Author Interviews, Heart Disease, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: Sung-Han Yoon MD Clinical Trials, Cardiology, Developmental Biology Cedars-Sinai Medical Center, Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) has become the standard treatment in inoperable patients in high surgical risk patients with symptomatic severe aortic stenosis (AS). However, major randomized trials excluded congenital bicuspid AS due to its unique morphological features. The indication of TAVR is expanding into a younger population, in which the frequency of bicuspid AS is higher. Therefore, we will encounter TAVR for bicuspid AS more frequently. However, the experience of TAVR in bicuspid AS is limited to small series. Therefore, we aim to evaluate the clinical outcomes of TAVR in bicuspid AS and compare them to tricuspid AS.
Author Interviews, Heart Disease, Imperial College, Medical Imaging, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33035" align="alignleft" width="149"]Dr. Justin Davies PhD Senior Reserch Fellow and Hononary Consultant Cardiologist National Heart and Lung Institute, Imperial College Londo Dr. Davies[/caption] Dr. Justin Davies PhD Senior Reserch Fellow and Hononary Consultant Cardiologist National Heart and Lung Institute, Imperial College London MedicalResearch.com: What is the background for this study? Response: We know from the FAME study that compared to angiography alone, FFR guided revascularization improves long-term clinical outcomes for our patients. Despite this, adoption of FFR into everyday clinical practice remains stubbornly low. One major factor for this is the need for adenosine (or other potent vasodilator medications) in order to perform an FFR measurement. Adenosine is expensive, unpleasant for the patient, time consuming and even potentially harmful. iFR is a newer coronary physiology index that does not require adenosine for its measurement. In the prospective, multi center, blinded DEFINE FLAIR study, 2492 patients were randomly assigned to either FFR guided revascularisation or iFR guided revascularization and followed up for a period of 1 year.
Author Interviews, Cannabis, Heart Disease, Stroke / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33103" align="alignleft" width="140"]Aditi Kalla, MD Cardiology Research Fellow Einstein Medical Center, Philadelphia Dr. Aditi Kalla[/caption] Aditi Kalla, MD Cardiology Research Fellow Einstein Medical Center Philadelphia MedicalResearch.com: What is the background for this study? Response: As of the recent 2016 election, decriminalization of cannabis passed in several states bringing the total count up to 28 states and D.C. where cannabis is now legal for medicinal and/or recreational purposes. From a physician’s perspective, it is rare that a drug has “hit the market” so to speak without undergoing clinical trials to determine safety and efficacy. Hence, we sought out to study if cannabis had any effects (positive or negative) on the cardiovascular system.
Author Interviews, Environmental Risks, Heart Disease, Medical Imaging / 19.03.2017

[caption id="attachment_32906" align="alignleft" width="200"]MedicalResearch.com Interview with: Dr. Marco Valgimigli, Dr. Marco Valgimigli[/caption] MedicalResearch.com Interview with: Dr. Marco Valgimigli, MD, PhD Interventional Cardiology Sandro Pertini Hospital, ASL RM2, Rome, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: Every year millions of people with coronary artery disease are treated worldwide with percutaneous coronary intervention (PCI). Radial access as compared to femoral access reduces bleeding and mortality in patients with acute coronary syndrome (ACS) undergoing invasive management. However, prior studies have raised concerns over the increased risk of radiation exposure for both patients and operators with radial instead of femoral access and it remains still unclear whether radial access increases the risk of operator or patient radiation exposure in contemporary practice when performed by expert operators. The MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial is the largest randomized trial comparing radial versus femoral access in ACS patients undergoing invasive management. In this radiation sub-study (RAD-MATRIX), we collected fluoroscopy time and dose area product (DAP) and equipped radial operators consenting to participate with dedicated dosimeters, each wearing a thorax (primary endpoint), wrist and head (secondary endpoints) lithium fluoride thermo luminescent dosimeter, during study conduct to establish non-inferiority of radial versus femoral access. Among eighteen operators, performing 777 procedures in 767 patients, the non-inferiority primary endpoint was not achieved. Operator equivalent dose at the thorax was significantly higher with radial than femoral access. After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ in the right radial compared to the left radial access. In the overall MATRIX population, fluoroscopy time and DAP were higher with radial as compared to femoral access.
Author Interviews, Heart Disease, NYU/NYMC, Surgical Research / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33090" align="alignleft" width="200"]Adam Skolnick, MD Cardiologist Associate professor of medicine NYU Langone Medical Center Dr. Adam Skolnick[/caption] Adam Skolnick, MD Cardiologist Associate professor of medicine NYU Langone Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings? Response: I am privileged to serve on the ACC Program Planning Committee and helped to design this important session that seeks to determine the line between when a cardiovascular procedure is high risk and when it is futile.    I am co-chairing the session with the incoming chair of the section on Geriatric Cardiology for the ACC, Dr. Karen Alexander from Duke. We are practicing medicine at one of the most extraordinary times when there are so many devices and procedures to prolong and improve quality of life.    It is critical to assess a patient's goals of care for a given intervention.   In some patients, particularly those who are multiple degenerative chronic conditions, are frail and/or have cognitive impairment it is difficult to know when a given procedure multiple medical conditions will achieve a patient's goals.   When is a procedure high risk, and when is it simply futile?    This is the fine line upon which many cardiologists often find themselves. The speakers present case examples of high risk patients considering TAVI, high risk PCI or CABG and mechanical support devices and with interaction from the audience work through when each procedure is high risk and when it is unlikely to achieve a patient's goals of care.   We also have a dedicated talk on high risk procedures in patients with cognitive impairment, such as advanced dementia.
Author Interviews, Heart Disease / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33084" align="alignleft" width="133"]Harmony Reynolds, MD Cardiologist and the Saul J. Farber Associate Professor of Medicine NYU Langone Medical Center Dr. Reynolds[/caption] Harmony Reynolds, MD Cardiologist Saul J. Farber Associate Professor of Medicine NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: Some patients with heart attack have open, rather than severely narrowed, coronary arteries when they have a heart attack. This type of heart attack, known as myocardial infarction with non-obstructive coronary arteries or MINOCA, can be caused by a number of different problems. Cardiac MRI is useful because it can help physicians to find the underlying cause of MINOCA. MINOCA patients with ST elevation on the ECG are at higher risk of death than those without ST elevation but it is not known whether ST elevation correlates with any specific underlying cause of MINOCA.
Author Interviews, Exercise - Fitness, Genetic Research, Heart Disease, JAMA, University of Michigan / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33068" align="alignleft" width="200"]Sara Saberi, MD Assistant Professor Inherited Cardiomyopathy Program Frankel Cardiovascular Center University of Michigan Hospital and Health Systems Dr. Sara Saberi[/caption] Sara Saberi, MD Assistant Professor Inherited Cardiomyopathy Program Frankel Cardiovascular Center University of Michigan Hospital and Health Systems  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients with hypertrophic cardiomyopathy are often told not to exercise or to significantly curb their exercise due to concern over the potential risk of increased ventricular arrhythmias and sudden cardiac death. There is no data regarding risks/benefits of exercise in HCM though. There is, however, data that shows that patients with HCM are less active and more obese than the general population AND a majority feel that exercise restrictions negatively impact their emotional well-being. So, we devised a randomized clinical trial of a 16-week moderate-intensity aerobic exercise program versus usual activity with the primary outcome being change in peak VO2 (oxygen consumption). This exercise intervention resulted in a 1.27 mL/kg/min improvement in peak VO2 over the usual activity group, a statistically significant finding. There were no major adverse events (no death, aborted sudden cardiac death, appropriate ICD therapies, or sustained ventricular tachycardia). There was also a 10% improvement in quality of life as measured by the Physical Functioning scale of the SF-36v2.
Author Interviews, Heart Disease, Medical Imaging, NEJM / 19.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33059" align="alignleft" width="200"]Dr. Matthias Götberg MD PhD Department of Cardiology, Clinical Sciences Lund University, Skåne University Hospital Lund, Sweden Dr. Matthias Götberg[/caption] Dr. Matthias Götberg MD PhD Department of Cardiology, Clinical Sciences Lund University, Skåne University Hospital Lund, Sweden MedicalResearch.com: What is the background for this study? Response: Cardiologists encounter patients with narrowing of the coronary arteries on a daily basis. They typically use visual estimation of the severity of narrowing when performing coronary angiography, but it is difficult to accurately assess, based on a visual estimation alone, whether a stent is needed to widen the artery and allow the blood to more freely. FFR (Fractional Flow Reserve) is more precise tool and results in better outcomes than using angiography alone to assess narrowing of the coronary arteries. With FFR, the doctor threads a thin wire through the coronary artery and measures the loss of blood pressure across the narrowed area. To acquire an accurate measurement, the patient must be given adenosine, which is a drug that dilates the blood vessels during the procedure. This drug causes discomfort; patients describe having difficulty breathing or feeling as if someone is sitting on their chest. The drug also adds to the cost of the procedure and can have other rare but serious side effects. iFR (Instantaneous Wave-Free Ratio) is also based on coronary blood pressure measurements using a thin wire, but unlike FFR, it uses a mathematical algorithm to measure the pressure in the coronary artery only when the heart is relaxed and the coronary blood flow is high. As a result, a vasodilator drug is not needed. iFR has been validated in smaller trials and have been found to be equally good as FFR to detect ischemia, but larger randomized outcome trials are lacking. iFR-Swedeheart is a Scandinavian Registry-based Randomized Clinical Trial (RRCT) in which 2000 patients were randomized between iFR and FFR as strategies for performing assessment of narrowed coronary vessels. The primary composite endpoint at 12 months was all-cause death, non-fatal myocardial infarction, and unplanned revascularization. RRCT is a new trial design originating from Scandinavia using existing web-based national quality registries for online data entry, randomization and tracking of events. This allows for a very high inclusion rate and low costs to run clinical trials while ensuring robust data quality. 
Author Interviews, Heart Disease / 15.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32976" align="alignleft" width="133"]Simon Graff MD Department of Public Health Research Unit for General Practice Aarhus University Aarhus C, Denmark Dr. Simon Graff[/caption] Simon Graff MD Department of Public Health Research Unit for General Practice Aarhus University Aarhus C, Denmark  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The presented study is a continuation of our interest in the role of stress and the possible causes of atrial fibrillation.  We published a study that showed that spousal bereavement were followed by a transiently increased risk of new onset of atrial fibrillation. With spousal bereavement being one of the most stressful life-event, we wanted to know whether minor and differentiated stress exposures had an effect as well. Therefore we used register based data on perceived stress as a new measure of exposure.
Author Interviews, Heart Disease, JAMA, Stroke / 14.03.2017

MedicalResearch.com Interview with: Dr. Ying Xian MD PhD Department of Neurology, Duke Clinical Research Institute Duke University Medical Center Durham, North Carolina MedicalResearch.com: What is the background for this study? Response: Atrial fibrillation (AF) is the most common arrhythmia. AF increases the risk for stroke and accounts for 10% to 15% of all ischemic strokes. While the burden of AF-related stroke is high, AF is a potentially treatable risk factor. Numerous studies have demonstrated that vitamin K antagonists, such as warfarin, or non-vitamin K antagonist oral anticoagulants (NOACs), reduce the risk of ischemic stroke. Based on these data, current guidelines recommend adjusted-dose warfarin or NOACs over aspirin for stroke prevention in high-risk patients with Atrial fibrillation.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Kidney Disease / 13.03.2017

MedicalResearch.com Interview with: Hon-Yen Wu, MD, PhD, on behalf of all authors Attending Physician and Assistant Professor, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Assistant Professor, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan. Assistant Professor, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Assistant Professor, School of Medicine, National Yang-Ming University, Taipei, Taiwan.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The effect of intensive blood pressure (BP) control in nondiabetic patients with chronic kidney disease (CKD) has long been a topic of debate. We summarized the published information comparing intensive BP control (< 130/80 mmHg) with standard BP control (< 140/90 mmHg) on major renal outcomes in CKD patients without diabetes. We pooled data from 9 randomized clinical trials with more than 8000 patients and over 800 events of kidney disease progression. We found that targeting blood pressure below the current standard did not provide additional benefit for renal outcomes compared with standard BP control, but may benefit nonblack patients or those with heavy proteinuria. MedicalResearch.com: What should readers take away from your report? Response: For the optimal blood pressure target in CKD patients without diabetes, an individually tailored treatment rather than a general rule to control hypertension is suggested.
Author Interviews, CMAJ, Fertility, Heart Disease, Women's Heart Health / 13.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32860" align="alignleft" width="200"]Jacob A. Udell MD MPH FRCPC Cardiovascular Division Women's College Hospital Toronto General Hospital University of Toronto Dr. Jacob Udell[/caption] Jacob A. Udell MD MPH FRCPC Cardiovascular Division Women's College Hospital Toronto General Hospital University of Toronto  MedicalResearch.com: What is the background for this study? Response: We’ve noticed for a long time that fertility drug treatment can cause short-term complications such as high blood pressure or diabetes in pregnancy. We recently started wondering whether there may be long term consequences for these women years after a baby was or was not born.  To do this, we looked at all women who were treated with fertility therapy in Ontario for the last 20 years, from what we could determine this amounted to more than 28,000 women. We then followed up years later to examine every woman’s cardiovascular health.
Author Interviews, CT Scanning, Heart Disease, JACC / 07.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32752" align="alignleft" width="200"]Won Young Kim, MD Department of Emergency Medicine Ulsan University College of Medicine Asan Medical Center Seoul, Korea Dr. Won Young Kim[/caption] Won Young Kim, MD Department of Emergency Medicine Ulsan University College of Medicine Asan Medical Center Seoul, Korea MedicalResearch.com: What is the background for this study? Response: The current advanced cardiac life support guidelines recommended emergent percutaneous intervention for out-of-hospital cardiac arrest (OHCA) survivors with ST-segment elevation and suspected cardiac origin without ST-segment elevation. However, spontaneous subarachnoid hemorrhage (SAH) is a well-known cause of cardiac arrest, and its electrocardiogram may mimic myocardial infarction or ischemia. The need and timing for brain computed tomography in non-traumatic OHCA remain controversial. The present study aimed at determining the role of the post-resuscitation ECG in patients with significant ST-segment changes on initial ECG to investigate the difference in post-resuscitation ECG characteristics between OHCA patients with SAH and those with suspected cardiac origin of OHCA.
Author Interviews, Heart Disease, JAMA, Lipids / 02.03.2017

MedicalResearch.com Interview with: Dr. Yashashwi Pokharel MD, MSCR Department of Cardiovascular Research Saint Luke’s Mid-America Heart Institute Kansas City, Missouri and Salim S. Virani, MD PhD, FACC, FAHA Associate Professor, Section of Cardiovascular Research Associate Director for Research, Cardiology Fellowship Training Program Baylor College of Medicine Investigator, Health Policy, Quality and Informatics Program Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center Houston, TX MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unlike the previous cholesterol management guideline that recommended use of either statin and non-statin therapy to achieve low density lipoprotein cholesterol (LDL-C) target, the 2013 American College of Cardiology/American Heart Association cholesterol management guideline made a major paradigm shift by recommending statin focused treatment in 4 specific patient groups and replaced LDL-C target with fixed statin intensity treatment (moderate to high intensity statin therapy). With this change, it was speculated that a large number of patients would be eligible for statin treatment (in one study, up to 11.1% additional patients were expected to be eligible for statin therapy). Our study provided the real world trends in the use of statin and non-statin lipid lowering therapy (LLT) from a national sample of cardiology practices in 1.1 million patients 14 months before and 14 months after the release of the 2013 guideline. We found a modest, but significant increasing trend in the use of statin therapy in only 1 of the 4 patient groups eligible for statin therapy (i.e., 4.3% increase in the use of moderate to high intensity statin therapy in patients with established atherosclerotic cardiovascular disease). We did not find any significant change in non-statin LLT use. Importantly, about a third to half of patients in statin eligible groups were not receiving moderate to high intensity statin therapy even after the publication of the 2013 guideline.
Author Interviews, Heart Disease, JAMA / 01.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32483" align="alignleft" width="200"]Thomas Engstrøm Senior Consultant dr. sci., MD, PhD The Heart Center | Rigshospitalet | University of Copenhagen | Denmark Professor in cardiology | University of Lund | Sweden Adjunct professor in cardiology | University of Aalborg | Denmark Dr. Engstrøm[/caption] Thomas Engstrøm  MD, PhD The Heart Center | Rigshospitalet | University of Copenhagen | Denmark Professor in cardiology | University of Lund | Sweden Adjunct professor in cardiology | University of Aalborg | Denmark  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Timely reperfusion by primary angioplasty (primary PCI) in patients with ST-elevation myocardial infarction is mandatory. However reperfusion it self can harm the myocardium - so called reperfusion injury. During a number of years ischemic postconditioning (iPOST) by repetitive interruptions of blood flow after reperfusion has been a promising technique to address reperfusion damage. The trial investigated the effect of iPOST in 1200 patients treated with primary PCI and in addition either iPOST or conventional angioplasty.
Author Interviews, Gender Differences, Heart Disease, JACC, Metabolic Syndrome / 01.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32345" align="alignleft" width="176"]Mark D. DeBoer, MD Associate Professor of Pediatrics Division of Pediatric Endocrinology University of Virginia Charlottesville, VA 22908 Dr. DeBoer[/caption] Mark D. DeBoer, MD Associate Professor of Pediatrics Division of Pediatric Endocrinology University of Virginia Charlottesville, VA 22908 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Worldwide there remains a need for accurate prediction of cardiovascular disease. One such predictor is the metabolic syndrome, a cluster of individual risk factors including central obesity, high blood pressure, high triglycerides, low HDL cholesterol, and high fasting glucose. Metabolic Syndrome is usually diagnosed using set criteria, where a person is diagnosed if he or she has abnormalities in at least 3 of the individual components. Using these criteria, someone with MetS (compared to without MetS) has a >50% greater chance of developing cardiovascular disease over the ensuing 10 years. The problem is that prior studies showed that having MetS did not increase risk above that seen for having the abnormalities in the individual risk factors themselves. Our study used a continuous MetS severity score that we derived previously and assessed this score as a predictor of future cardiovascular disease in two large cohorts. We found that even when analyzed with abnormalities in the individual Metabolic Syndrome components, higher levels of the MetS severity score conferred higher risk for cardiovascular disease. This suggests the potential for following this score in individuals over time to identify those at higher risk for future cardiovascular disease.
Author Interviews, Heart Disease, JACC, Lifestyle & Health, Race/Ethnic Diversity / 01.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32341" align="alignleft" width="200"]Lu Qi, MD, PhD, FAHA HCA Regents Distinguished Chair and Professor Director, Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112 Dr. Lu Qi[/caption] Lu Qi, MD, PhD, FAHA HCA Regents Distinguished Chair and Professor Director, Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Adherence to healthy lifestyle (high physical activity, less smoking, moderate alcohol consumption, healthy diet, and low adiposity) has been related to substantially reduced risk of cardiovascular diseases in large cohorts from the US and Europe, however, similar evidence in Asians such as Chinese is lacking.
Author Interviews, Heart Disease, JACC, Mayo Clinic, Technology / 27.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32456" align="alignleft" width="200"]Jay Millerhagen Jay Millerhagen[/caption] MedicalResearch.com: What is the background for this study? Response: Journal of the American College of Cardiology (JACC): Clinical Electrophysiology (JACC CEP) publication entitled, “Novel Electrophysiology Recording System Enables Specific Visualization of the Purkinje Network and Other High-Frequency Signals” reports important findings obtained using BioSig Technologies’ PURE EP System during a series of pre-clinical studies conducted at Mayo Clinic in Rochester, Minnesota. These studies are part of a company-funded Advanced Research Program announced on March 28, 2016. The JACC CEP manuscript provides an excellent example of the PURE EP System’s ability to record challenging high frequency signals known as Purkinje potentials. These signals are of great interest to electrophysiologists when assessing arrhythmia syndromes dependent on the Purkinje network.
AHA Journals, Allergies, Author Interviews, Heart Disease / 27.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32432" align="alignleft" width="133"]Roberta Rossini, MD, PhD USC Cardiologia, Cardiovascular Department Bergamo, Italy Dr. Rossini[/caption] Dr. Roberta Rossini, MD, PhD USC Cardiologia, Cardiovascular Department Bergamo, Italy  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Aspirin (ASA) is stilll the cornerstone of antithrombotic therapy in patients with coronary artery disease, especially after PCI, both in the acute and the chronic phase of treatment. However, ≈2% of patients have hypersensitivity to ASA. ASA desensitization may represent a valid approach. Desensitization protocols generally involve gradual increases in patient exposure to ASA with the goal of mitigating or abolishing immune-mediated reaction. However, many desensitization protocols require several days to be completed, making them unpractical. This may also contribute to the limited experience with applying ASA desensitization protocols in real-world practice in patients with CAD. We previously reported the results of a pilot investigation supporting the feasibility of performing a rapid (<6 hours) Aspirin desensitization protocol in patients undergoing PCI with stent implantation (Rossini R, Angiolillo DJ, Musumeci G, Scuri P, Invernizzi P, Bass TA, Mihalcsik L, Gavazzi A. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol. 2008;101:786–789. doi: 10.1016/j.amjcard.2007.10.045). The encouraging findings from our pilot feasibility investigation prompted the design of a larger scale multicenter investigation aimed to assess the safety and efficacy of a rapid aspirin  desensitization protocol in patients with a history of ASA hypersensitivity undergoing coronary angiography.
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, Geriatrics, Heart Disease, Stroke / 26.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32407" align="alignleft" width="200"]Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Instructor in Medicine, Harvard Medical School Dr. Ariela Orkaby[/caption] Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Instructor in Medicine, Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial Fibrillation is a common heart rhythm that affects 1 in 25 adults over age 60 and 1 in 10 adults over age 80. The feared consequence of atrial fibrillation is stroke, leading to the prescription of blood thinning medications (anticoagulants such as warfarin) to prevent strokes. However, there is an underutilization of these life-saving medications in older adults, and particularly in those who have dementia. In part, this is due to a lack of research and inclusion of older adults with dementia in prior studies. In this study, we used clinical Veterans Administration data, linked to Medicare, to follow 2,572 individuals over age 65 who had atrial fibrillation and until a diagnosis of dementia. The average age was 80 years, and 99% were male. We found that only 16% remained on warfarin. We used statistical methods to account for reasons why a patient would or would not be treated with warfarin and found that those who continued to take warfarin had a significantly lower risk of stroke (HR 0.74, 95% Confidence interval 0.54- 0.99, p=0.47) and death (HR 0.72, 95% CI 0.60-0.87, p<0.01) compared to those who did not continue to take warfarin, without an increased risk of bleeding.
Author Interviews, Heart Disease, Karolinski Institute, Outcomes & Safety / 25.02.2017

MedicalResearch.com Interview with: Lars H. Lund, MD Phd, Assoc. Prof., FESC Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: Registries are accepted for quality reporting but it is actually unknown whether in heart failure they directly improve outcomes. Here, enrollment in SwedeHF was strongly associated with reduced mortality.
Author Interviews, Heart Disease, JAMA / 25.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32393" align="alignleft" width="200"]David Gaist, MD, PhD</strong> Department of Neurology Odense University Hospital University of Southern Denmark Odense, Denmark Dr. David Gaist[/caption] MedicalResearch.com: What is the background for this study? What are the main findings? Response: The incidence of subdural hematoma (SDH; a bleed located within the skull, but outside the brain) has been reported to be on the increase. Previous studies have shown an association between use of antithrombotic drugs and SDH. However, studies with updated estimates of this risk and with focus on current more complex and aggressive regimens of antithrombotic treatment are scarce. We therefore performed this study, where we identified 10,010 patients aged 20-89 years that were admitted with SDH in Denmark in 2000 through 2015. Preadmission use of antithrombotic drugs (low-dose aspirin, clopidogrel, vitamin K antagonist, e.g. warfarin, and direct oral anticoagulants) of these cases was compared to that of 400,380 individuals from the general population with no history of SDH (controls). We found that use of antithrombotic drugs was associated with an increased risk of subdural hematoma . The magnitude of this risk varied by type of antithrombotic, and was, e.g., low for use of low-dose aspirin, and highest for warfarin. Further, with a single exception (low-dose aspirin and dipyridamole), concurrent use of more than one antithrombotic drug was associated with higher risk of SDH, particularly if warfarin was taken along with an antiplatelet drug, e.g., low-dose aspirin or clopidogrel. Increasing use of antithrombotic drugs was observed in the study period. The incidence of subdural hematomas in the Danish population also increased markedly in the years 2000-2015, particularly among those aged 75+ years. Our study indicates that this increased incidence, can, at least partly, be explained by increased use of antithrombotic drugs.
Author Interviews, Heart Disease, MRI, NEJM / 25.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32206" align="alignleft" width="200"]Robert Russo, MD, PhD, FACC The Scripps Research Institute The La Jolla Cardiovascular Research Institute Dr. Robert Russo[/caption] Robert Russo, MD, PhD, FACC The Scripps Research Institute The La Jolla Cardiovascular Research Institute  MedicalResearch.com: What is the background for this study? Response: For an estimated 2 million people in the United States and an additional 6 million people worldwide, the presence of a non-MRI-conditional pacemaker or implantable cardioverter defibrillator (ICD) is considered a contraindication to magnetic resonance imaging. This creates a dilemma for at least half of these patients, who are predicted to require an MRI scan during their lifetime after a cardiac device has been implanted. Safety concerns for patients with an implanted cardiac device undergoing MRI are related to the potential for magnetic field-induced cardiac lead heating resulting in myocardial thermal injury, and a detrimental change in pacing properties. As a result, patients with an implanted device have long been denied access to MRI, although it may have been the most appropriate diagnostic imaging modality for their clinical care. Despite the development of MRI-conditional cardiac devices, a strategy for mitigating risks for patients with non MRI-conditional devices and leads will remain an enduring problem for the foreseeable future due to an ever increasing demand for MRI and the large number of previously and currently implanted non-MRI-conditional devices.
Author Interviews, Heart Disease, JAMA, Stroke / 25.02.2017

MedicalResearch.com Interview with: Peter Brønnum Nielsen MD PhD Aalborg Thrombosis Research Unit Department of Clinical Medicine Faculty of Health Department of Cardiology, Atrial Fibrillation Study Group Aalborg University Hospital Aalborg, Denmark   MedicalResearch.com: What is the background for this study? What are the main findings? Response:   Patients who sustain an intracranial hemorrhage (ICH) event are often excluded from randomized trials investigating stroke prevention in atrial fibrillation (AF) by use of oral anticoagulant treatment.
Author Interviews, Cancer Research, Heart Disease, JAMA / 24.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32371" align="alignleft" width="134"]Philip C. Haycock, PhD MRC Integrative Epidemiology Unit University of Bristol Bristol, England Dr. Philip Haycock[/caption] Philip C. Haycock, PhD MRC Integrative Epidemiology Unit University of Bristol Bristol, England MedicalResearch.com: What is the background for this study? What are the main findings? Response: The direction and causal nature of the association of telomere length with risk of cancer and other diseases is uncertain. In a Mendelian randomization study of 83 non-communicable diseases, including 420,081 cases and 1,093,105 controls, we found that longer telomeres were associated with increased risk for several cancers but reduced risk for some other diseases, including cardiovascular diseases.
AHA Journals, Author Interviews, Heart Disease, Menopause, University of Pittsburgh, Women's Heart Health / 23.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32321" align="alignleft" width="160"]Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Department of Epidemiology University of Pittsburgh Graduate School of Public Health Dr. El Khoudary,[/caption] Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Department of Epidemiology University of Pittsburgh Graduate School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study revealed a previously unknown, menopause-specific indicator of heart disease risk. For the first time, we’ve pinpointed the type of heart fat, linked it to a risk factor for heart disease and shown that menopausal status and estrogen levels are critical modifying factors of its associated risk in women. My team evaluated clinical data, including blood samples and heart CT scans, on 478 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were in varying stages of menopause, averaged 51 years old and were not on hormone replacement therapy. In a previous study, we showed that a greater volume of paracardial fat, but not epicardial fat, after menopause is associated with a decline in the sex hormone estradiol—the most potent estrogen—in women. The higher volume of epicardial fat was tied to other risk factors, such as obesity. In the new study, we built on those findings to discover that not only is a greater paracardial fat volume specific to menopause, but—in postmenopausal women and women with lower levels of estradiol—it’s also associated with a greater risk of coronary artery calcification, an early sign of heart disease that is measured with a heart CT scan.
Author Interviews, Heart Disease, Microbiome, Nutrition, Race/Ethnic Diversity / 23.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32312" align="alignleft" width="200"]Akira Sekikawa, Ph.D.</strong> Associate professor of epidemiology University of Pittsburgh Graduate School of Public Health Dr. Sekikawa[/caption] Akira Sekikawa, Ph.D. Associate professor of epidemiology University of Pittsburgh Graduate School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: We found that Japanese men who are able to produce equol—a substance made by some types of “good” gut bacteria when they metabolize isoflavones (micronutrients found in dietary soy)—have lower levels of a risk factor for heart disease than their counterparts who cannot produce it. All monkeys can produce equol, as can 50 to 70 percent of people in Asian countries. However, only 20 to 30 percent of people in Western countries can. Scientists have known for some time that isoflavones protect against the buildup of plaque in arteries, known as atherosclerosis, in monkeys, and are associated with lower rates of heart disease in people in Asian countries. It was surprising when a large trial of isoflavones in the U.S. didn’t show the beneficial effects on atherosclerosis. My colleagues and I recruited 272 Japanese men aged 40 to 49 and performed blood tests to find out if they were producing equol. After adjusting for other heart disease risk factors such as high blood pressure, cholesterol, smoking and obesity as well as dietary intake of isoflavones, we found that the equol-producers had 90-percent lower odds of coronary artery calcification, a predictor of heart disease, than the equol non-producers.
Author Interviews, Heart Disease, JAMA, Testosterone, UCLA / 23.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32281" align="alignleft" width="140"]Ronald S. Swerdloff, MD Chief of the Division of Endocrinology, Department of Medicine and Director of a World Health Organization Collaborative Center in Reproduction a Mellon Foundation Center for Contraceptive Development and a NIH Contraceptive Clinical Trial Center Director of the Harbor-UCLA Reproductive Program LA BioMed Lead Researcher David Geffen School of Medicine UCLA Health Dr. Ronald Swerdloff[/caption] Ronald S. Swerdloff, MD Chief of the Division of Endocrinology, Department of Medicine and Director of a World Health Organization Collaborative Center in Reproduction a Mellon Foundation Center for Contraceptive Development and a NIH Contraceptive Clinical Trial Center Director of the Harbor-UCLA Reproductive Program LA BioMed Lead Researcher David Geffen School of Medicine UCLA Health MedicalResearch.com: What is the background for this study? Response: While we have long known that testosterone levels decrease as men age, very little was known about the effects of testosterone treatment in older men with low testosterone until last year. Our team of researchers from LA BioMed and 12 other medical centers in the U.S., in partnership with the National Institute on Aging, conducted a coordinated group of seven trials known as The Testosterone Trials (TTrials). We studied the effects of testosterone treatment for one year as compared to placebo for men 65 and older with low testosterone. The TTrials are now the largest trials to examine the efficacy of testosterone treatment in men 65 and older whose testosterone levels are low due seemingly to age alone. The first published research from the TTrials last year reported on some of the benefits to testosterone treatment. We have now published four additional studies in the Journal of the American Medical Association (JAMA) and JAMA Internal Medicine that found additional benefits and one potential drawback.
Author Interviews, Environmental Risks, Heart Disease, Radiology / 22.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32304" align="alignleft" width="150"]Alessandro Sciahbasi, MD, PhD Sandro Pertini Hospital Rome, Italy Dr. Sciahbasi[/caption] Alessandro Sciahbasi, MD, PhD Sandro Pertini Hospital Rome, Italy MedicalResearch.com: What is the background for this study? Response: Radiation exposure is an important issue for interventional cardiologists due to the deterministic and stochastic risks for operators, staff and patients. Consequently, it is important to know which are the determinants of operator radiation exposure during percutaneous coronary procedures in order to reduce radiation exposure. Despite different studies have already evaluated the radiation dose during percutaneous coronary procedures, most data were obtained using an indirect measure of the operator dose expressed in term of fluoroscopy time or dose area product (DAP) and only in a minority of studies dedicated operator dosimeters were used. The aim of our study was to evaluate operator radiation exposure during percutaneous coronary procedures with dedicated electronic dosimeters in a high volume center for transradial procedures.