Patients With Highest LDL Levels Benefit Most From Lipid-Lowering Drugs

MedicalResearch.com Interview with:

Dr. Jennifer Robinson, MD MPH professor of epidemiology, University of Iowa College of Public Health. CREDIT Tom Langdon

Dr. Robinson

Dr. Jennifer Robinson, MD MPH
Professor, Departments of Epidemiology & Medicine
Director, Prevention Intervention Center
Department of Epidemiology
University of Iowa

MedicalResearch.com: What is the background for this study?

Response: Compared to previous placebo-controlled statin trials, the FOURIER trial where all patients were on high or moderate intensity statin, had no reduction in cardiovascular or total mortality and the reduction in cardiovascular events was less than expected.  However, other PCSK9 inhibitor trials performed in populations with higher baseline low density lipoprotein cholesterol (LDL-C) had cardiovascular risk reductions similar to that in the statin trails.

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Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes

MedicalResearch.com Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion.  Continue reading

Heart Attacks Less Common in Women, But More Likely To Be Fatal

MedicalResearch.com Interview with:
Dr. Edina Cenko  MD, PhD first author  and
Dr. Raffaele Bugiardini M.D. FESC, FAHA,
Professor of Cardiovascular Medicine, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

MedicalResearch.com: What is the background for this study?

Response: Recent studies have identified younger women as “at-higher risk of mortality” after acute myocardial infarction. However, There are few studies looking at sex differences in mortality of patients with ST-Elevation Myocardial Infarction (STEMI). None of these studies have adjusted outcomes for treatment and delay to primary PCI, which may largely contribute to variations in clinical decision making and sex differences in outcomes. We used a large data set with fully risk and medications-adjusted models to investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age in this excess of risk.

MedicalResearch.com: What are the main findings? 

Response: The different twist to this manuscript is to demonstrate that even when women have the same aggressive interventional and medical therapy as men, they die more than men and much more if women are younger , less than 60 years

MedicalResearch.com: What should readers take away from your report?

Response: Younger women are less likely to have a STEMI, but when they do so they show an excess of 30-day death than men, even in primary PCI treated patients. One strategy does not fit all in terms of women and men and mortality after STEMI. We need a more personalized approach to cardiovascular care. Behind sex disparities, sex is a biological variable in myocardial infarction. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The study supports the new NIH initiative requiring researchers to factor sex into the design, analysis, and reporting of studies. Severe adverse effects in women were not recognized by clinical trials as there was not a sufficient sample of women. Studying (balancing or randomizing) both sexes may inform appropriate medical care for women.  

MedicalResearch.com: Is there anything else you would like to add? 

Response: The current study is the first investigation which demonstrates that differences between younger men and younger women in STEMI mortality rates are unrelated to disparities in treatment. This holds true even in patients undergoing primary PCI. However, more studies are needed. Findings from men could not necessarily be applied to women. It is central considering the effects of sex as a biological variable at all stages and in any type of research on ischemic heart disease.

Any disclosures? Nothing to disclose 

Citations:

Cenko E, Yoon J, Kedev S, et al. Sex Differences in Outcomes After STEMIEffect Modification by Treatment Strategy and Age. JAMA Intern Med. Published online April 09, 2018. doi:10.1001/jamainternmed.2018.0514 

 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Sacubitril/Valsartan Reduces Physical and Social Limitations in Heart Failure Patients

MedicalResearch.com Interview with:
Dr. Alvin Chandra  MD first author  and
Dr. Scott David Solomon M.D.
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In general, the quality of life of heart failure with reduced ejection fraction patients is quite impaired, and  similar to that of patients on dialysis.

PARADIGM-HF was the largest trial of heart failure patients and showed that sacubitril/valsartan was superior to the gold-standard enalapril in reducing cardiovascular death, heart failure hospitalization and all-cause mortality. In addition, patients on sacubitril/valsartan, when compared to enalapril, showed significant improvement in overall quality of life.

In this study we looked in more detail at the individual components of “quality of life” and found that in virtually all domains and activities, patients who were randomized to sacubitril/valsartan reported improvement in their limitations  compared to those who were randomized to enalapril. These activities included jogging, doing hobbies, and household chores, with the largest improvement seen in  sexual activities limitations.

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Epigenetic DNA Variants Predictive of Coronary Artery Disease

MedicalResearch.com Interview with:

Stella Aslibekyan, PhD Associate Professor PhD Program Director Department of Epidemiology University of Alabama at Birmingham

Dr. Aslibekyan

Stella Aslibekyan, PhD
Associate Professor
PhD Program Director
Department of Epidemiology
University of Alabama at Birmingham

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When the human genome was sequenced in 2003, there were somewhat unrestrained expectations of unraveling all etiologic mysteries and discovering breakthrough treatments. Needless to say, that did not happen, in part because individual genetic variants can only account for a small fraction of trait variability. Since then, epigenetics– the study of mitotically heritable changes in gene expression– has emerged as another promising avenue for understanding disease risk. The best studied epigenetic process in humans is DNA methylation, and earlier studies (including some from our group) have shown interesting associations between changes in methylation in specific genomic regions and cardiovascular disease traits, e.g. plasma cholesterol levels.

In this project, we have combined DNA methylation data on thousands of individuals from multiple international cohorts and interrogated epigenetic contributions to circulating tumor necrosis factor alpha (TNFa), a marker of systemic inflammation. We identified and replicated several epigenomic markers of TNFa, linked them to variation in gene expression, and showed that these methylation changes (which were located in interferon pathway genes) were predictive of coronary heart disease later in life. Interestingly, the variants we discovered were not sequence-dependent (in other words, they were not associated with any genetic mutations), highlighting the role of the environment.

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Migraine Linked To Increased Risk of Heart Disease and Stroke

MedicalResearch.com Interview with:

Islam Elgendy MD Division of Cardiovascular Medicine University of Florida  

Dr. Elgendy

Islam Elgendy MD
Division of Cardiovascular Medicine
University of Florida  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Migraine headache is a prevalent medical condition, often being chronic and debilitating to many. Previous studies have shown that migraine, particularly migraine with aura, is associated with an increased risk of cardiovascular events. Recently, a number of these studies have reported long-term follow up data. To better understand the long-term morbidity that is associated with migraines, we performed a systematic evaluation to study the link between migraine and risk of cardiovascular and cerebrovascular events.

This study demonstrated that migraine is associated with an increased risk of major adverse cardiovascular and cerebrovascular events, which was driven by an increased long-term risk of myocardial infarction and stroke. This effect was predominantly observed in migraineurs who have aura.  Continue reading

Smartphone App Bests Clinical Assessment of Blood Flow

MedicalResearch.com Interview with:

Benjamin Hibbert MD PhD FRCPCz Interventional Cardiologist Clinician Scientist and Assistant Professor CAPITAL Research Group Vascular Biology and Experimental Medicine Laboratory University of Ottawa Heart Institute

Dr. Benjamin Hibbert

Benjamin Hibbert MD PhD FRCPCz
Interventional Cardiologist
Clinician Scientist and Assistant Professor
CAPITAL Research Group
Vascular Biology and Experimental Medicine Laboratory
University of Ottawa Heart Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When we designed the study in 2014 we were routinely using the modified allen’s test (MAT) to screen patients for transradial access for coronary angiography and PCI. We all had iPhones and we started using the HeartRate monitoring application as a photoplethysmograph. Quite quickly we found that using the application was simple, worked well and because we always had our iPhone with us we tended to use it more often. That being said – we wanted to test it in a scientifically rigorous method and thus we elected to perform an RCT to evaluate it’s diagnostic accuracy.

smart app measures blood flowThe current study is the first to use the photoplethysmographic capabilities of smartphones to assess blood flow – in this case in the hand to assess for blockages in arteries before accessing them for a procedure. The hand is supplied by two arteries – the radial artery and the ulnar artery. In many cases in medicine we use the radial artery, whether it be placing a catheter to monitor blood pressure, as a method of getting to the heart for angioplasty and in coronary artery bypass grafting it is removed and used as a bypass to restore blood flow to the heart. In many instances doctors assess the patency of the ulnar artery to decided if they are going to use the radial artery for a procedure – the concept being that if the ulnar is compromised and we use the radial then the hand can develop complications from not enough blood flow. To determine if a patient is eligible doctors would use a bedside physical exam test called the modified Allen’s test in which they occlude both arteries to cause the hand to turn white. They then release pressure on the ulnar letting blood only pass through this vessel to see if the hand turns pink. However, there is a lot of variability in what doctors consider to be abnormal and determining if the test is positive can depend on numerous factors including skin tone, the amount of pressure applied and the size of the vessels. Continue reading

More Heart Attacks In Younger Men Following Canadian Hockey Games

MedicalResearch.com Interview with:
“Wings Hawks Game 2-11” by Michael Kumm is licensed under CC BY 2.0

Hung Q. Ly, M.D., S.M., FRCPC

President, Canadian Association of Interventional Cardiology
Program Director, Adult Cardiology Postgraduate Training Program
Associate Professor of Clinical Medicine
Interventional Cardiology Division,
Dept. of Medicine, Montreal Heart Institute, Montréal, Québec, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prior scientific reports have discussed the association between major sporting events and cardiovascular events, irrespective of the sport.

Ours is the first to report an increase in hospital admission rates for heart attacks in men younger than 55yo in the day following a hockey game.

MedicalResearch.com: What should readers take away from your report?

Response:  Emotional stress and lifestyle habits/behavioural patterns surrounding the spectatorship of hockey (i.e. drinking, unhealthy eating patterns, etc.) might make some Hockey (sports) fans more susceptible to heart attacks. We report a statistically significant increase in the incidence of heart attacks in young men watching the sport. This was an association that we manage to document but not an actual causal relationship. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response:  (1) Ascertain causality: Document that the “watching/attending a hockey game” was indeed an activity that the patient presenting with a heart attack did indeed do; (2) randomize sports fan to lifestyle changes and/or stress management strategies to explore if there is a decrease in cardiovascular events around the time of a sporting event. 

MedicalResearch.com: Is there anything else you would like to add? 

Response:  (1) I am a hardcore, diehard (no pun intended) Montreal Canadiens fan, which motivated me to perform this analysis; (2) We accounted for the effect of harsh winter conditions as a potential confounder of the increase in hospital rate admission for heart attacks; (3) we were quite surprised that victory, instead of defeat, lead to an increase in events; (4)  I have to conflict of interest to declare.

Citations:

Caroline E. Gebhard, Catherine Gebhard, Foued Maafi, Marie-Jeanne Bertrand, Barbara E. Stähli, Karin Wildi, Zurine Galvan, Aurel Toma, Zheng W. Zhang, David Smith, Hung Q. Ly. Hockey Games and the Incidence of ST-Elevation Myocardial Infarction. Canadian Journal of Cardiology, 2018; DOI: 10.1016/j.cjca.2017.12.028

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Every Minute Counts! Short Bursts of Physical Activity Reduces Mortality

MedicalResearch.com Interview with:

Pedro F. Saint-Maurice, Ph.D. Postdoctoral Fellow Metabolic Epidemiology Branch Division of Cancer Epidemiology and Genetics National Cancer Institute, NIH, HHS Rockville, MD 20850

Dr. Saint-Maurice

Pedro F. Saint-Maurice, Ph.D.
Postdoctoral Fellow
Metabolic Epidemiology Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute, NIH, HHS
Rockville, MD 20850

MedicalResearch.com: What is the background for this study?

 Response: The 2008 Physical Activity Guidelines for Americans recommends adults do 150 minutes/week of moderate intensity physical activity (PA) in increments of at least 10 minutes at a time. However, there is limited epidemiologic evidence supporting the use of the 10-minute increment and whether shorter increments (for instance walking up the stairs) can also be beneficial for health in adults. We looked at accelerometer-measured physical activity in roughly 5,000 adults (40 and older) representative of the US population and followed them prospectively (over 7 years) to determine whether physical activity accumulated in 10-minute increments, but also accumulated in shorter bursts, were associated with lower risk of death (mortality data came from the National Death Index). Continue reading

Bone Density Scans Can Also Assess Abdominal Aortic Calcification and Cardiovascular Risk

MedicalResearch.com Interview with:

Dr. Joshua Lewis, PhD National Health and Medical Research Council Career Development Fellow, Edith Cowan University, School of Medical and Health Sciences / Centre for Kidney Research Children’s Hospital Westmead Honorary Senior Research Fellow, Sydney Medical School, School of Public Health University of Sydney

Dr. Lewis

Dr. Joshua Lewis, PhD
National Health and Medical Research Council Career Development Fellow, Edith Cowan University, School of Medical and Health Sciences / Centre for Kidney Research
Children’s Hospital Westmead
Honorary Senior Research Fellow, Sydney Medical School, School of Public Health
University of Sydney 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Bone scans from bone density machines are widely used to predict future fracture risk. These scans can also be used to detect the presence and severity of abdominal aortic calcification (AAC), which is a marker of advanced atherosclerosis.

We examined bone scans of over one thousand Australian women that were taken in the late 1990s using a method developed many years ago by one of the authors Dr. Kiel from the Institute for Aging Research at Hebrew SeniorLife and Harvard Medical School, and validated on scans from bone density machines by the joint first author Dr. Schousboe from the University of Minnesota. More than 2/3rd of these women had detectable AAC and women with more advanced calcification had increased likelihood of long-term cardiovascular hospitalizations and deaths as well as deaths from any cause. These finding remained significant even after adjusting for conventional cardiovascular risk factors.

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