolysis, and/or mechanical thrombectomy. But the number of patients eligible to these treatments is low (» 15% of all patients) and the success rate does not exceed 50%. The responsibility of platelets in the failure for thrombolysis / thrombectomy to restore vascular patency is strongly suspected.

There is thus a clear medical need for new antiplatelet drugs with an improved safety profile. We set out to develop ACT017, a novel, first in class, therapeutic antibody to platelet glycoprotein VI with potent and selective antiplatelet effects. The interest of GPVI resides in the fact that it’s a receptor involved in the development of occlusive thrombi but that it is not strictly required for physiological hemostasis.
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Is Immediate Cardioversion Necessary in New Onset Atrial Fibrillation? Interview with:

Atrial Fibrillation  Wikipedia example

Atrial Fibrillation
Wikipedia example

Harry J.G.M Crijns, MD, PhD
University Hospital Maastricht
Maastricht, The Netherlands What is the background for this study? What are the main findings? 

Response: An episode of the heart rhythm disorder ‘atrial fibrillation’ is a frequent reason for a visit to the Emergency Department. Patients commonly undergo a cardioversion to restore sinus rhythm – either electrical or pharmacological. However, it is known that episodes of atrial fibrillation frequently terminate spontaneously. Therefore, we conducted a multicenter randomized clinical trial in the Netherlands, researching whether a wait-and-see approach – consisting of heart rate slowing drugs and cardioversion only if the heart rhythm does not resolve spontaneously – was non-inferior to the current standard of care of immediate cardioversion.

The primary end point was the presence of sinus rhythm on the ECG at the 4 weeks visit, which was present in 91% in the wait-and-see approach and 94% in the standard of care, which was within the non-inferiority margin.

In the wait-and-see approach, 69% of patients returned to sinus rhythm spontaneously, i.e. without cardioversion. Complications were rare and comparable in both treatment arms, and the percentage of patients experiencing a recurrence of atrial fibrillation during the first 4 weeks after the index visit was comparable (30% vs 29% respectively). We concluded that in patients presenting to the emergency department with recent-onset, symptomatic atrial fibrillation, a wait-and-see approach was non-inferior to early cardioversion in achieving a return to sinus rhythm at 4 weeks. What should readers take away from your report?

Response: Recent-onset symptomatic atrial fibrillation usually terminates spontaneously and therefore an acute cardioversion is not always necessary, as a wait-and-see approach is equally effective and safe. Quality of life is the same in both treatment options. Physicians should discuss with their patients which one of the two approaches – wait-and-see or immediate cardioversion – would be more suitable in their situation. What recommendations do you have for future research as a result of this work? 

Response: Now that we have shown that early, i.e. immediate cardioversion may not be necessary, we are planning future studies on how to implement a delayed cardioversion into daily practice. Is there anything else you would like to add?

Response: Funding for this trial was provided by the Netherlands Organization for Health Research and Development, and Boehringer Ingelheim. 



 Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
Nikki A.H.A. Pluymaekers, M.D., Elton A.M.P. Dudink, M.D., Ph.D., Justin G.L.M. Luermans, M.D., Ph.D., Joan G. Meeder, M.D., Ph.D., Timo Lenderink, M.D., Ph.D.,
Jos Widdershoven, M.D., Ph.D., Jeroen J.J. Bucx, M.D., Ph.D.,
Michiel Rienstra, M.D., Ph.D., Otto Kamp, M.D., Ph.D.,

Jurren M. Van Opstal, M.D., Ph.D., Marco Alings, M.D., Ph.D.,
Anton Oomen, M.D., and Harry J.G.M. Crijns, M.D., Ph.D
et al., for the RACE 7 ACWAS Investigators*

March 18, 2019
DOI: 10.1056/NEJMoa1900353



Apr 15, 2019 @ 8:56 pm




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Suboptimal Physical Activity in Women Associated With Increased Healthcare Spending Interview with:
Erin D. Michos, MD, MHS, FACC, FAHA, FASE
Associate Professor of Medicine and Epidemiology
Associate Director of Preventive Cardiology
Ciccarone Center for the Prevention of Heart Disease
Johns Hopkins School of Medicine

Victor Okunrintemi, MD, MPH
Department of Internal Medicine
East Carolina University
Greenville, North Carolina What is the background for this study?  

Response: Women are less physically active than men on average, and the lack of regular physical activity has been associated with increased risk of cardiovascular disease and poorer health outcomes. Although recommendations encouraging regular physical activity has been in place for decades, we do not know how much of these recommendations are met, particularly among high risk women with established cardiovascular disease for secondary prevention.

This study was therefore designed with the aim of describing the 10-year trends for the proportion of women with cardiovascular disease who do not meet these recommend physical activity levels, overall and by key sociodemographic groups, and the associated cost implications.

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Stress from Traumatic Events Linked to Increased Risk of Heart Disease Interview with:

Huan Song Associated Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Huan Song

Huan Song, PhD
Center of Public Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavík, Iceland
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet, Stockholm, Sweden What is the background for this study?  

Response: Cardiovascular disease (CVD) presents a group of diseases that are common and sometimes fatal in general population. The possible role of stress-related disorders in the development of CVD has been reported. However, the main body of the preceding evidence was derived from male samples (veterans or active-duty military personnel) focusing mainly on posttraumatic stress disorder (PTSD) or self-reported PTSD symptoms. Data on the role of stress-related disorders in CVD in women were, until now, limited. Although incomplete control for familial factors and co-occurring psychiatric disorder, as well as the sample size restriction, limit the solid inference on this association, especially for subtypes of CVD.

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Collagen Biomarker Associated With Atrial Fibrillation and Heart Failure Risk Interview with:
Susana Ravassa PhD

Program of Cardiovascular Diseases, CIMA
University of Navarra, and IdiSNA
Navarra Institute for Health Research
Pamplona, Spain What is the background for this study?

Response: Atrial fibrillation (AF) is an evolving epidemic responsible for substantial morbidity, mortality and health-care expenditure. In particular, when AF and heart failure (HF) occur in combination, clinical evolution is particularly poor. Left atrial (LA) myocardial interstitial fibrosis (MIF) is the main structural lesion in AF and considered as the main factor responsible for the perpetuation of this pathology. In addition, it is known that MIF is associated with a lower effectiveness of the treatment of AF by pulmonary vein isolation with catheter ablation. Therefore, the identification of biomarkers related to MIF, as an affordable and minimally invasive approach, is of great interest to detect patients at risk of AF, as well as to monitor their response to the LA ablation therapy.

We had previously demonstrated that the deleterious impact of MIF in the heart is due to alterations in both the quality (i.e., extent of cross-linking among collagen fibrils and type of collagen fibers that determine their rigidity and resistance to degradation [collagen cross-linking or CCL]) and the quantity (i.e., extent of collagen fibers that occupy the myocardial tissue [collagen deposition or CD]) of fibrotic tissue. We have shown that certain circulating biomarkers related to collagen type I metabolism are associated with CCL and CD. On the one hand, the serum carboxy-terminal propeptide of procollagen type I (PICP), released during the conversion of procollagen type I into fibril-forming mature collagen type I, is directly correlated with myocardial CD.

On the other hand, the ratio of serum carboxy-terminal telopeptide of collagen type I to serum matrix metalloproteinase-1 (serum CITP:MMP-1 ratio) is inversely correlated with myocardial CCL, as the higher is the cross-linking among collagen type I fibrils the lower will be the cleavage of CITP by MMP-1 during the process of degradation of the fiber. Interestingly, we have previously reported that the combination of these biomarkers identifies patients with heart failure presenting with a complex pattern of MIF characterized by both increased CCL and CD (CCL+CD+) showing a higher risk of adverse clinical evolution as compared with heart failure  patients without this combination of biomarkers. As both increased CCL and CD have been found in the left atrial myocardium in patients with AF, we designed this investigation to explore whether the CCL+CD+ combination of biomarkers is associated with AF. Continue reading

Even Small Amounts of Red and Processed Meat Linked to Increase in Cardiovascular Mortality Interview with:

Saeed Mastour Alshahrani, MPH, PhDSchool of Public Health, Loma Linda University, California, USACollege of Applied Medical Sciences, King Khalid UniversityAbha, Saudi Arabia

Dr. Mastour Alshahrani

Saeed Mastour Alshahrani, MPH, PhD
School of Public Health, Loma Linda University, California, USA
College of Applied Medical Sciences, King Khalid University
Abha, Saudi Arabia What is the background for this study? What are the main findings? 

Response: -The consumption of red and processed meat has been associated with risks of importance to public health including cardiovascular diseases and cancer.

Several studies have found that red and processed meat intake was associated with an increased risk of mortality. However, levels of meat intake in those studies were relatively high. It remains of interest whether even relatively low intake levels of red and processed meat might be associated with greater mortality, compared to zero intake.  Continue reading

Contact Allergic Reactions to Implanted Cardiac Devices Interview with:

Amber Reck Atwater, M.D.Dermatology Residency Program DirectorAssociate Professor of DermatologyDirector, Contact Dermatitis ClinicDuke Dermatology

Dr. Reck Atwater

Amber Reck Atwater, M.D.
Dermatology Residency Program Director
Associate Professor of Dermatology
Director, Contact Dermatitis Clinic
Duke Dermatology What is the background for this study? What are the main findings?

Response: We completed an evaluation of our Duke Dermatology patients who underwent patch testing for possible allergy to their cardiac devices – pacemakers and defibrillators.

From March 1, 2012 to September 15, 2017 we saw 11 patients with suspected allergy to their devices.  Concern for allergy, skin eruption, skin symptoms, and concern for infection were common. 73% of patients had erythema at their implant scars; pruritus and pain were also noted.  Six of our patients had relevant reactions, and the most common allergies were metals, silicone and rubber accelerators.  Continue reading

Hands-Only CPR Increases Bystander Participation and Survival After Cardiac Arrest Interview with:

Hands only CPR AHA image

Hands only CPR
AHA image

Gabriel Riva, Graduate Student
Department of Medicine, Solna (MedS),
Karolinka Institute What is the background for this study? What are the main findings?

Response: During the last decade there has been a gradual adoption of compression-only CPR, as an option to conventional CPR with chest compressions and rescue breaths, in international CPR guidelines. The simplified technique is recommended for bystanders who are untrained and in “telephone assisted CPR”. One of the reasons was the assumption that more people would actually do CPR with the simplified technique.  We could in this nationwide study running over 3 guideline periods demonstrate a 6-fold higher proportion of patients receiving compression-only CPR and a concomitant almost doubled rate of CPR before emergency medical services arrival over time. This very large increase in simplified CPR was surprising to us, especially considering there has never been any public campaigns promoting compression-only CPR in Sweden and training still include compressions and ventilations.  Continue reading

Shorter Individuals at Greater Risk of Heart Disease Interview with:

Eirini MarouliWilliam Harvey Research InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of London, London

Eirini Marouli

Eirini Marouli
William Harvey Research Institute
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London What is the background for this study?  

Response: Epidemiological studies suggest that shorter stature is associated with increased risk of coronary artery disease (CAD) or type 2 diabetes (T2D). It is not clear though whether these associations are causal or there are other factors mediating these effects. When randomized trials are inappropriate or impossible, we can use Mendelian Randomisation as a good alternative to study the causal relationship between a trait and a disease. Here, we examined over 800 places in the human genome known to be associated with adult height and evaluated how genetically predicted height can affect the risk of CAD or T2D. Furthermore, we evaluated the role of several risk factors including, cholesterol, triglycerides, blood pressure, body mass index, fat percentage, socio-economic parameters including education and income as well as lung function. Lung function was assessed by spirometry measures including FEV1: forced expiratory volume in 1 second, FVC: forced vital capacity.

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Dietary Cholesterol from Eggs Linked to Cardiovascular and All-Cause Mortality Interview with:

Victor Wenze Zhong, Ph.D.Postdoctoral fellowDepartment of Preventive MedicineFeinberg School of MedicineNorthwestern University 680 N Lake Shore Dr, Suite 1400Chicago, IL 60611

Dr. Zhong

Victor Wenze Zhong, Ph.D.
Postdoctoral fellow
Department of Preventive Medicine
Feinberg School of Medicine
Northwestern University
Chicago, IL 60611 What is the background for this study?

Response: Dietary cholesterol is a common nutrient in human diet. Eggs, specially egg yolks, are the single richest source of dietary cholesterol among all commonly consumed foods. The associations between dietary cholesterol consumption and cardiovascular disease and mortality remain controversial despite decades of research. Eating less than 300 mg of dietary cholesterol per day was the guideline recommendation before 2015. However, the most recent 2015-2020 Dietary Guidelines for Americans no longer include a daily consumption limit for dietary cholesterol and recommend weekly egg consumption as part of the healthy US-style eating pattern. Whether these recommendations are appropriate have been intensely debated.

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Exercise: A Non-Pharmaceutical “Drug” To Reduce Heart Disease in Breast Cancer Patients Interview with:

Christina M. Dieli-Conwright, PhD, MPH, FACSM, CSCSAssistant Professor of ResearchDirector, Integrative Center for Oncology Research in ExerciseDivision of Biokinesiology & Physical Therapy, Ostrow School of DentistryDepartment of Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos Angeles, CA 90033

Dr. Dieli-Conwright

Christina M. Dieli-Conwright, PhD, MPH, FACSM, CSCS
Assistant Professor of Research
Director, Integrative Center for Oncology Research in Exercise
Division of Biokinesiology & Physical Therapy, Ostrow School of Dentistry
Department of Medicine, Keck School of Medicine
University of Southern California
Los Angeles, CA 90033 What is the background for this study? What are the main findings? 

Response: This study was designed to assess the effects of an aerobic and resistance exercise on metabolic dysregulation in sedentary, obese breast cancer survivors, however we further examined the effects on cardiovascular disease risk measured by the Framingham Risk Score, reported here.

Our findings indicated that exercise, indeed, reduces the risk of cardiovascular disease in this population.  Continue reading

Gene Transfer Improved Cardiac Function in Diabetic Mouse Model Interview with:

H. Kirk Hammond, MDProfessor of Medicine at University of California, San DiegoBasic research scientist and cardiologistSan Diego Veterans' Affairs Healthcare System

Dr. Hammond

H. Kirk Hammond, MD
Professor of Medicine at University of California
San Diego
Basic research scientist and cardiologist
San Diego Veterans’ Affairs Healthcare System

Dr. Hammond is winner of the 2017 William S. Middleton Award – the highest research honor in the U.S. Department of Veterans Affairs What is the background for this study? What are the main findings?

Response: Worldwide, 9% of adults have diabetes, predominantly due to insulin resistance, known as Type 2 diabetes. It is associated with obesity and diets high in fat and carbohydrates. In this gene transfer study we showed that a single injection of a vector encoding a natural hormone (urocortin 2, Ucn2) increased glucose disposal and improved heart function in a model of diet-induced Type 2 diabetes in mice. 

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Cardiac Surgery: No Difference in Outcomes Between Inhaled and IV Anesthesia Interview with:

Dr. Giovanni LandoniIntensive Care and Anesthesia Unit Associate professorUniversità Vita-Salute San Raffaele

Dr. Landoni

Dr. Giovanni Landoni
Intensive Care and Anesthesia Unit
Associate professor
Università Vita-Salute San Raffaele What is the background for this study?  

Response: Patients undergoing cardiac surgery are still at risk for perioperative complications. Studies to improve clinical outcomes this setting are important. Inhaled anesthetics have pharmacological properties which reduce myocardial infarction size by 50% in laboratory and animal studies and which might decrease postoperative mortality according to aggregated published randomized data.

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Psoriasis: No Difference Found in Cardiovascular Risk Between Ustekinumab vs TNF Inhibitor Therapy Interview with:

Seoyoung C. Kim, MD, ScD, MSCEDirector, Program in Rheumatologic, Immunologic, and Musculoskeletal PharmacoEpidemiology Associate Professor of MedicineDivision of Pharmacoepidemiology & PharmacoeconomicsDivision of Rheumatology, Immunology and Allergy Brigham and Women's Hospital, Harvard Medical School

Dr. Kim

Seoyoung C. Kim, MD, ScD, MSCE
Director, Program in Rheumatologic, Immunologic, and Musculoskeletal PharmacoEpidemiology
Associate Professor of Medicine
Division of Pharmacoepidemiology & Pharmacoeconomics
Division of Rheumatology, Immunology and Allergy
Brigham and Women’s Hospital
Harvard Medical School What is the background for this study?

Response: Given a high cardiovascular (CV) risk among patients with psoriasis and psoriatic arthritis, it is important to have more information with regard to potential effect of different treatment agents on CV risk.

As the number of treatment options for psoriasis and psoriatic arthritis has been rising over the few decades, it is even more crucial to have high-quality evidence on comparative safety of different treatment options so physicians and patients can choose an agent based on the benefit-risk profile of each drug they are considering.

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Flu Linked to Marked Increase in Heart Failure Admissions Interview with:

Sonja Kytomaa MAResearch AssociateBrigham and Women’s Hospital

Sonja Kytomaa

Sonja Kytomaa MA
Research Associate
Brigham and Women’s Hospital

Scott D. Solomon, MDThe Edward D. Frohlich Distinguished ChairProfessor of MedicineHarvard Medical SchoolSenior PhysicianBrigham and Women’s HospitalInternational Associate Editor, European Heart Journal

Dr. Scott Solomon

Scott D. Solomon, MD
The Edward D. Frohlich Distinguished Chair
Professor of Medicine
Harvard Medical School
Senior Physician
Brigham and Women’s Hospital
International Associate Editor, European Heart Journal What is the background for this study? What are the main findings? 

Response: Influenza is associated with an increased risk of cardiovascular events, yet few studies have explored the temporal association between influenza activity and hospitalizations, especially due to heart failure (HF).

Our aim with this study was to explore the temporal association between influenza activity and hospitalizations for HF and myocardial infarction (MI) in the general population. We related the number of MI and HF hospitalizations by month, which were sampled from 4 US communities and adjudicated in the surveillance component of the Atherosclerosis Risk in Communities (ARIC) study, to monthly influenza-like illness activity, as reported by the Centers for Disease Control and Prevention. We found that a 5% increase in influenza activity was associated with a 24% increase in HF hospitalizations rates, while overall influenza was not significantly associated with MI hospitalizations. Influenza activity in the months before hospitalization was not associated with either outcome.

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Mesenchymal Stem Cells May Reduce Complications in Heart Failure Patients with LVAD Interview with:

Annetine C. Gelijns, PhDChair, Department of Population Health Science & PolicyEdmond A. Guggenheim Professor of Health PolicyCo-Director, InCHOIR

Dr. Gelijns

Annetine C. Gelijns, PhD
Professor and System Chair
Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

Alan J Moskowitz, MDProfessor, Population Health Science and PolicyDepartment of Population Health Science & PolicyIcahn School of Medicine at Mount SinaiNew York, NY 10029-6574

Dr. Moskowitz

Alan J Moskowitz, MD

Professor of Population Health Science and Policy
Icahn School of Medicine at Mount Sinai What is the background for this study? Where do these mesenchymal cells come from? 

Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery.

Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients.

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Atrial Fibrillation: Antithrombotic Therapy after Acute Coronary Syndrome or PCI Interview with:

Renato D. Lopes MD, MHS, PhD Duke University Medical Center Duke Clinical Research Institute Durham, NC 27705

Dr. Renato Lopes

Renato D. Lopes MD, MHS, PhD
Professor of Medicine
Division of Cardiology
Duke University Medical Center
Duke Clinical Research Institute What is the background for this study? What are the main findings?

Response: In patients with acute coronary syndromes (ACS), approximately 20% to 30% of those with nonvalvular atrial fibrillation (NVAF) have concomitant coronary artery disease (CAD), and 5 to 10% of patients who undergo PCI have NVAF. These patients often receive both antiplatelet therapy and oral anticoagulants; and how best to combine these agents to minimize bleeding risk without compromising protection against thrombosis is an important unanswered question.

Analysis of results for bleeding indicated no significant interaction between the two randomization factors permitting independent analysis of results for the two key comparisons. The first showed that apixaban was both non-inferior and significantly superior to VKA for the primary outcome with a 31% reduction in the relative risk for bleeding. Aspirin significantly increased the relative risk for bleeding versus placebo by 89%.

Results for the composite of death and hospitalization showed that apixaban resulted in a relative risk reduction of 17%, primarily driven by a reduction in all cause hospitalization. There was no significant difference between results for aspirin versus placebo for this outcome.

Analysis of the composite of death and ischemic events indicated no significant differences in results for apixaban versus VKA or aspirin versus placebo.

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Most Cardiovascular Guidelines Not Supported By Randomized Clinical Trials Interview with:
Renato D. Lopes MD, MHS, PhD
Professor of Medicine
Division of Cardiology
Duke University Medical Center
Duke Clinical Research Institute

Alexander C. Fanaroff, MD, MHS
Division of Cardiology and Duke Clinical Research Institute
Duke University, Durham, North Carolina What is the background for this study? What are the main findings?

Response: About ten years ago, a group of researchers examined the evidence supporting guideline recommendations in cardiology for the first time. Quite surprisingly, they found that only 11% of recommendations in American College of Cardiology/American Heart Association (ACC/AHA) guidelines were supported by evidence from randomized controlled trials, the highest level of evidence. The researchers called for greater collaboration among investigators and funders in identifying key research questions, development of streamlined clinical trial methods, and expansion of funding for clinical research. Over the past 10 years, some of these steps have been taken, but it is unclear how the evidence supporting guideline recommendations has changed.

We therefore analyzed the 51 current cardiovascular guideline documents — 26 from the ACC/AHA and 25 from the European Society of Cardiology (ESC) — including 6,329 recommendations.

Overall, 8.5% of recommendations in ACC/AHA guidelines and 14.3% of recommendations in ESC guidelines were supported by evidence from randomized controlled trials. When looking specifically at guidelines that have been updated, we found no significant changes in the proportion of recommendations supported by evidence from randomized controlled trials.

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Erectile Dysfunction: Advanced Imaging Demonstrates Link with Atherosclerosis Interview with:

Jagat Narula, MD, PhDPhilip J. and Harriet L. Goodhart Professor of Medicine (Cardiology)Associate Dean for Global HealthDirector of the Cardiovascular Imaging ProgramMount Sinai Medical Center

Dr. Narula

Jagat Narula, MD, PhD
Philip J. and Harriet L. Goodhart Professor of Medicine (Cardiology)
Associate Dean for Global Health
Director of the Cardiovascular Imaging Program
Mount Sinai Medical Center What is the background for this study? What are the main findings?

Response: Atherosclerosis has been linked to causing erectile dysfunction (ED) in the majority of patients with this cardiovascular condition, but researchers have not had the means of demonstrating atherosclerosis in penile arteries until now.  This unique study uses advanced imaging to detect how strong the association actually is.  For the first time, researchers have used advanced imaging of penile arteries to show a link between atherosclerosis and erectile dysfunction (ED).

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TAVRcathAID Mobile App Facilitates Coronary Access Education After TAVR Interview with:

Annapoorna Kini, MDZena and Michael A Wiener Professor of MedicineDirector of the Cardiac Catheterization LaboratoryMount Sinai Heart at Mount Sinai Hospital

Dr. Kini

Annapoorna Kini, MD
Zena and Michael A Wiener Professor of Medicine
Director of the Cardiac Catheterization Laboratory
Mount Sinai Heart at Mount Sinai Hospital What is the background for this study?  

  • Expanding indication and use of Transcatheter aortic valve replacement (TAVR) poses a unique problem of coronary access after valve implantation.
  • Troubleshooting tools and techniques have been published but are not available at the fingertips of the user at all the times.
  • We tried to address this unique problem with an innovative educational mobile application (app) called “TAVRcathAID”.

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Atrial Fibrillation: Study Finds Quality of Life Better After Ablation vs Medication Interview with:

Dr. Carina Blomström-Lundqvist, MDProfessor of CardiologyDepartment of CardioloyInstitution of Medical ScienceUppsala, Sweden

Dr. Blomström-Lundqvist

Dr. Carina Blomström-Lundqvist, MD
Professor of Cardiology
Department of Cardioloy
Institution of Medical Science
Uppsala, Sweden What is the background for this study?  

Response: While all previous trials comparing atrial fibrillation (AF) ablation and antiarrhythmic drugs to our best knowledge have evaluated the efficacy of these treatments in terms of atrial fibrillation (AF) recurrences (with an AF episode of 30 seconds duration as standard primary endpoint) we wanted to use quality of Life (QoL) – general health – as primary endpoint, since the indication for treatment is improving QoL.

This was important since, despite the fact that the indication for treatment is to improve (QoL) and reduce symptom, all prior trials have used 30 seconds AF episodes as standard primary endpoint, which if occurred it would be defined as a failed treatment.

We also wanted to assess effects on various clinical outcome events.

We know from registries such as ORBIT AF registry that around 60 % of AF patients have symptoms resulting in repeated hospitalisation visits in at least 30-40% of patients annually, and that only around 5 % of the AF population are being referred for AF ablation.

Previous trials have used intermittent 24 hours Holter recordings whioch does not give the true AF burden (% of time in AF). We therefore also wanted to assess and compare treatments effects on true AF burden by implanting an implantable cardiac monitor (ICM) which continuosly records the heart rhythm. We would then be able to prove that improvement in QoL was directly related to a reduction in AF burden and that treatment differences in QoL was related to a difference in reduction in AF burden.

We also wanted to study an AF population in their early AF disease state so that we could offer atrial fibrillation ablation to a broader AF population before their atria have become remodelled and too damaged for a pulmonary vein isolation to be effective. 

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New HeartMate 3 LAVD Reduces Risk of Strokes and Clots Interview with:

Mandeep R. Mehra, MD, MSc, FRCP (London)The William Harvey Distinguished Chair in Advanced Cardiovascular MedicineMedical Director, Heart and Vascular Center, Brigham and Women’s HospitalExecutive Director, Center for Advanced Heart DiseaseBrigham and Women’s HospitalProfessor of Medicine, Harvard Medical School

Dr. Mehra

Mandeep R. Mehra, MD, MSc, FRCP (London)
The William Harvey Distinguished Chair in Advanced Cardiovascular Medicine
Medical Director, Heart and Vascular Center
Brigham and Women’s Hospital
Executive Director
Center for Advanced Heart Disease
Brigham and Women’s Hospital
Professor of Medicine, Harvard Medical School What is the background for this study? What are the main findings?

Response: The MOMENTUM 3 trial is the largest study of LVAD therapy in Advanced Heart Failure with over 1000 randomized patients followed to at least 2 years. This trial tested a novel fully magnetically levitated LVAD, the HeartMate 3 pump against a mechanical bearing containing LVAD, the HeartMate II pump in patients suffering from advanced heart failure (85% of whom were on continuous intravenous Inotropic therapy or IABP device at the time of randomization). While LVADs have improved survival for such patients, the morbidity has remained excessive due to serious complication as a result of problems with hemocompatibility.

The principal concerns revolve around complications of pump thrombosis requiring surgical replacement, strokes and bleeding events, especially gastrointestinal bleeding. The trial has previously reported two interim analyses which suggested signals for superiority on pump replacement and even a decrease in ischemic stroke.

This final full report concludes convincingly that all three domains of hemocompatibility related adverse events are reduced with the novel LVAD with near elimination of pump thrombosis, halving of strokes of any kind and any severity and a marked decrease in bleeding complications.

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