Author Interviews, Depression, Heart Disease, JAMA / 27.02.2018

MedicalResearch.com Interview with: David Bekelman, MD, MPH  Associate Professor of Medicine and Nursing Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, CO University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many of the 5.8 million Americans with heart failure live with bothersome symptoms, reduced function and poor quality of life.  Improving their care is important because many people with heart failure live with these challenges for years.

This study evaluated the effect of a team intervention, Collaborative Care to Alleviate Symptoms and Adjust to Illness, also called CASA, on several aspects of quality of life in 314 patients with heart failure.  The patients, who received care at diverse health systems in Colorado, were randomized to receive usual care or usual care supplemented with the CASA intervention, which included a nurse and a social worker who collaborated with a primary care provider, cardiologist, and palliative care physician to address the patients’ needs.

The study found that the CASA intervention did not influence the primary outcome of heart failure health status, yet did improve patients’ depression and fatigue.  CASA did not influence number of patient hospitalizations or mortality. (more…)

Author Interviews, End of Life Care, Heart Disease, JAMA, Technology / 27.02.2018

MedicalResearch.com Interview with: Larry A. Allen, MD, MHS Associate Professor, Medicine Associate Head for Clinical Affairs, Cardiology Medical Director, Advanced Heart Failure Aurora, CO 80045 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Deciding whether or not to get a left ventricular assist device (LVAD) is one of the most challenging medical decisions created by modern medicine. LVADs improve overall survival but also come with serious risks and lifestyle changes. Particularly for older patients with multiple medical problems, this is a complex choice. Our research group at the University of Colorado spent years systematically developing unbiased pamphlet and video decision aids for patients and caregivers. We also developed a clinician-directed decision support training for LVAD program staff. The DECIDE-LVAD trial studied the implementation and effectiveness of this decision support intervention with patients and their caregivers in 6 hospitals in the U.S. When compared to previously used education materials, the decision aids appeared to improve patients’ decision quality and lowered the total number of patients getting LVADs. (more…)
AHA Journals, Author Interviews, Heart Disease, Mediterranean Diet, Nutrition, Vegetarians, Weight Research / 26.02.2018

MedicalResearch.com Interview with: “Vegetarian dan dan noodles” by Andrea Nguyen is licensed under CC BY 2.0Francesco Sofi, MD PhD Department of Experimental and Clinical Medicine University of Florence, Florence, Italy; Clinical Nutrition Unit, Careggi University Hospital Don Carlo Gnocchi Foundation Italy, Onlus IRCCS Florence, Italy  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mediterranean and Vegetarian diets are two of the most beneficial dietary patterns for prevention of chronic degenerative diseases. No studies have been conducted in the same group of subjects, by comparing these two dietary profiles. Main results are that both diets have been found to be beneficial for cardiovascular prevention, in the same group of subjects at low risk of cardiovascular disease. In particular, vegetarian diet determined a reduction of total and LDL-cholesterol, whereas Mediterranean diet resulted in lower levels of triglycerides and some inflammatory parameters (more…)
Author Interviews, Emergency Care, Heart Disease, JAMA / 26.02.2018

MedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaDaniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, California  MedicalResearch.com: What is the background for this study? What are the main findings? Response: When people talk about medical error, they are usually referring to treatment error—giving the wrong medication, operating on the wrong side of the body, etc.  But many believe that diagnostic error—the failure to diagnose a condition when a patient seeks care—is at least as widespread and consequential a problem.  However, diagnostic errors are intrinsically difficult to measure, since one can rarely prove that a condition was present at the time it was not diagnosed. In this study, we introduce a novel method for measuring how often patients who come to the emergency room with symptoms of an imminent cardiovascular emergency such as acute myocardial infarction (heart attack) are discharged home without a diagnosis. We find that among Medicare patients whose ER visits were attributable to symptoms of an imminent infarction, only about 2.3% were discharged home, and that the figure was under 5% for each of the other four conditions we studied.    However, we also found that these relatively low rates did not improve between 2007 and 2014. (more…)
Author Interviews, Diabetes, Heart Disease, JACC, Surgical Research / 21.02.2018

MedicalResearch.com Interview with: Dr. Jayan Nagendran MD, PhD, FRCSC Director of Research, Division of Cardiac Surgery Associate Professor, Department of Surgery Division of Cardiac Surgery University of Alberta MedicalResearch.com: What is the background for this study? Response: The primary modalities of treatment of symptomatic coronary artery disease (coronary heart disease) are either percutaneous coronary intervention (coronary stunting) or coronary artery bypass grafting surgery. There are well designed clinical trials that guide clinical practice for the treatment of patients with diabetes requiring coronary revascularization and there are trials that examine the best modality of coronary revascularization in patients with left ventricular dysfunction. However, there is a lack of evidence for patients with both diabetes and left ventricular dysfunction. As such, we performed a propensity matched study of patients with diabetes and left ventricular dysfunction undergoing either percutaneous coronary intervention compared to coronary artery bypass grafting surgery. We used our provincial database that captures >100,000 patients undergoing coronary angiography to attain our two cohorts for comparison. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 16.02.2018

“Doctors” by Tele Jane is licensed under CC BY 2.0MedicalResearch.com Interview with: Dr. Apostolos Tsimploulis, Chief Medical Resident Dr. Phillip H. Lam, Chief Cardiology Fellow The Washington, DC Veterans Affairs Medical Center, Georgetown University, and MedStar Washington Hospital Center, Washington, DC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hypertension is a major risk factor for the development of new heart failure (HF). Findings from multiple randomized controlled trials in hypertension have consistently demonstrated that controlling systolic blood pressure (SBP) to normal levels such as to SBP <120 mm Hg reduces the risk of developing new HF. However, interestingly, once patients develop heart failure, those with a normal SBP value such as SBP <120 mm Hg tend to have poor outcomes. This paradoxical association – also called reverse epidemiology – although poorly understood – has been described with other HF risk factors such as smoking and obesity. Regarding poor outcomes associated with lower SBP in HF patients with reduced ejection fraction (HFrEF – pronounced Hef-ref), it has been suggested that it may be a marker of weak heart muscle that is unable to pump enough blood. However, less is known about this association in patients with HF and preserved ejection fraction (HFpEF – pronounced Hef-pef) –– the heart muscle is not weak in the traditional sense. This is an important question for a number of reasons: nearly half of all heart failure patients have HFpEF which accounts for about 2.5 to 3 million Americans. These patients have a high mortality similar to those with HFrEF – but unlike in HFrEF few drugs have been shown to improve their outcomes. Thus, there is a great deal of interest in improving their outcomes. One of those approaches is to control . systolic blood pressure and the 2017 ACC/AHA/HFSA Focused Update of the HF guidelines recommend that SBP “should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity.” Thus, our study was designed to answer that simple question: do patients with HFpEF and SBP <120 mmHg, which is considered to be normal SBP, have better outcomes than those with SBP ≥120 mmHg. Using a sophisticated approach called propensity score matching we assembled two groups of patients with HFpEF – one group with SBP <120 mmHg and the other groups had SBP ≥120 mmHg – and patients in both groups were similar in terms of 58 key baseline characteristics. In this population of balanced patients with HFpEF, those with a normal systolic blood pressure had a higher risk of mortality – starting 30 days post-discharge up to about 6 years. Finding from our restricted cubic spline plots suggest that compared with SBP <120 mm Hg, SBP values ≥120 mm Hg (up to 200 mm Hg) was not associated with a higher risk of death. (more…)
Author Interviews, Heart Disease, JACC, Stroke / 13.02.2018

MedicalResearch.com Interview with: João Pedro Ferreira, MD, PhD & Faiez Zannad, MD, PhD National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative–Cardiovascular and Renal Clinical Trialists, Nancy, France Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is uncertain whether patients with a myocardial infarction with systolic dysfunction but without atrial fibrillation have increased risk for stroke. In this study including >22,000 patients and 600 stroke events we found a subgroup of patients at high risk for stroke despite not having atrial fibrillation. These patients are older, have worse renal function, frank signs of pulmonary congestion, hypertension and previous stroke history. We created a simple and “ready to use” score that allows the identification of these patients in routine clinical practice.  (more…)
Author Interviews, Environmental Risks, Heart Disease, JACC / 06.02.2018

MedicalResearch.com Interview with: “Siren” by Michael Pereckas is licensed under CC BY 2.0Professor Dr. med. Thomas Muenzel Universitätsmedizin Mainz Zentrum für Kardiologie, Kardiologie I MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this review is that people more and more acknowledge that noise is not just annoying the people as reported for many years, evidence is growing that chronic noise can cause cardiovascular disease including metabolic disease such as diabetes type II and mental disease such as depression and anxiety disorders and noise impairs as well the cognitive development of children. More recent studies also provided some insight into the mechanisms underlying noise-induced vascular damage. Noise interrupts communication or sleep and thus is causing annoyance. If this occurs chronically the people develop stress characterized by increased stress hormone levels. If this persists for a long time people develop cardiovascular risk factors on tis own such as diabetes, hypercholesterolemia, one measures an increase of the blood to coagulate and the blood pressure will increase. To this end people will develop cardiovascular disease including coronary artery disease, arterial hypertension, stroke, heart failure an arrhythmia such as atrial fibrillation. So, there is no doubt that noise makes us sick ! (more…)
Author Interviews, BMJ, Heart Disease, Pain Research, Stroke / 01.02.2018

MedicalResearch.com Interview with: “Headache.” by Avenue G is licensed under CC BY 2.0Kasper Adelborg, MD, PhD Postdoctoral Fellow Department of Clinical Epidemiology Aarhus University Hospital  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Around one billion people worldwide are affected by migraine. Migraine has considerable impact on quality of life and imposes a substantial burden on society. Migraine is primarily a headache disorder, but previous studies have suggested a link between migraine and stroke and myocardial infarction, particularly among women, while the link between migraine and other heart problems are less well known. In this large register-based Danish study published in the BMJ, we confirmed that migraine is associated with increased risks of stroke and myocardial infarction, but we also found that migraine was associated with increased risks of other cardiovascular diseases (specifically, venous thromboembolism and atrial fibrillation). Migraine was not associated with increased risks of heart failure or peripheral artery disease. In contrast to most previous studies, our study had a very large sample size and an age- and sex- matched comparison cohort from the general population, which allowed us to put migraine in a population context and to perform several subgroup analyses. Here, we found several interesting findings.
  • In general, the associations were strongest in the first year after diagnosis but persisted in the long term (up to 19 years after diagnosis).
  • Most associations applied to both migraine patients with aura (warning signs before a migraine, such as seeing flashing lights) and in those without aura, and in both women and in men. 
(more…)
Annals Internal Medicine, Author Interviews, Cannabis, Heart Disease / 24.01.2018

MedicalResearch.com Interview with: Divya Ravi, MD, MPH The Wright Center for Graduate Medical Education Scranton, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is evidence to suggest that Marijuana can bring about changes at the tissue level and has the ability to potentiate vascular disease, in ways similar to tobacco.  With change in legalization and increase usage trends, we conducted this review to examine the known effects of marijuana on cardiovascular outcomes and risk factors, given that cardiovascular disease remains the greatest cause of morbidity and mortality worldwide. Our review found insufficient evidence to draw meaningful conclusions that marijuana use is associated with cardiovascular risk factors and outcomes. The few studies that suggested a possible benefit from marijuana use, were cross-sectional, and were contradicted by more robust longitudinal studies that reported potential harmful effects. (more…)
Author Interviews, CT Scanning, Heart Disease, Technology / 23.01.2018

MedicalResearch.com Interview with: Cardiologist Mark Rabbat, MD, FSCCT Who pioneered the use of FFRct at Loyola Medicine and was first author of an international expert panel of leading cardiologists and radiologists from centers in the United States, Canada, Denmark, Italy, Belgium and the Netherlands on how to interpret and report the tests published in the Journal of Cardiovascular Computed Tomography.   MedicalResearch.com: What is the scope of the problem? Response: Coronary artery disease is a very large healthcare burden. Over sixteen million individuals in the United States have coronary artery disease.  Coronary artery disease may result in your heart not getting enough blood and increases your risk of a heart attack. Historically, we have been faced with either using tests we knew were not always accurate or putting a patient through an invasive angiogram just to determine whether they would need another invasive procedure to restore blood flow.  The CT-derived fractional flow reserve (FFRct) analysis is the first technology that bridges the gap between the non-invasive and invasive tests within one platform.  Any patient with symptoms such as chest pain, chest tightness, fatigue, or shortness of breath without known coronary artery disease may be a candidate for the FFRct study.  (more…)
Author Interviews, Biomarkers, Heart Disease, JACC / 16.01.2018

MedicalResearch.com Interview with: Nick West MA MD FRCP FESC FACC Chief Medical Officer PlaqueTec Ltd MedicalResearch.com: What is the background for the Liquid Biopsy System and this study? Response: Despite huge advances in the diagnosis and treatment of coronary artery disease, this form of cardiovascular disease remains as the world’s number one cause of death. Although interventions such as coronary angioplasty and cholesterol lowering with statins have improved morbidity, patients still experience high rates of recurrent cardiovascular events. Various technologies have been applied to predict future patient events with limited success, such as ‘virtual histology’ intravascular ultrasound (VH-IVUS) in the PROSPECT study (Stone GW et al. N Engl J Med 2011; 364: 226-235). Many experts acknowledge that imaging alone may be insufficient to gauge risk, and that the utility of a more biological endpoint may be more appropriate. This supposition is supported by recent data that added endothelial shear stress estimation to the PROSPECT data and significantly improved subsequent event prediction (Stone PH et al. JACC Cardiovascular Imaging 2017; Sep 18 epub ahead of print). Coronary artery disease has long been recognised to be underpinned by an inflammatory pathogenesis, and it is bioactive molecules (growth factors, cytokines etc) within the vasculature that affect plaque growth, transformation and vulnerability to rupture, resulting in myocardial infarction. Measuring these biomolecules in situ is challenging owing to an inability to reliably sample from the ‘boundary layer’ – a slower-moving circumferential stratum of blood adjacent to the endothelial surface that does not mix with the general bulk flow. The PlaqueTec Liquid Biopsy System™ (LBS) was designed specifically to sample from the boundary layer at four sites simultaneously within the coronary artery, where biomolecules released from plaques are likely to be most concentrated. With the LBS, we can also detect small gradients of released molecules by simultaneously collecting blood both upstream and downstream of individual plaques. The LBS has demonstrated safety and feasibility in preclinical and preliminary clinical studies, and was awarded a CE mark in Europe as a dedicated coronary blood sampling device in 2014. (more…)
Annals Internal Medicine, Author Interviews, Heart Disease, Lipids / 14.01.2018

MedicalResearch.com Interview with: Børge G. Nordestgaard, MD, DMSc Department of Clinical Biochemistry Herlev and Gentofte Hospital, Copenhagen University Hospital Herlev, Denmark MedicalResearch.com: What is the background for this study? Response: Five major organizations recently published guidelines for using statins to prevent atherosclerotic cardiovascular disease  -- the American College of Cardiology/American Heart Association (ACC/AHA) in 2013, the United Kingdom’s National Institute for Health and Care Excellence (NICE) in 2014, and in 2016 the Canadian Cardiovascular Society (CCS), the US Preventive Services Task Force (USPSTF), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). We applied these five guidelines to a contemporary study cohort of 45,750 40-75 year olds from the Copenhagen General Population Study. (more…)
Author Interviews, Blood Pressure - Hypertension, Exercise - Fitness, Heart Disease / 08.01.2018

MedicalResearch.com Interview with: “Sauna • 10 Ellen Street” by Tracey Appleton is licensed under CC BY 2.0Prof. Jari A. Laukkanen MD, PhD Cardiologist, Department of Medicine Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio, Finland MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have shown that sauna bathing is associated with a variety of health benefits, based on a large population study. Using an experimental setting this time, the research group now investigated the physiological mechanisms through which the heat exposure of sauna may explain positive effects on cardiovascular system. (more…)
Author Interviews, Heart Disease, JACC, Pediatrics, Surgical Research, UCSD / 04.01.2018

MedicalResearch.com Interview with: Rakesh K. Singh MD, MS Department of Pediatrics, University of California–San Diego and Rady Children’s Hospital San Diego, California Steven E. Lipshultz MD Department of Pediatrics Wayne State University School of Medicine and Children’s Hospital of Michigan Detroit, Michigan  MedicalResearch.com: What is the background for this study? Response: Dilated cardiomyopathy (DCM) is a disease characterized by dilation and dysfunction of the left ventricle of the heart. While DCM is a relatively rare disease in children, nearly 40% of children with DCM require a heart transplant or die within 2 years of diagnosis. Heart transplantation has improved the outcomes of children with DCM over the last 3 decades, but is limited by donor heart availability. Newer therapies, including advanced ICU care and artificial heart machines, are now being used to treat children with DCM. This study published in the November 28, 2017 issue of the Journal of American College of Cardiology (JACC) sought to determine whether more children with DCM were surviving longer in the more recent era. Specifically, it investigated whether children with DCM were surviving longer without the need for heart transplantation. Rakesh Singh, MD is the first author and an Associate Professor of Pediatrics at UC San Diego/Rady Children’s Hospital, while the senior author is Steven Lipshultz, MD, Professor at Wayne State University School of Medicine/Detroit Medical Center’s Children’s Hospital of Michigan and Director of Children’s Research Center of Michigan. The Pediatric Cardiomyopathy Registry (PCMR) is a National Heart, Lung, and Blood Institute (NHLBI) sponsored registry from 98 pediatric centers in United States and Canada created to study the outcomes of children with various heart muscle disorders known as cardiomyopathies. For this study, outcomes of 1,199 children diagnosed with DCM from 1990-1999 were compared with 754 children diagnosed with DCM from 2000-2009. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 04.01.2018

MedicalResearch.com Interview with: Edward L. Hannan, PhD, MS, MS, FACC Distinguished Professor and Associate Dean Emeritus University at Albany School of Public Health Rensselaer, NY 12144     MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have done a lot of work on complete revascularization (CR) vs. incomplete revascularization (IR) already, and as a follow-up it seemed as if there may be different types of IR that are associated with even worse outcomes relative to CR and other IR. Incomplete revascularization is associated with worse outcomes if it involves multiple vessels, vessels with severe stenosis, or significant proximal left anterior descending artery vessel (PLAD) stenosis. (more…)
Author Interviews, Heart Disease / 19.12.2017

MedicalResearch.com Interview with: David A. Bluemke, MD PhD, MsB Professor, Radiology Editor in Chief (2018), Radiology University of Wisconsin-Madison, School of Medicine and Public Health Madison WI 53792  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Heart failure is expected to markedly increase in the United States, because of the aging population (https://www.ncbi.nlm.nih.gov/pubmed/23616602. For patients with congestive heart failure, NT-proBNP is an excellent marker of disease severity. The presence of elevated levels of NT-proBNP also predicts future cardiac events. For individuals who do not have clinically diagnosed heart failure, the significance of small elevations in NT-proBNP is not known. We hypothesized that these small elevations were related to subclinical elevations in myocardial wall stress. However, in patients with advanced heart disease, we do know that greater myocardial wall stress is associated with histological evidence of fibrosis --- i.e., replacement of myocardial muscle by greater fibrotic tissue. New techniques using MRI can find evidence of expansion of the space between myocytes (the extracellular volume). The most common cause of this expansion is diffuse myocardial fibrosis/ collagen deposition. Using MRI to detect myocardial fibrosis is an advance because MRI is non-invasive (we would not otherwise perform myocardial biopsy for patients without clinically evident disease). Thus we can use MRI to probe the actual composition of myocardial tissue. Using MRI, we found evidence that individuals in the community (in the MESA study) who had small elevations of NT-proBNP also have evidence of myocardial fibrosis.   The mean NT-proBNP levels in the MESA study (1,334 study subjects) was 65 pg/ml. That level is considered to be normal; levels of NT-proBNP of 1200 pg/ ml or greater are found in patients with congestive heart failure. Of note, the relationship between elevations of NT-proBNP and myocardial fibrosis were independent of multiple risk factors such as age, gender, smoking status, blood pressure, cholesterol levels and diabetes. That is, if the NT-proBNP level was slightly higher (for example, due to increased wall stress), then MRI found an association with greater myocardial fibrosis. (more…)
ADHD, Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, OBGYNE / 14.12.2017

MedicalResearch.com Interview with: Krista F. Huybrechts, MS PhD Assistant Professor of Medicine Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital Harvard Medical School Boston, MA 02120   MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years, use of stimulant medications in adults, including women of reproductive age, has increased substantially. However, data regarding the safety of stimulant medications in early pregnancy are sparse and conflicting.  For example, two recent cohort studies failed to detect an association between use of methylphenidate in early pregnancy and overall or cardiac malformations, while another found an 81% increased risk of cardiac malformations, although the estimate was imprecise. Given the rapidly increasing use of stimulant medications during pregnancy and among women of reproductive age who may become pregnant inadvertently, there is an urgent need to better understand their safety. (more…)
Author Interviews, Geriatrics, Heart Disease, Personalized Medicine, UCLA / 12.12.2017

MedicalResearch.com Interview with: Joseph A. Ladapo, MD, PhD Principal Substudy Investigator, PRESET Registry Subgroup Analysis, Elderly Patients Associate Professor, Division of General Internal Medicine and Health Services Research David Geffen School of Medicine University of California, Los Angeles MedicalResearch.com: What is the background for this study?  Response: The mapping of the Human Genome 14 years ago ushered in a new era of precision medicine. Many people are familiar with advances in oncology using precision medicine, but recently, new developments in precision medicine in cardiology have allowed us to develop a tool to differentiate patients likely to have obstructive coronary artery (CAD) from those who have non-cardiac causes of their symptoms. Diagnosing CAD in the elderly is challenging. Aging individuals often present with atypical symptoms of CAD which can complicate the evaluation process. The typical diagnostic pathway for possible CAD often starts with less invasive testing and progresses to invasive testing, especially in older patients. Invasive procedures pose greater risk in the elderly population than they do in younger patients because of the higher risk of side effects, including bleeding, vascular complications and kidney injury. Elderly adults evaluated for CAD have a higher pretest probability of CAD and are also at higher risk of experiencing procedure-related complications during their evaluation.[i],[ii] It is also important to note that elderly patients are often underrepresented in clinical trials and other types of comparative effectiveness research.[iii],[iv] For example, the 2013 American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease Risk Algorithm is only formally approved to be used in individuals up to the age of 75, despite the fact that individuals exceeding this threshold in age experience higher rates of adverse cardiovascular events.[v] All of this means that the elderly population may have the most to gain from timely and accurate determination of their currently likelihood of obstructive CAD. This precision medicine tool, the age, sex and gene expression score (ASGES), and its clinical utility in the elderly population is the focus of this study. It was based on patient data from the PRESET Registry, a prospective, multicenter, observational study enrolling stable, symptomatic outpatients from 21 U.S. primary care practices from August 2012 to August 2014. (more…)
Author Interviews, Fertility, Heart Disease, OBGYNE, Pediatrics / 30.11.2017

MedicalResearch.com Interview with: “2010 Nobel Prize in Medicine - development of the in vitro fertilization procedure” by Solis Invicti is licensed under CC BY 2.0Paolo Cavoretto MD PhD San Raffaele Scientific Centre Obstetrics and Gynaecology Department Milan Italy MedicalResearch.com: What is the background for this study? Response: Congenital heart defects (CHD) are the most common forms of congenital disorders and a relevant cause of perinatal morbidity and mortality involving about 0.8% of pregnancies. IVF pregnancies are very common nowadays with increasing rates in the developed countries worldwide. There is no consensus in current practice guidelines whether IVF/ICSI conception represents an indication for performing a fetal echocardiogram according to different eminent scientific societies due to differences in the estimations of the risk for CHD in the available literature. (more…)
Author Interviews, Heart Disease, Technology / 29.11.2017

MedicalResearch.com Interview with: Nenad Bursac PhD Professor of Biomedical Engineering Associate Professor of Medicine Duke University Durham, NC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Every year about 1 million new people in US suffers from heart attack, resulting in death of hundreds of millions of cardiac muscle cells. This massive cell loss leads to gradual deterioration of heart function, which for many patients results in the occurrence of heart failure that ultimately will require heart transplant. Heart transplantation is complicated and expensive procedure and donor hearts are in short supply, rendering this disease to be not only highly prevalent but ultimately lethal. For almost 30 years, researchers have been exploring transplantation of stem cells into injured hearts as a means to replace dead cardiac muscle with new muscle cells that would yield improved heart function. However, injections of stem cells in the heart have so far met with limited clinical success and surgical implantation of pre-made heart muscle tissue in a form of a "cardiac patch" has been explored as an alternative strategy with a proven benefit of enhancing transplanted cell survival. Others and we have engineered cardiac tissue patches in a dish starting from human pluripotent stem cells, which have advantage of being able to become bona fide contracting cardiac muscle cells. So far, however, no one has been able to engineer a highly functional cardiac muscle patch of a size that is large enough to be used in human therapies for heart disease. (more…)
Author Interviews, Heart Disease, Lipids, Sanofi / 29.11.2017

MedicalResearch.com Interview with: Dr. Jay Edelberg MD, PhD VP Head of CV Development and Head Global CV Medical Affairs Sanofi  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients with heterozygous familial hypercholesterolemia (HeFH) are often not able to achieve their target low-density lipoprotein cholesterol (LDL-C) levels, and some may require lipoprotein apheresis (LA) to lower their “bad cholesterol.” Apheresis is a procedure similar to kidney dialysis, where bad cholesterol is mechanically removed from the blood. It is an invasive, expensive, and time-consuming treatment for patients, as well as physicians. The Phase III ESCAPE clinical study looked at the potential effect of LA on total Praluent, free and total PCSK9 concentrations, as well as the combined pharmacodynamics effect of total Praluent on LDL-C-lowering. Praluent levels remained unaffected by apheresis, and Praluent consistently suppressed free PCSK9 levels in patients with HeFH, regardless of LA treatment. This analysis further confirms clinical ESCAPE data that Praluent can be used in conjunction with LA and may reduce or potentially eliminate the need for LA in some patients. (more…)
Author Interviews, Heart Disease, Pharmaceutical Companies / 28.11.2017

MedicalResearch.com Interview with: https://www.verseon.com/ Anirban Datta, PhD Director Discovery Biology Verseon Corporation MedicalResearch.com: What is the background for this study? Response: Today’s anticoagulant market is dominated by the NOACs. These oral anticoagulants require less constant monitoring and have reduced drug and food interactions compared to their predecessors, warfarin and heparin. However, there is still a significant bleeding risk associated with the NOACs. This is particularly problematic when they are co-dosed with antiplatelet drugs. While life-long therapy combining an oral anticoagulant with one or two antiplatelet drugs is desired for the many patients suffering from both non-valvular atrial fibrillation and coronary artery disease, current treatment guidelines limit such therapy to a maximum of six months to a year due to safety concerns. At Verseon, we are developing a novel class of precision anticoagulants that combine efficacy comparable to the NOACs with a significantly reduced bleeding risk in preclinical testing. We believe that this profile can have a positive impact on the lives of the many patients in need of long-term anticoagulation-antiplatelet combination therapy. We are currently advancing two development candidates toward clinical trials in 2018. VE-1902, our first development candidate, is scheduled to enter phase I in the first half of the year. (more…)
Aging, Author Interviews, Heart Disease, Lancet, Social Issues / 26.11.2017

MedicalResearch.com Interview with: Prof Kazem Rahimi FRCP The George Institute for Global Health Oxford Martin School University of Oxford, Oxford MedicalResearch.com: What is the background for this study? Response: We decided to investigate this topic because disease incidence data is very important for public health bodies; for example, for the allocation of healthcare resources or for the design and assessment of disease prevention measures. When we reviewed the literature, we found that estimates of heart failure incidence, temporal trends, and association by patient features were scarce. Studies often referred to restricted populations (such as relatively small cohorts that may or may not be representative of the general population), or limited data sources (for example, only including patients hospitalized for their heart failure and not considering those diagnosed by clinicians outside of hospitals). Few studies reported comparable, age-standardized rates, with the result that the rates reported varied considerably across the literature. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Personalized Medicine / 21.11.2017

MedicalResearch.com Interview with: Dr. MalikDr. Shaista Malik MD PhD MPH Director of Samueli Center For Integrative Medicine Assistant Professor, School of Medicine University of California, Irvine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Having diabetes has been considered to be a risk equivalent to already had a myocardial infarction for predicting future cardiovascular events.  We were interested in testing whether further risk stratification in those with diabetes and metabolic syndrome, using coronary artery calcium (CAC), would result in improved prediction of cardiovascular events. We found that CAC score was associated with incident coronary heart disease and cardiovascular disease more than a decade after the scoring was performed.  We also found that even after we controlled for the duration of diabetes (of 10 years or more), insulin use, or hemoglobin A1c level, coronary artery calcium remained a predictor of cardiovascular events. (more…)
Author Interviews, Heart Disease, JACC, Kidney Disease, Mayo Clinic / 21.11.2017

Interview with: Dr Xiaoxi Yao PhD Assistant Professor Researcher Mayo Clinic What is the background for this study? What are the main findings? Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin. The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Nutrition / 20.11.2017

MedicalResearch.com Interview with: “Nuts” by fdecomite is licensed under CC BY 2.0Marta Guasch-Ferre, PhD Research Fellow Department of Nutrition. Harvard TH Chan School of Public Health 655 Huntington Ave, Building 2 Boston, Ma, 02115  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although previous evidence has shown that frequent nut consumption is associated with reduced cardiovascular risk factors including dyslipidaemia, type 2 diabetes and metabolic syndrome; as well as with lower risk of coronary heart disease (CHD); most of the previous prospective studies have focused on total nut consumption in relation to the risk of CVD. However, the associations between peanut butter and specific types of nuts, such as peanuts and walnuts, with major cardiovascular events, and specifically the relation with stroke were unclear. Of note, because the nutritional composition of peanuts and walnuts differs from other nuts, it was of particular interest to evaluate the health effects of specific types of nuts. Therefore, our main aim was to look at several types of nuts including total nut consumption, peanuts, walnuts, and tree nuts. Briefly, in three large prospective cohorts with up to 32 years of follow-up, people who regularly eat nuts, including peanuts, walnuts and tree nuts, have a lower risk of developing cardiovascular disease or coronary heart disease compared to people who never or almost never eat nuts. We found a consistent inverse association between total nut consumption and total cardiovascular disease (14% lower risk for those consuming nuts five or more times per week) and coronary heart disease (20% lower risk). Also, after looking at individual nut consumption, eating walnuts one or more times per week was associated with a 19 percent lower risk of cardiovascular disease and 21 percent lower risk of coronary heart disease. Participants who ate peanuts or tree nuts two or more times per week had a 15 percent and 23 percent, respectively, lower risk of coronary heart disease compared to those who never consumed nuts. (more…)
Author Interviews, Heart Disease, Surgical Research, Weight Research / 16.11.2017

MedicalResearch.com Interview with: “Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Dr. Carlos Aurelio Schiavon Research Institute, Heart Hospital São Paulo, Brazil  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obesity and hypertension are highly prevalent diseases and when they are associated,  cardiovascular risk is almost double over patients with obesity alone. 60-70% of hypertension in adults may be attributable to adiposity. To address both problems, we designed the GATEWAY TRIAL to evaluate the efficacy of Gastric Bypass in the reduction of antihypertensive medications in obese patients using at least 2 medications at maximum doses. After 1 year, results were very consistent. 83.7 % of the patients submitted to Gastric Bypass reduced at least 30% of the total number of medications maintaining a controlled blood pressure (<140/90 mm Hg) and 51% remitted from hypertension, defined by controlled blood pressure without medications. When we evaluated the reduction of the medication maintaining the Systolic blood pressure below 120 mmHg (SPRINT TARGET), 22.4% of the patients showed remission of hypertension. (more…)
Author Interviews, Cost of Health Care, Emergency Care, Heart Disease, JAMA / 16.11.2017

MedicalResearch.com Interview with: David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 10 million patients present to emergency rooms in the US annually for evaluation of acute chest pain. The goal of that evaluation is to rule out the diagnosis of an acute heart attack. Imaging with coronary CT angiography and stress testing are not part of the diagnostic algorithm for acute heart attack.  Nevertheless many chest pain patients undergo some form of noninvasive cardiac testing in the ER. We found that CCTA or stress testing adding nothing to the care of chest pain patients beyond what is achieved by a history, physical examination, ECG and troponin test. (more…)