Opioid Crisis Linked To Rapid Increase in Chronically Infected Heart Valves

MedicalResearch.com Interview with:

Serena Day, MDOhio State University.

Dr. Serena Day

Serena Day, MD
Ohio State University 

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

Response: The idea for this research came from my own observations of patients that I was caring for in the hospital first as an Internal Medicine Resident and now as a senior Cardiology Fellow. I did my residency here at Ohio State and noticed a marked increase in the number of patients with endocarditis that we were caring for just in my short time here as a trainee.

Over 5 years, we saw an increase of 436% in intravenous drug use related endocarditis. How this disease is treated as changed as well. It used to be that if a patient was a good surgical candidate, we would offer a replacement valve. Now, we see that these patient’s have such a high rate of recurrent intravenous drug use and reinfection of their heart valves that we now treat with antibiotics only rather than surgery. In many cases, the infection never goes away because we can’t offer definitive therapy with surgery due to their high relapse and reinfection rates of nearly 50%.
Continue reading

Home Treatment of Patients with Low-Risk Pulmonary Embolism

MedicalResearch.com Interview with:
Stavros V. Konstantinides, MD, PhD, FESC, FRCP(Glasg)

Professor, Clinical Trials, and Medical Director
Center for Thrombosis and Hemostasis (CTH)
Johannes Gutenberg University Mainz
Mainz, Germany

Stavros V. Konstantinides, MD, PhD, FESC, FRCP(Glasg)Professor, Clinical Trials, and Medical DirectorCenter for Thrombosis and Hemostasis (CTH)Johannes Gutenberg University MainzMainz, Germany

Dr. Konstantinides

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

Response: Acute pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. It encompasses a wide spectrum of clinical symptoms and severity, ranging from massive, immediately life-threatening PE with hemodynamic collapse to the low-risk, stable patient with very few symptoms. These latter patients with acute low-risk PE may qualify for early discharge from hospital (e.g., within 48 hours) and continuation of treatment at home. This is a very promising strategy, because it may not only increase patient satisfaction and quality of life, but also help to reduce hospital-related complications and costs. However, it needed to be clearly determined, and tested in a prospective management trial, who are the appropriate candidates for an effective and safe home treatment approach. To this date, trials suggesting favorable clinical outcomes with home treatment of PE are small and date back to the era of vitamin K antagonists. Direct oral anticoagulants permitting a single drug treatment of PE are more promising in this regard, as they may make an early transition from hospital to ambulatory care both safer and more convenient.

The international Home Treatment of Pulmonary Embolism (HoT-PE) phase 4 management trial tested the efficacy and safety of early discharge and ambulatory anticoagulation treatment with the direct factor Xa inhibitor rivaroxaban in patients with acute low-risk PE. Patients were identified on the basis of

  • clinical criteria or PE severity, comorbidity, and contraindications; and
  • the absence of right heart failure or intracardiac thrombi on cardiac imaging. Early termination of the study was possible following the prespecified interim analysis, which was performed after recruitment and 3-month evaluation of 525 patients (50% of the planned trial population). At the interim analysis, the primary efficacy outcome of symptomatic recurrent venous thromboembolism or PE-related death occurred in only 3 (0.6%) patients (compared to an estimated 1.7% rate based on historical data). This rate was sufficiently low to reject the primary hypothesis as predefined in the statistical analysis plan. None of the recurrent events was nonfatal.Major bleeding occurred in 6 (1.2%) patients of the safety population. The study could therefore be terminated early for efficacy. 

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Even with Controlled LDL-Cholesterol, PCI Stent Patients Have Residual Inflammatory Risk

MedicalResearch.com Interview with:

Dr. George Dangas MD PhDProfessor of Medicine, CardiologyMount Sinai Health System

Dr. Dangas

Dr. George Dangas MD PhD
Professor of Medicine, Cardiology
Mount Sinai Health System

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

Response: Widespread use of statins targeted to decrease levels of low density lipoprotein cholesterol (LDL-C) below 70mg/dL are recommended by guidelines. However, residual cholesterol risk may only be one part of the residual risk equation. Indeed, Biological inflammation has long been known as a pathophysiological mechanism of atherosclerosis and the recent CANTOS trial opened new therapeutic perspective by demonstrating that inflammation modulation via selective interleukin-1β inhibition could result in improved diagnosis in patients with coronary artery disease.

However, the prevalence and impact of a residual inflammatory biological syndrome in patients with controlled cholesterol risk is unclear. Continue reading

Do Elevated Troponins Always Indicate a Heart Attack?

MedicalResearch.com Interview with:

Prof. Nick Curzen  BM(Hons) PhD FRCPProfessor of Interventional Cardiology/Consultant CardiologistUniversity Hospital SouthamptonSouthampton

Prof. Curzen

Prof. Nick Curzen  BM(Hons) PhD FRCP
Professor of Interventional Cardiology/Consultant Cardiologist
University Hospital Southampton
Southampton

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

Response: The commonest blood test now used to assess whether a patient has had a heart attack or not is called high sensitivity troponin (hs trop).  The test is supplied with an Upper Limit of Normal, which is based upon results from relatively healthy people.  When doctors take the hs trop, they then use this ULN to decide if the patient had has a heart attack.

This study set out to see what the hs trop level is in a large number of patients attending the hospital for any reason, either inpatient or outpatient, in most of whom there was no clinical suspicion of heart attack at all.  We therefore took hs trop measurements on 20,000 consecutive patients attending our hospital and having a blood sample for any reason.  Continue reading

Genetic Evidence Suggests New LDL-C Lowering Drug May Decrease Cardiovascular Events and Have Additive Effect with Statins

MedicalResearch.com Interview with:

Brian A Ference, MD, MPhil, MSc, FACC, FESCProfessor and Director of Research in Translational TherapeuticsExecutive Director, Centre for Naturally Randomized TrialsStrangeways Research LaboratoryUniversity of CambridgeCambridge, UK

Dr. Ference

Brian A Ference, MD, MPhil, MSc, FACC, FESC
Professor and Director of Research in Translational Therapeutics
Executive Director, Centre for Naturally Randomized Trials
Strangeways Research Laboratory
University of Cambridge
Cambridge, UK

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

Response: Bempedoic acid is a novel therapy currently in development that lowers LDL-C by inhibiting ATP-citrate lyase, an enzyme in the same cholesterol biosynthesis pathway as HMG-CoA reductase (the target of stains).  However, whether lowering LDL-C by inhibiting ATP-citrate lyase will reduce the risk of cardiovascular events to the same extent as lowering LDL-C by inhibiting HMG-CoA reductase with a statin is unknown.

We conducted a “naturally randomized trial” using Mendelian randomization in more than 650,000 participants who experienced more than 100,000 cardiovascular events to evaluate the potential clinical benefit of lowering LDL-C by inhibiting ATP-citrate lyase as compared to lowering LDL-C by inhibiting HMG-CoA reductase.

Continue reading

Bempedoic Acid Lowers LDL When Statins Alone Aren’t Enough

MedicalResearch.com Interview with:

Prof. Kosh Ray, MB ChB, MD, MPhil Faculty of Medicine, School of Public HealthChair in Public Health (Clinical)Imperial College London

Dr. Ray

Prof. Kosh Ray, MB ChB, MD, MPhil
Faculty of Medicine, School of Public Health
Chair in Public Health (Clinical)
Imperial College London

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

Response: Bempedoic acid is the first in class of a new therapy for lowering LDL cholesterol. This is the largest and longest study to date with this therapy and involved about 2200 pts with patients with either established cardiovascular disease or familial hypercholestrolaemia and in whom LDL was > 70mg/dl or 1.8 mmol/L despite maximally tolerated statins. %0% were on high intensity statins and the majority of the rest on moderate intensity.

The aim was to show long term safety 1 year and efficacy at 24 weeks and at 1 year.  Continue reading

Short Naps May Aid in Blood Pressure Control

MedicalResearch.com Interview with:

Dr Manolis S Kallistratos MD, PhD, FESC,EHSAsklepeion General HospitalGreece

Dr. Kallistratos

Dr Manolis S Kallistratos MD, PhD, FESC,EHS
Asklepeion General Hospital
Greece 

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

Response: Lifestyle changes represent the cornerstone of treatment of arterial hypertension. Alcohol and salt reduction may decrease blood pressure levels by 2 to 8 mmHg.

In our study 60 minutes of midday sleep decrease 24 hours systolic blood pressure levels by up to 3 mmHg in well controlled hypertensives. That is an effect as potent as other well-established life style changes.

The magnitude of blood pressure decrease might seem small, but a drop in blood pressure as small as 2 mmHg can reduce the risk of cardiovascular events by up to 10 percent.  Continue reading

Many Patients Taking Warfarin Plus Aspirin Without Clear Indication

MedicalResearch.com Interview with:

Geoffrey Barnes, MD, MScAssistant ProfessorVascular and Cardiovascular MedicineUniversity of Michigan

Dr. Barnes

Geoffrey Barnes, MD, MSc
Assistant Professor
Vascular and Cardiovascular Medicine
University of Michigan

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

Response: Both aspirin and warfarin are commonly used medications meant to prevent thrombotic complications, but might increase rates of bleeding complications.

We used a multi-center anticoagulation collaborative to explore how often patients being treated with warfarin were also taking aspirin but without a clear indication. We found that more than one-third (37.5%) of warfarin-treated patients without a clear reason for aspirin therapy were receiving aspirin. And these patients on both warfarin and aspirin experienced higher rates of bleeding and emergency department visits for bleeding than the patients taking warfarin alone. There were no differences in the rate of thrombotic events between the patients taking warfarin alone or those taking warfarin plus aspirin.  Continue reading

African American Patients with Psoriasis at Even Greater Risk of Atherosclerotic Heart Disease

MedicalResearch.com Interview with:

Francis Alenghat, MD, PhD Assistant Professor of Medicine Section of Cardiology University of Chicago

Dr. Alenghat

Francis Alenghat, MD, PhD
Assistant Professor of Medicine
Section of Cardiology
University of Chicago

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

Response: Psoriasis has been associated with higher rates of atherosclerotic cardiovascular disease (ASCVD), potentially due to higher-than-normal levels of systemic inflammation. Whether this association varies by race was unknown. Also, it was unclear whether patients with psoriasis have more frequent ASCVD because of higher rates of traditional cardiovascular risk factors (smoking, diabetes, hypertension, hyperlipidemia) or because of components intrinsic to psoriasis itself.

We found that, amongst a large population of patients with psoriasis, patients of both sexes and most ages had elevated ASCVD rates compared to those without psoriasis. Overall, African American patients with psoriasis had a 15% ASCVD prevalence, whereas it was 10% in white patients with psoriasis. Increased ASCVD associated with psoriasis occurred at earlier ages in African American patients compared to white patients.

Traditional cardiovascular risk factors were common in patients with psoriasis and appeared to play a large role in the driving the higher rates of ASCVD in these patients, but even in patients with psoriasis but without any documented traditional risk factors, ASCVD rates were elevated compared to patients without psoriasis.  Continue reading

How Does a Stroke Affect Cognitive Function?

MedicalResearch.com Interview with:

Sarah Parish, MSc, DPhil Professor of Medical Statistics and Epidemiology MRC Population Health Research Unit Nuffield Department of Population Health University of Oxford

Dr. Parish

Sarah Parish, MSc, DPhil
Professor of Medical Statistics and Epidemiology
MRC Population Health Research Unit
Nuffield Department of Population Health
University of Oxford

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

Response: Acquiring reliable randomized evidence of the effects of cardiovascular interventions on cognitive decline is a priority. In this secondary analysis of 3 randomized intervention trials of cardiovascular event prevention, including 45 029 participants undergoing cognitive testing, we estimated the association of the avoidance of vascular events with differences in cognitive function in order to understand whether reports of non-significant results exclude worthwhile benefit.  Continue reading

Equation Predicts Bleeding Risk of Aspirin for Prevention of Cardiovascular Disease

MedicalResearch.com Interview with:

Dr Vanessa Selak, MBChB, MPH, PhD, FAFPHM, FNZCPHMSenior Lecturer, Section of Epidemiology & BiostatisticsSchool of Population Health, Faculty of Medical and Health SciencesUniversity of Auckland

Dr. Selak

Dr Vanessa Selak, MBChB, MPH, PhD, FAFPHM, FNZCPHM
Senior Lecturer, Section of Epidemiology & Biostatistics
School of Population Health
Faculty of Medical and Health Sciences
University of Auckland

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

Response: In order to determine the balance of benefits and harms of aspirin in primary prevention there’s a need to know an individual’s risk of CVD and their risk of a major bleed without aspirin.

We have lots of equations that can be used to determine, among people considering aspirin for primary prevention, an individual’s risk of CVD, but few bleeding risk equations that can be used to determine their risk of a major bleed.

We sought to develop a bleeding risk equation that can be used to determine the risk of a major bleed among people in whom aspirin is being considered for the primary prevention of CVD. Continue reading

Sleep is Good For Your Health, Including Your Heart!

MedicalResearch.com Interview with:

Cameron S. McAlpine, Ph.D. Banting Postdoctoral Fellow Center for Systems Biology Massachusetts General Hospital Harvard Medical School Boston, MA, 02114

Dr. McAlpine

Cameron S. McAlpine, Ph.D.
Banting Postdoctoral Fellow
Center for Systems Biology
Massachusetts General Hospital
Harvard Medical School
Boston, MA, 02114

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

Response: Cardiovascular disease is caused by the build up of white blood cells and fat in arteries. We have known for a long time that poor sleep is associated with an increased risk of developing cardiovascular disease. A number of human observational studies have found this correlation. However, the reasons for this correlation have been largely unknown.

Our study, performed in mice, provides one possible explanation. We found that when we disturbed the sleep of mice they produced more inflammatory white blood cells. These cells caused larger lesions in their arteries and more advanced cardiovascular disease.

We found that his phenomenon is controlled by a hormone produced in the brain that normally suppresses the production of white blood cells. When mice have their sleep disturbed this pathway breakdown causing the increased production of white blood cells.

Continue reading

Aortic Stenosis Staging Helps Predict TAVR Outcomes

MedicalResearch.com Interview with:
JOÃO L. CAVALCANTE, MD, FASE, FACC, FSCCT, FSCMR
Director, Cardiac MRI and Structural CT Labs
Director, Cardiovascular Imaging Research Core Lab
Minneapolis Heart Institute
Abbott Northwestern Hospital
Minneapolis, MN, 55407

MIHO FUKUI MD
Division of Cardiovascular Diseases, Department of Internal Medicine, Heart & Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota

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

Response: Recent study by Généreux et al (1), using the Placement of Aortic Transcatheter Valves (PARTNER) 2A and 2B data, provided the first framework of a staging system for severe aortic stenosis (AS) that quantifies the extent of structural and functional cardiac change associated with AS and importantly its association with 1-year mortality in patients receiving either surgical or transcatheter AVR (TAVR):

  • Stage 0: No other cardiac damage;
  • Stage 1: LV damage as defined by presence of LV hypertrophy, severe LV diastolic, or LV systolic dysfunction;
  • Stage 2: Left atrium or mitral valve damage or dysfunction;
  • Stage 3: Pulmonary artery vasculature or tricuspid valve damage or dysfunction; and
  • Stage 4: right ventricular damage.

Continue reading

Multiple Modifiable Risk Factors in Young Adults with Heart Attack

MedicalResearch.com Interview with:

Srikanth Yandrapalli, MD Chief Resident in Internal Medicine at New York Medical College at  Westchester Medical Center Program 

Dr. Yandrapalli

Srikanth Yandrapalli, MD
Chief Resident in Internal Medicine at New York Medical College at
Westchester Medical Center Program 

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

Response: Risk factors play an important role in the development of and progression of coronary heart disease, thus necessitating strategies to address the leading modifiable risk factors to reduce the burden of coronary heart disease. Data are lacking regarding therecent temporal trends in the prevalence of these risk factors during a first AMI in US young adults.

In our study, we report that among young adults in the US with a first acute myocardial infarction, the prevalence rates of major modifiable risk factors were very high with over 90% of patients having at least 1 such risk factor. Significant sex and racial disparities were observed. Sex differences in the rates of certain  risk factors were clearly evident with males having higher rates of smoking, dyslipidemia, and drug abuse, whereas females had higher rates metabolic risk factors like diabetes mellitus, hypertension, and obesity. Sex differences in the rates of certain risk factors narrowed with increasing age and over time. Blacks had higher rates of hypertension, obesity, and drug abuse, Whites had higher rates of smoking, Hispanics had higher rates of diabetes mellitus and patients of Asian/Pacific Islander race had higher rates of dyslipidemia. Prevalence rates progressively increased between 2005 and 2015 except for dyslipidemia for which a decreasing trend was noted more recently. Continue reading

Poor Fitness and Obesity in Early Life Linked to Greater Disability as Adult

MedicalResearch.com Interview with:

Pontus Henriksson | PhD and Registered Dietitian Postdoctoral Researcher | SFO-V Fellow Department of Biosciences and Nutrition Karolinska Institutet

Dr. Henriksson

Pontus Henriksson | PhD and Registered Dietitian
Postdoctoral Researcher | SFO-V Fellow
Department of Biosciences and Nutrition
Karolinska Institutet 

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

Response: In many countries, disability pensions are granted to working-aged persons who are likely to never work full-time again because of a chronic disease or injury diagnosed by a physician. In addition to serving as an important indicator of chronic disease, disability pensions are associated with high societal costs.

Hence, we examined whether cardiorespiratory fitness and obesity (two potentially modifiable factors) were associated with disability pension later in life.

Our main findings were that low physical fitness and/or obesity during adolescence, were strongly associated with disability pension later in life due to a wide range of diseases and causes.  Continue reading

Life in the Womb Can Program Future Heart Disease

MedicalResearch.com Interview with:

Professor Dino A. Giussani PhD ScD FRCOG Professor of Developmental Cardiovascular Physiology & Medicine Department of Physiology Development & Neuroscience University of Cambridge UK Director of Studies in Medicine College Lectureship in Medicine '1958' Gonville & Caius College

Prof. Giussani

Professor Dino A. Giussani PhD ScD FRCOG
Professor of Developmental Cardiovascular Physiology & Medicine
Department of Physiology Development & Neuroscience
University of Cambridge
Director of Studies in Medicine
College Lectureship in Medicine ‘1958’
Gonville & Caius College
UK

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

Response: Heart disease kills 1 in 3 people worldwide.  When we hear about heart disease, the first thing we think of is a gene-environent interaction.  That is to say, how our genes interact with traditional lifestyle factors, such as smoking, obesity and/or a sedentary lifestyle to promote an increased risk of cardiovascular disease.  However,  it has also become established that the gene-environment interaction early in life may be just as, if not more, important in ‘programming’ future heart health and heart disease. That is to say, how the quality of the intrauterine environment in which we develop may also shape our future heart risk.  Evidence from human sibling-pair studies suggests that these relationships are causal, that they occur independently of genotype and that they are significantly influenced by the quality of the intrauterine environment during pregnancy.  For instance, bariatric surgery to decrease the weight of obese women reduced the risk of obesity, insulin resistance and raised blood pressure in children born after surgery compared to those born before. Therefore, these studies highlight a disproportionate risk of disease in offspring born from the same mother but under different in utero conditions, providing strong evidence in humans that the environment experienced during this critical period of development directly influences long-term cardiovascular health.

One of the most common outcomes of complicated pregnancy in humans is chronic fetal hypoxia, as can occur during placental insufficiency or preeclampsia.

The main findings of our study show that prenatal hypoxia can programme future heart disease in the offspring and that maternal treatment with the antioxidant vitamin C can be protective (see paper attached). Continue reading

How Functional Are Frail Adults After Aortic Valve Replacement?

MedicalResearch.com Interview with:

Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center

Dr. Dae Hyun Kim

Dae Hyun Kim, MD, MPH, ScD
Assistant Professor of Medicine, Harvard Medical School
Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital
Division of Gerontology, Department of Medicine,
Beth Israel Deaconess Medical Center

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

Response: The number of older adults undergoing aortic valve replacement is increasing.  Since these patients are at high risk for complications and functional decline due to preexisting multimorbidity and frailty, the latest guideline (Otto et al. J Am Coll Cardiol 2017;69:1313–46) emphasizes shared decision-making based on patient-centered outcomes.  Despite this recommendation, we witness many decision-making processes are cardio-centric—mainly informed by expected benefit in terms of cardiac-specific measures.  Many patients are not adequately informed about what their daily life would be like after the procedure.

In this single-center prospective cohort study, we examined functional status trajectories via assessments of global functional status at 1, 3, 6, 9, and 12 months in 246 patients who underwent transcatheter and surgical aortic valve replacement.  We identified 5 clinically meaningful functional trajectories, ranging from high baseline function-early complete recovery to low baseline function-large and persistent decline.  We were able to predict most likely trajectory as well as best possible and worse possible trajectories using the preoperative frailty index.  Delirium and postoperative complications were also strongly associated with undesirable functional trajectories.  Continue reading

Waist to Height Ratio Linked to Cardiovascular Disease Risk in Men

MedicalResearch.com Interview with:

Vitor Engrácia Valenti Professor São Paulo State University Marília

Dr. Valenti

Vitor Engrácia Valenti, PhD
Professor
São Paulo State University Marília

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

Response: Autonomic modulation and cardiorespiratory variables are influenced by numerous factors. Abdominal fat tissue is a relevant variables related to metabolic and cardiovascular disorders, including diabetes mellitus, dyslipidemia and hypertension, which are associated to increased risk of morbidity and mortality.

We evaluated cardiorespiratory variables and autonomic nervous system before and during recovery from exercise in healthy physically active men divided according to with waist-stature ratio (WSR): G1 – between 0.40 and 0.449 (N = 19), and G2 – between 0.45 and 0.49. This metholodigcal procedure is able to provide important information regarding the risk for developing cardiovascular disease in the future.

Our main findings indicated that healthy physically active men with waist-stature ratio values close to the risk limit (between 0.449 and 0.5) presented slower return of autonomic and cardiorespiratory variables to baseline values after moderate exercise. It suggests that this group present an elevated probability of developing cardiovascular disease in the future compared to the groups with lower values of waist-stature ratio.

Continue reading

Validation of MEESSI Score for Acute Heart Failure Risk

MedicalResearch.com Interview with:
Desiree Nadine Wussler MD
Cardiovascular Research Institute
Universitätsspital Basel

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

Response: Acute heart failure is the most common cause of hospitalization in patients 50 years or older with more than 2 millions of hospitalizations annually in both Europe and the United States.

As most patients with  acute heart failure present to the emergency department, an early risk stratification is of crucial importance in order to decide whether to hospitalize a patient or even treat him in an intensive care unit setting.

Recently, the MEESSI Acute heart failure risk score was developed to predict 30-day mortality in patients presenting with acute heart failure to emergency departments in Spain.  However, it was unknown whether it also performs well in other countries. When externally validating the MEESSI-Score in unselected AHF patients treated in another European country, we report the following major findings.

  1. After stratifying patients into the original MEESSI-AHF Score risk groups, a pronounced difference in 30-day mortality was found.
  2. The MEESSI-Score showed excellent discrimination for every applied model.
  3. In patients assigned to low and intermediate risk of 30-day mortality, the MEESSI-score showed near ideal calibration.
  4. After recalibration there was also a high concordance of the predicted 30-day mortality according to the MEESSI Score and the observed mortality in patients stratified to high and very high-risk.

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

Response: The MEESSI Score seems to be a highly promising tool for stratifying patients presenting to the emergency department with acute heart failure according to their risk. However, recalibration may be needed when introducing the score to new populations. Furthermore, recalibration could also be important when outcome frequencies change due to novel therapies and consecutive improved outcomes. To the best of our knowledge, except for the MEESSI-Score there is no other heart failure risk score which could be adapted to changed outcome frequencies that easily. 

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

Response: In my opinion the next step would be a clinical trial. In such a study, patients should be either randomized to a control group in which risk stratification and the following further treatment are left to the discretion of the attending physician or to the intervention group in which patients are stratified into different risk groups according to their MEESSI Score. In this setting the clinical implications and additional application areas of the MEESSI Score could be further characterized. 

Citation:

Wussler D, Kozhuharov N, Sabti Z, Walter J, Strebel I, Scholl L, et al. External Validation of the MEESSI Acute Heart Failure Risk ScoreA Cohort Study. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-1967

 

Feb 1, 2019 @ 11:48 am

 

 

 

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Endurance Athletes May Have More Coronary Artery Calcification But No Greater Risk

MedicalResearch.com Interview with:

Laura DeFina, MD President and Chief Executive Officer Chief Science Officer The Cooper Institute 

Dr. DeFina

Laura DeFina, MD
President and Chief Executive Officer
Chief Science Officer
The Cooper Institute

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

Response: Several studies suggest that endurance athletes may be at higher risk for asymptomatic hardening of the coronary arteries.  These studies, however, have been done on small numbers of endurance athletes (ie – marathon runners) and do not show whether this increase in hardening actually leads to increase in heart attacks or death of cardiovascular disease.

In our population of 21,758 generally healthy individuals (average age 52 years) who presented for a preventive medicine examination, we were able to evaluate for the presence of hardening and cardiovascular events in individuals who exercised high volumes (≥3000 MET·minutes/week or comparable to running 6 miles/hour for an hour 5 days a week) versus those exercising less. Continue reading

Link Between Thyroid Function Genetics and Atrial Fibrillation Grows

MedicalResearch.com Interview with:

Joe-Elie Salem, MD, PhD Associate Professor - MCU-PH, Sorbonne Université - INSERM - CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology Clinical Pharmacology, Nashville, TN

Dr. Salem

Joe-Elie Salem, MD, PhD
Associate Professor – MCU-PH, Sorbonne Université – INSERM – CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France
Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology
Clinical Pharmacology, Nashville, TN

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

Response: A study by researchers at Vanderbilt University Medical Center has strengthened the link between thyroid function and atrial fibrillation (AF), an irregular heart rhythm that increases the risk of stroke and other heart-related complications.

They phenome-wide association study scanned the medical records of more than 37,000 people for an association between genetically determined variation in thyroid stimulating hormone levels (a measure of thyroid function) and AF risk.

Previous observational studies have found that subclinical hyperthyroidism, an overactive thyroid which does not meet the clinical threshold for diagnosis or treatment, nevertheless can increase the risk of atrial fibrillation.  But whether to treat subclinical hypo- or hyperthyroidism to reduce AF risk remains a matter of debate in the medical community.  Continue reading

ILARIS® (canakinumab) Not Cost Effective For Prevention of Cardiovascular Disease

MedicalResearch.com Interview with:

Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte

Dr. Sehested

Thomas S. G. Sehested MD
Department of Cardiology
Copenhagen University Hospital Gentofte

Jenny Bjerre, MD Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen, Denmark Department of Health Research and Policy Stanford University School of Medicine Stanford, California

Dr. Bjerre

 
Jenny Bjerre, MD
Department of Cardiology
Copenhagen University
Department of Health Research and Policy
Stanford University School of Medicine
Stanford, California
 

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

Response: n 2017, the results from the much-awaited Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial were published, confirming the inflammatory hypothesis, i.e. that targeting inflammation can reduce cardiovascular disease. The trial tested the monoclonal antibody canakinumab in a population of post-myocardial infarction patients with elevated inflammation markers (hs-CRP). Canakinumab is currently used for rare diseases and carries an orphan drug price: the 150mg dose used in CANTOS costs approximately $73,000 per year.

Due to the high prevalence of cardiovascular disease, millions of patients could potentially be eligible for treatment with this high-priced anti-inflammatory drug. Therefore, we wanted to investigate the cost-effectiveness for canakinumab for secondary prevention of cardiovascular disease, using the reported results from CANTOS.

Continue reading

Value of Postconditioning after Heart Attack May Be Seen only on Long Term Followup

MedicalResearch.com Interview with:

JAY H. Traverse, MD, FACC, FAHA Director of Research, Minneapolis Heart Institute Foundation Associate Professor of Medicine, Cardiovascular Division University of Minnesota School of Medicine

Dr. Traverse

JAY H. Traverse, MD, FACC, FAHA
Director of Research
Minneapolis Heart Institute Foundation
Associate Professor of Medicine
Cardiovascular Division
University of Minnesota School of Medicine

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

Response: Reperfusion injury may contribute a significant amount to final infarct size in setting of ST-elevation myocardial infarction (STEMI).

Several studies from Europe and Asia have suggested that modifying reperfusion with an angioplasty balloon of an occluded artery called postconditioning can reduce infarct size. However, not all studies show a benefit.

We hypothesized that patient selection of STEMI patients could contribute to these inconsistent findings so we performed the first postconditioning study in the US sponsored by the NIH using the strictest enrollment criteria of any study to minimize factors that influence infarct size (ischemic time, collaterals, pre-infarction angina, TIMI 0 flow) designed to maximize the benefit of postconditioning to see if it can actually reduce infarct size.

Continue reading

Less Than Six Hours of Sleep May Raise Risk of Heart Disease

MedicalResearch.com Interview with:

José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics            JM-USDA-HNRCA at Tufts University Boston, MA 02111

Dr. Ordovás

José M. Ordovás, PhD
Director Nutrition and Genomics
Professor Nutrition and Genetics
JM-USDA-HNRCA at Tufts University
Boston, MA 02111

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

Response: The current knowledge supports the notion that poor sleep is associated with cardiovascular risk factors such as obesity, hypertension, and diabetes. Besides, there is some proof that poor sleep might be related to the development of atherosclerosis; however, this evidence has been provided by studies including few participants and, in general, with sleep disorders, such as sleep apnea. Our research has used state-of-the-art imaging technology to measure plaque buildup in the arteries, and objective measures of sleep quantity and quality in about 4000 participants of the PESA CNIC- Santander Study. Moreover, this is the first study to look at the multiterritory development of plaques versus other studies that looked exclusively at the coronary arteries. Therefore, this combination provides stronger evidence than previous studies about the risk of poor sleep on the development of atherosclerosis.

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Blood Clots Linked to Oral Hormone Replacement for Menopause Symptoms

MedicalResearch.com Interview with:

Yana Vinogradova, PhD Research Fellow Department of Primary Care School of Medicine University of Nottingham University Park, Nottingham

Dr. Vinogradova

Yana Vinogradova, PhD
Research Fellow
Department of Primary Care
School of Medicine
University of Nottingham
University Park, Nottingham

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

Response: The study targeted middle age women going through menopause.  This is the stage of life when women naturally reach the end of their reproductive life and their hormones gradually decrease.  Some women experience unpleasant effects such as hot flushes, night sweats, mood swings, memory and concentration loss, headaches.  Quality of life may be severely affected.  Hormone replacement therapy uses a class of drugs, which, like all drugs, have side effects.   VTE is a serious side effect which can have a lethal outcome.

There are different preparations of hormones available for such women.  Some of them were extensively studied in a large American Trial Women’s Health Initiative and showed the risk of VTE to be twice as high for women who took them.  However, these well-studied drugs are mostly prescribed in America.  The more popular drugs in Europe and the UK have been much less studied, so it was unclear how they compared.  Continue reading