Patients Who Discharge From Hospital Against Medical Advice Have Double Rate of Readmission

MedicalResearch.com Interview with:

Professor Mamas Mamas (BM BCh, MA, DPhil, MRCP) Professor of Cardiology at Keele University and an Honorary Professor of Cardiology at the University of Manchester

Prof. Mamas

Professor Mamas Mamas (BM BCh, MA, DPhil, MRCP)
Professor of Cardiology at Keele University and an
Honorary Professor of Cardiology at the University of Manchester

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

Response: Discharge against medical advice occurs in 1 to 2% of all medical admissions but little / no data around how frequently this occurs in the context of PCI or the outcomes associated with such a course of action. We undertook this study to understand both how commonly discharge against medical advice occurs, the types of patients it occurs in and outcomes in terms of both readmission rates and causes of readmisison.   Continue reading

Study Finds No Link Between Dairy Fats and Heart Disease or Mortality

MedicalResearch.com Interview with:
“Milk” by Mike Mozart is licensed under CC BY 2.0Marcia C. de Oliveira Otto, PhD, FAHA
Assistant Professor
Division of Epidemiology, Human Genetics and Environmental Sciences
University of Texas
Houston, TX 77030-3900 |

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

Response: Our research adds to a growing body of evidence showing no harm in relation to heart disease or overall mortality associated with consumption of whole-fat dairy foods.

The findings also indicate that one of three fatty acids present in dairy fat was linked to lower risk of stroke among older adults. To the best of our knowledge, ours was the first large study to use repeated measures of fatty acids over time and evaluate association with mortality in older adults, which allowed us to expand and contribute to this important debate regarding fat intake and health.

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Asthma Linked to Increased Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

Aivaras Cepelis, MSci Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology Trondheim, Norway

Aivaras Cepelis

Aivaras Cepelis, MSci
Department of Public Health and Nursing, Faculty of Medicine and Health Science
NTNU, Norwegian University of Science and Technology
Trondheim, Norway

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

Response: Atrial fibrillation is the most common sustained, irregular and often rapid heart rate with a lifetime risk of 26%. The number of adults with atrial fibrillation is projected to double by 2050. Atrial fibrillation is also linked to adverse cardiovascular outcomes such as doubled risk of stroke and cardiovascular mortality. Therefore, we believe that research into the novel risk factors of the disease is highly warranted.

One of the potential condition that could play a role in the growing prevalence of atrial fibrillation is asthma. Asthma is a chronic inflammatory airway disease, affecting as many as 30 million children and adults in Europe. High levels of systemic inflammation biomarkers have been reported in both uncontrolled asthmatics and patients with atrial fibrillation. Furthermore, beta-agonists, the most common prescribed asthma control medication, has been shown to influence heart rate and increase the risk of irregular heartbeat.

However, research looking at asthma and atrial fibrillation link are lacking and no previous studies have assessed the dose-response relationship between levels of asthma control and atrial fibrillation. We utilized over 54 000 adults from a large well-defined Norwegian population cohort The Nord-Trøndelag Health Study (HUNT) to explore this association.

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Cardiovascular Risks of Hormone Therapy in Transgender Individuals

MedicalResearch.com Interview with:

Michael Goodman, MD, MPH Professor of Epidemiology Director, MD/MPH program Emory University School of Public Health Atlanta, GA  30322

Dr. Goodman

Michael Goodman, MD, MPH
Professor of Epidemiology
Director, MD/MPH program
Emory University School of Public Health
Atlanta, GA  30322

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

Response: There is a concern that hormone therapy may be associated with higher risk of certain cardiovascular problems such as heart attacks, stroke and formation of blood clots (“venous thromboembolism”).

To study this concern we examined data on 4,960 transgender and gender non-conforming people enrolled in Kaiser Permanente health systems in Georgia, Northern California, and Southern California. They were matched to 48,686 cisgender men and 48,775 cisgender women.  Below are the main findings

  • Rates of venous thromboembolism in all transwomen were approximately twice as high as the rates among cisgender men or cisgender women. The data for stroke and myocardial infarction demonstrated little difference between transwomen and cisgender men, but 80% to 90% higher rates among transwomen compared to cisgender women.
  • When the analyses focused specifically on transwomen who started therapy with female hormone estrogen at Kaiser Permanente, the incidence of both venous thromboembolism and stroke was more clearly elevated relative to either reference group.  There was evidence that incidence of both of these conditions among transwomen was particularly increased two to six years after estrogen initiation. By contrast, the association between estrogen therapy and myocardial infarction was less evident due to relatively few observed events.
  • Transmen did not appear to have significantly higher rates of venous thromboembolism, ischemic stroke, or myocardial infarction than their non-transgender counterparts, but this group was rather young and included a relatively small proportion of participants who initiated their hormone therapy during the study.

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Study Finds Direct Oral AntiCoagulants (DOACs) Safe in A Fib

MedicalResearch.com Interview with:

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

Dr. Vinogradova

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

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

Response: Anticoagulants are prescribed for treatment and prevention of thrombosis and stroke but may lead to major bleeding.  Unlike the older drug warfarin, newer direct oral anticoagulants do not require regular blood tests but their safety was shown only in selected patients and in trial conditions.

The study found that Direct Oral AntiCoagulants (DOACs) are safer than warfarin in terms of bleeding risks with apixaban being the safest. 

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Women With History of Preeclampsia or Gestational Hypertension Have Increased Risk of Cardiovascular Disease

MedicalResearch.com Interview with:

Jennifer J. Stuart, ScD Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology  Department of Epidemiology Harvard T.H. Chan School of Public Health  Division of Women's Health Brigham and Women's Hospital and Harvard Medical School

Dr. Stuart

Jennifer J. Stuart, ScD
Postdoctoral Research Fellow in Reproductive & Cardiovascular Epidemiology
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Division of Women’s Health
Brigham and Women’s Hospital and Harvard Medical School

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

Response: Preeclampsia and gestational hypertension are common pregnancy complications involving high blood pressure that develops for the first time during pregnancy and returns to normal after delivery. Approximately 10 to 15% of all women who have given birth have a history of either preeclampsia or gestational hypertension. Previous studies have shown that women with a history of high blood pressure in pregnancy are more likely to develop cardiovascular disease events like heart attack and stroke later in life when compared to women with normal blood pressure in pregnancy. However, what is less clear is to what extent these women are more likely to develop chronic hypertension, diabetes, and high cholesterol and when these risk factors begin to emerge after pregnancy.

We examined this question in a cohort of nearly 60,000 American women who we were able to follow for up to 50 years after their first pregnancy. Previous studies have been limited by small numbers, short follow-up, or a lack of information on shared risk factors, such as pre-pregnancy body mass index, smoking, and family history. This research was conducted within the Nurses’ Health Study II, which collected data on these pre-pregnancy factors in tens of thousands of women over several decades.

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Bad Genes and Unhealthy Lifestyle Contribute to Cardiovascular Risk

MedicalResearch.com Interview with:

Pim van der Harst MD, MSc Professor and Scientific Director Cardiac Catheterization Laboratory University Medical Center Groninger

Dr. van der Harst

Pim van der Harst MD, MSc
Professor and Scientific Director Cardiac Catheterization Laboratory
University Medical Center Groninger

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

Response: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. The disease is driven by both genetic (inherited) and lifestyle factors such as smoking, physical activity and body mass index (BMI).

However, little is known about the interplay between genetic and lifestyle factors. So we looked into how lifestyle influences risk in individuals with a low genetic risk compared to those with a high genetic risk.

 

MedicalResearch.com: What are the main findings?

Response: We studied 339,003 unrelated individuals participating in UK Biobank project and looked into 5 very important cardiovascular conditions: coronary artery disease, atrial fibrillation, stroke, hypertension and type 2 diabetes.

We then calculated the genetic risk of these individuals bases on the DNA information and assessed their lifestyle. We found that both genetics and an unhealthy lifestyle increased the risk of developing these conditions in an additive way.

Risk appears simply as a summation of bad genes and an unhealthy lifestyle, there is no multiplier effect. A healthy lifestyle is always beneficial, independent of the luck you had with your genes. However, we do see patterns suggesting that for some conditions the risk is approximately the same for those with good genes and poor lifestyle compared to those with poor genes and a poor lifestyle. Best is to have both, good genes and a healthy lifestyle. 

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

Response: No matter how good your genes are, a good lifestyle is always beneficial. However, if you have a high genetic risk you really should pay even more attention an adhering to a healthy lifestyle, otherwise they are in double trouble. Also our study is important as it lays a foundation for personalized risk assessment. 

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

Response: Now we can combine the personal genetics with a person’s lifestyle we should work towards personalized risk assessment and estimate the effect of lifestyle changes for an individual.

No disclosures

Citation: 

Associations of Combined Genetic and Lifestyle Risks With Incident Cardiovascular Disease and Diabetes in the UK Biobank Study – M. Abdullah Said, Niek Verweij, Pim van der Harst. JAMA Cardiology 2018 

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Safety Net and Smaller Hospitals Not Well Represented in Medicare’s Bundled Payment Program for Heart Disease

MedicalResearch.com Interview with:

Dan Blumenthal, MD, MBA Assistant in Medicine, Division of Cardiology Massachusetts General Hospital Instructor in Medicine Harvard Medical School

Dr. Blumenthal

Dan Blumenthal, MD, MBA
Assistant in Medicine, Division of Cardiology
Massachusetts General Hospital
Instructor in Medicine
Harvard Medical School 

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

Response: Despite dramatic advances in the treatment of cardiovascular disease (CVD) over the past half-century, CVD remains a leading cause of death and health care spending in the United States (US) and worldwide. More than 2000 Americans die of CVD each day, and more than $200 billion dollars is spent on the treatment of CVD each year in the US By 2030, over 40% of the US population is projected to have some form of CVD, at a cost of $1 trillion to the US economy.

The tremendous clinical and financial burden of cardiovascular illness has helped motivated policymakers to develop policy tools that have the potential to improve health care quality and curb spending.  Alternative payment models, and specifically bundled payments—lump sum payment for defined episodes of care which typically subsume an inpatient hospitalization and some amount of post-acute care—represent a promising tool for slowing health care spending and improving health care value.

Despite broad interest in implementing bundled payments to achieve these aims, our collective understanding of the effects of bundled payments on .cardiovascular disease care quality and spending, and the factors associated with success under this payment model, are limited.

Medicare’s Bundled Payments of Care Improvement (BPCI) is an ongoing voluntary, national pilot program evaluating bundled payments for 48 common conditions and procedures, including several common cardiovascular conditions and interventions.   In this study, we compared hospitals that voluntarily signed up for the four most commonly subscribed cardiac bundles—those for acute myocardial infarction, congestive heart failure, coronary artery bypass graft surgery, and percutaneous coronary intervention—with surrounding control hospitals in order to gain some insight into the factors driving participation, and to assess whether the hospitals participating in these bundles were broadly representative of a diverse set of U.S. acute care hospitals.  Continue reading

For Low Risk Patients, USPSTF Does Not Recommend Adding ECG Screening to Standard Risk Management Assessment

MedicalResearch.com Interview with:

Dr. Michael Barry MD Director of the Informed Medical Decisions Program Health Decision Sciences Center at Massachusetts General Hospital Physician at Massachusetts General Hospit Professor of Medicine,Harvard Medical School

Dr. Barry

Dr. Michael Barry MD
Director of the Informed Medical Decisions Program
Health Decision Sciences Center at Massachusetts General Hospital
Physician at Massachusetts General Hospit
Professor of Medicine,Harvard Medical School

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

Response: Cardiovascular disease (CVD), which can lead to heart attack and stroke, causes 1 in 3 deaths among adults in the United States. The Task Force reviewed the latest research on whether adding an electrocardiogram—or ECG, which is a test that records a person’s heart activity—to the standard ways we measure CVD risk can help prevent heart attack and stroke in people who do not have symptoms and are generally healthy, as well as people who are already at risk for these conditions.

The evidence shows that adding screening with ECG to the ways we already measure CVD risk is unlikely to help prevent heart attack or stroke in people at low risk. It can also cause harms—such as those from follow-on procedures like angiography and angioplasty, which can lead to heart attack, kidney failure, and even death. As a result, the Task Force recommends against screening with ECG for this group.

For those who might benefit the most—people who are already at medium or high risk of CVD—there is not enough evidence to say whether or not adding screening with an ECG to standard care helps prevent heart attack and stroke. This is an area where we need more research.  Continue reading

Enabling Angioplasty-Ready “Smart” Stents to Detect In-Stent Restenosis and Occlusion

MedicalResearch.com Interview with:

Kenichi Takahata, Ph.D., P.Eng. Associate Professor Department of Electrical & Computer Engineering Faculty of Applied Science University of British Columbia Vancouver, B.C., Canada

Dr. Takahata

Kenichi Takahata, Ph.D., P.Eng.
Associate Professor
Department of Electrical & Computer Engineering
Faculty of Applied Science
University of British Columbia
Vancouver, B.C., Canada

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

Response: Cardiovascular disease (CVD) is the number one cause of mortality globally. One of the most common and proven treatments for CVD is stenting. Millions of stents are implanted annually worldwide. However, the most common complication called in-stent restenosis, re-narrowing of stented arteries, still poses a significant risk to patients.

To address the current lack of diagnostic technology to detect restenosis at its early stage, we are developing “smart” stents equipped with microscale sensors and wireless interface to enable continuous monitoring of restenosis through the implanted stent. This electrically active stent functions as a radio-frequency wireless pressure transducer to track local hemodynamic changes upon a re-narrowing condition. We have reported a new smart stent that has been engineered to fulfill clinical needs for the implant, including its applicability to current stenting procedure and tools, while offering self-sensing and wireless communication functions upon implantation.

The stent here has been designed to function not only as a typical mechanical scaffold but also as an electrical inductor or antenna. To construct the device, the custom-designed implantable capacitive pressure sensor chip, which we developed using medical-grade stainless steel, are laser-microwelded on the inductive antenna stent, or “stentenna”, made of the same alloy. This forms a resonant circuit with the stentenna, whose resonant frequency represents the local blood pressure applied to the device and can be wirelessly interrogated using an external antenna placed on the skin.

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Bisexual Men Face Greater Risk of Heart Disease

MedicalResearch.com Interview with:

Billy A. Caceres, PhD, RN, AGPCNP-BC NYU Rory Meyers College of Nursing New York, NY 10010

Dr. Caceres

Billy A. Caceres, PhD, RN, AGPCNP-BC
NYU Rory Meyers College of Nursing
New York, NY 10010

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

Response: Although current evidence, primarily based on self-reported data, suggests gay and bisexual men report higher rates of cardiovascular risk factors (such as poor mental health and tobacco use) than heterosexual men, few studies have examined heart disease risk in this population. This study is one of the few studies to examine heart disease risk in gay and bisexual men using biological measures.

Using data from a nationally representative sample we identified higher rates of mental distress, obesity, hypertension, and diabetes among bisexual men compared to exclusively heterosexual men after adjusting for traditional risk factors (demographic characteristics, mental distress, and health behaviors). We also included men who identified as heterosexual but report a history of same-sex sexual behavior. Gay and heterosexual-identified men who have sex with men displayed similar risk profiles to exclusively heterosexual men.

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Individuals With Very High Levels of Lipoprotein(a) May Benefit Most From LDL(a)-Lowering Drugs

MedicalResearch.com Interview with:

Dr. Stephen Burgess PhD Programme Leader at the Medical Research Council Biostatistics Unit University of Cambridge

Dr. Burgess

Dr. Stephen Burgess PhD
Programme Leader at the Medical Research Council Biostatistics Unit
University of Cambridge

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

Response: Lipoprotein(a) is a lipoprotein subclass, and an important biomarker for coronary heart disease. As a clinical biomarker, it has a similar story to LDL-cholesterol (“bad” cholesterol), in that it is thought to be a causal risk factor for coronary heart disease, and so is a potential target for drug development. However, while drugs that lower LDL-cholesterol, such as statins, have been successful in reducing coronary heart disease risk, drugs that lower lipoprotein(a) have not as yet been successful. New drugs are currently in development that specifically target lipoprotein(a) and can lower lipoprotein(a) concentrations by 80-90%. We performed this study to investigate whether these drugs are likely to be successful in reducing coronary heart disease risk.

We compared individuals with naturally-occurring genetic variants that predispose them to a higher or lower lifetime concentration of lipoprotein(a) as a way of mimicking a randomized controlled trial. This approach has previously been undertaken for other biomarkers, including LDL-cholesterol. We found that having 10mg/dL lower genetically-predicted concentration of lipoprotein(a) was associated with a 5.8% reduction in coronary heart disease risk.

However, associations between genetically-predicted LDL-cholesterol and coronary heart disease risk are quantitatively much stronger than the proportional effect of LDL-cholesterol lowering on coronary heart disease risk as estimated by statin trials. This is because differences in genetic variants reflect lifelong changes in LDL-cholesterol, whereas statin trials only lower LDL-cholesterol for a few years. Hence, using the ratio between the genetic and trial estimates for LDL-cholesterol, we estimate that lowering lipoprotein(a) by 10mg/dL in a short-term clinical trial would only reduce coronary heart disease risk by 2.7%. To obtain the same reduction in coronary heart disease risk of around 20% as observed in statin trials, lipoprotein(a) would have to be lowered by around 100mg/dL. This explains why previous trials of less specific and less potent lipoprotein(a)-lowering drugs have failed to demonstrate benefit.

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Stress Echocardiography vs Coronary CT To Evaluate Chest Pain in ER

MedicalResearch.com Interview with:

Jeffrey M. Levsky, M.D., Ph.D. Associate Professor, Department of Radiology Associate Professor, Department of Medicine (Cardiology) Albert Einstein College of Medicine Montefiore Medical Center 

Dr. Levsky

Jeffrey M. Levsky, M.D., Ph.D.
Associate Professor, Department of Radiology
Associate Professor, Department of Medicine (Cardiology)
Albert Einstein College of Medicine
Montefiore Medical Center

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

Response: Millions of Americans are evaluated each year for acute chest pain in the Emergency Department.  There are multiple modalities that can be used to triage these patients and there have only been a few studies comparing different imaging methods.

We chose to study Stress Echocardiography and Coronary CT Angiography, two exams that have not been compared directly in this population.  We found that Stress Echocardiography was able to discharge a higher proportion of patients in a shorter amount of time as compared to Coronary CTA.  Continue reading

Some Young People With Sudden Cardiac Death Have Congenital Heart Defect

MedicalResearch.com Interview with:

Thomas Hadberg Lynge MD The Department of Cardiology The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark

Dr. Hadberg Lynge

Thomas Hadberg Lynge MD
The Department of Cardiology
The Heart Centre, Copenhagen University Hospital
Rigshospitalet, Denmark

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

Response: Congenital heart defects are common and affect ≈0.8% of all live births. Despite substantially improve survival over the past decades, morbidity and mortality remain significant, in particular among patients with complex congenital heart defects. This decreased life expectancy is in part explained by an increased risk of sudden cardiac death among people with congenital heart defects. However, the incidence of sudden cardiac death among people with congenital heart defects is largely unknown in an unselected and nationwide setting.
Sudden cardiac death can occur both at rest and during exercise and it is well-known that exercise is associated with an increased risk of sudden cardiac death during activity. Fear of sudden cardiac death has led to restrictions of physical activity among patients with congenital heart defects and these patients have lower levels of physical activity compared with healthy peers. Appropriate counseling of these patients requires estimates on risk of sudden cardiac death in relation to physical activity.

Nationwide fetal ultrasound screening was implemented in Denmark in 2005 and this together with improved surgical and medical treatment during the study period, is likely to have changed the epidemiology of sudden cardiac death in people with congenital heart defects. It was therefore also an important aim of the study to examine temporal changes in sudden cardiac death in people with congenital heart defects.

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Fewer Re-infarctions With hs Troponin To Assess Heart Attacks

MedicalResearch.com Interview with:

Martin J Holzmann MD, PhD

Dr. Holzmann

Martin J Holzmann MD, PhD
Functional Area of Emergency Medicine
Department of Internal Medicine,
Solna, Karolinska Institutet
Stockholm, Sweden

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

Response: We wanted to investigate how the introduction of the new high-sensitivity cardiac troponin T (hs-cTnT) assay affected incidence of myocardial infarction (MI) use of coronary angiography, cardiac revascularizations, and prognosis in patients with myocardial infarction.

We found that the incidence of MI increased by approximately 5%, with no change in mortality, but with an 11% reduced risk of reinfarctions, and a small increase in coronary angiographies, and cardiac revascularizations by 16%, and 13%, respectively.  Continue reading

Cardiovascular Risk and Gout Treatment: Febuxostat v. Allopurinol

MedicalResearch.com Interview with:
“Gout in my foot” by vagawi  is licensed under CC BY 2.0Seoyoung C. Kim, MD, ScD, MSCE
Associate Professor of Medicine
Division of Pharmacoepidemiology & Pharmacoeconomics
Division of Rheumatology, Immunology and Allergy
Brigham and Women’s Hospital, Harvard Medical School

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

Response: Since patients with gout are at an increased risk of cardiovascular events, we wanted to examine comparative cardiovascular safety of the two most commonly used urate-lowering drugs – febuxostat and allopurinol.

Using claims data from US Medicare, we conducted a cohort study of 24,936 febuxostat initiators PS-matched to 74,808 allopurinol initiators.

We found the risk of the primary cardiovascular endpoint (MI or stroke) was similar between the two groups. Analyses on secondary endpoints as well as all-cause mortality showed similar findings except that febuxostat was associated with a modestly reduced risk of heart failure exacerbation among patients with preexisting heart failure. In our sensitivity analysis, the risk of all-cause mortality associated with long-term use of febuxostat v. allopurinol appears to be increased but statistically not significant.

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Tobacco Flavorings On Their Own May Cause Heart Disease

MedicalResearch.com Interview with:
“fathers day” by James Simkins is licensed under CC BY 2.0Jessica L. Fetterman, PhD

Assistant Professor of Medicine
Boston University School of Medicine

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

Response: In our study, we studied endothelial cells, the cells that line the inside of the blood vessels. We collected endothelial cells from smokers both who use menthol and non-menthol cigarettes are impaired compared to non-smokers and we could make the non-smoker cells look like the endothelial cells of smokers by treating with menthol or eugenol (provides a clove spice-flavoring).

To test a wider variety of commonly used flavoring additives, we treated cultured (outside of the body in a dish) endothelial cells with some of the most commonly used flavoring additives in tobacco products and at different concentrations/doses. We then evaluated the effects of flavoring additives by looking at measures of cell death, oxidative stress, inflammation, and the ability of the cells to produce nitric oxide, a cardio-protective chemical made by endothelial cells that is lost when the cells become damaged.

We found that the flavoring additives used in tobacco products like e-cigarettes are toxic to the cells that line the blood vessels (endothelial cells). Our works suggests that the flavoring additives used in tobacco products may be harmful to the cardiovascular system.

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Statins Underused in Veterans with Severely Elevated Cholesterol

MedicalResearch.com Interview with:

Fatima Rodriguez, MD, MPH Division of Cardiovascular Medicine Stanford University Stanford, CA 94305-5406,

Dr. Rodriguez

Fatima Rodriguez, MD, MPH
Division of Cardiovascular Medicine
Stanford University
Stanford, CA 94305-5406,

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

Response: Individuals with LDL-cholesterol levels above 190mg/dL are often underdiagnosed and undertreated, yet remain at high-risk of cardiovascular disease. In a national sample of veterans, we identified over 60,000 patients who met criteria for uncontrolled, severe hypercholesterolemia based on an index LDL-C value ≥190mg/dL. We found that only half of these high-risk patients are being treated with statins, and less than 10% are on high-intensity statin therapy as recommended by the 2013 ACC/AHA guidelines. We also found that both older and younger patients were less likely to be treated with statins. Women were less likely to be treated with statins, whereas minority groups and those with a diagnosis of hypertension were more likely to be treated. Disparities in use of statins were also noted by geographic region and hospital teaching status. Continue reading

African Americans Less Likely To Be Treated With Statins

MedicalResearch.com Interview with:

Michael G. Nanna, MD Fellow, Division of Cardiology Duke University Medical Center Durham, NC

Dr. Nanna

Michael G. Nanna, MD
Fellow, Division of Cardiology
Duke University Medical Center
Durham, NC

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

Response: We know that African Americans are at higher risk for cardiovascular disease than white patients. We also know that African American individuals have been less likely to receive statin therapy compared to white individuals in the past. However, the reasons underlying these racial differences in statin treatment are poorly understood. We set out to determine if African American individuals in contemporary practice are treated less aggressively than whites and, if so, we wanted to investigate potential reasons why this might be the case.

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Children of Older Mothers More Susceptible to Heart Disease

MedicalResearch.com Interview with:

Sandra T. Davidge, PhD, FCAHS Executive Director, Women and Children's Health Research Institute Canada Research Chair in Maternal and Perinatal Cardiovascular Health Professor, Depts. of Ob/Gyn and Physiology University of Alberta Edmonton, Alberta Canada

Dr. Davidge

Sandra T. Davidge, PhD, FCAHS
Executive Director, Women and Children’s Health Research Institute
Canada Research Chair in Maternal and Perinatal Cardiovascular Health
Professor, Depts. of Ob/Gyn and Physiology
University of Alberta
Edmonton, Alberta
Canada

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

Response: This research contributes to the growing body of literature that developmental programming of adult onset cardiovascular disease originates in the womb.

Our study is among the first to discover that maternal age may be considered a ‘prenatal stress’ in certain circumstances.

Continue reading

Work Stress Associated With Increase Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

atrial-fibrillation

Atrial Fibrillation-
Wikipedia

Eleonor Fransson, PhD
Associate Professor in Epidemiology
Department of Natural Sciences and Biomedicine
School of Health and Welfare
JÖNKÖPING UNIVERSITY

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

Response: Atrial fibrillation is a very common heart rhythm disorder affecting a large number of people in the population, but there is limited knowledge about risk factors for the disease. This is especially true when it comes to the role of occupational factors.

MedicalResearch.com: What are the main findings?

Response: We found that work stress measured as job strain, that is, a combination of having high psychological job demands and low control over the work situation, was associated with almost 50% increased risk of atrial fibrillation. When we combined the results from our study with two previously published studies on the same topic, we found that work stress was associated with 37% increased risk.

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Benefits of Implementing 2017 Hypertension Guidelines Would Outweigh Side Effects

MedicalResearch.com Interview with:

Dr-Jiang He

Dr. Jiang He

Jiang He, MD, PhD
Joseph S. Copes Chair of Epidemiology, Professor
School of Public Health and Tropical Medicine
Tulane University

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

 

Response: The 2017 American College of Cardiology and American Heart Association hypertension guideline recommended lower blood pressure cut points for initiating antihypertensive medication and treatment goals than the previous hypertension guideline. We estimated the prevalence of hypertension and the proportion of the US adult population recommended for antihypertensive treatment according to the 2017 hypertension guideline. More importantly, we estimated the risk reductions of cardiovascular disease and all-cause mortality, as well as increases in adverse events, assuming the entire US adult population achieved the 2017 guideline-recommended systolic blood pressure treatment goals of less than 130 mmHg.

Our study indicated the prevalence of hypertension was 45.4%, representing 105 million US adults with hypertension, according to the 2017 hypertension guideline. In addition, the proportion of individuals recommended for antihypertensive treatment was 35.9% or 83 million US adults.

Based on data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and US population-based cohort studies, we estimated 610 thousand cardiovascular disease events and 334 thousand total deaths could be prevented annually in the US population if the 2017 hypertension guideline systolic blood pressure treatment goals were achieved in the entire US population.

Compared to full implementation of the previous hypertension guideline, we estimated the 2017 hypertension guideline recommendations would reduce an additional 340 thousand cardiovascular disease events and 156 thousand deaths per year in the US.

Implementing the 2017 hypertension guideline was estimated to increase 62 thousand hypotension, 32 thousand syncope, 31 thousand electrolyte abnormality, and 79 thousand acute kidney injury or kidney failure events.

These analyses indicated implementing the 2017 hypertension guideline would significantly increase the proportion of US adults recommended for antihypertensive treatment and further reduce cardiovascular disease events and all-cause mortality, but might increase the number of adverse events in the US population. Continue reading

Female Residents Do Not Perceive Cardiology As Conducive To Work-Family Balance

MedicalResearch.com Interview with:

Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine  Durham, NC 27715   

Dr. Douglas

Pamela S. Douglas, MD, MACC, FASE, FAHA
Ursula Geller Professor of Research in Cardiovascular Disease
Duke University School of Medicine
Durham, NC 27715    

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

Response: For any profession to succeed, it needs to attract top talent. We surveyed internal medicine residents to find out what they valued most in their professional development, how they perceived cardiology as field and how these two areas are associated with  their choosing a career in cardiology or another specialty.

We found that trainees were seeking careers that had stable hours, were family friendly and female friendly, while they perceived cardiology to  have adverse work conditions, interfere with family life and to not be diverse. We were able to predict career choice with 89-97% accuracy from these responses; the predictors are mix of things that attract to cardiology and those that are deterrents.

For men, the attractors outnumber the deterrents, for women its just the opposite.

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Obese Women Remain at Risk For Heart Disease, Even When Metabolically Healthy

MedicalResearch.com Interview with:
Nathalie Eckel, MSc

German Diabetes Center
Düsseldorf, Germany 

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

 Response: Obesity is associated with metabolic disorders such as diabetes, high blood pressure and hypercholesterolemia, and with a higher risk of cardiovacular disease compared to normal weight. However, there is also the phenomenon of the so-called “metabolically healthy obesity” and “metabolically unhealthy normal-weight”. So far it has been unclear how metabolic risk factors change over time in metabolically healthy people depending on body weight and what cardiovascular disease risk results from this.

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More Complications When Pacemaker Required After TAVR

MedicalResearch.com Interview with:

Harindra C. Wijeysundera MD PhD FRCPC FCCS FAHA Director of Research, Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre Senior Scientist, Sunnybrook Research Institute (SRI) Associate Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation, University of Toronto Adjunct Senior Scientist, Institute for Clinical Evaluative Sciences (ICES)

Dr. Wijeysundera

Harindra C. Wijeysundera MD PhD FRCPC FCCS FAHA
Director of Research, Division of Cardiology,
Schulich Heart Centre, Sunnybrook Health Sciences Centre
Senior Scientist, Sunnybrook Research Institute (SRI)
Associate Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation, University of Toronto
Adjunct Senior Scientist, Institute for Clinical Evaluative Sciences (ICES)
Toronto, ON, Canada

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

Response: One of the most common complications post TAVR is the need for a permanent pacemaker.  It is unclear if the need for a pacemaker is associated with long term adverse outcomes.

Using a population level registry of all TAVR procedures in ontario, canada, we found that pacemakers were required in ~15% of cases.  Requiring a pacemaker was associated with worse long term outcomes, including death, readmission to hospital and emergency room visits.  Continue reading