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Author Interviews, CT Scanning, Heart Disease, JACC / 07.03.2017

MedicalResearch.com Interview with: 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. (more…)
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. (more…)
Author Interviews, Heart Disease, JAMA / 01.03.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Gender Differences, Heart Disease, JACC, Metabolic Syndrome / 01.03.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, JACC, Lifestyle & Health, Race/Ethnic Diversity / 01.03.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, JACC, Mayo Clinic, Technology / 27.02.2017

MedicalResearch.com Interview with: 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. (more…)
AHA Journals, Allergies, Author Interviews, Heart Disease / 27.02.2017

MedicalResearch.com Interview with: 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. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, Geriatrics, Heart Disease, Stroke / 26.02.2017

MedicalResearch.com Interview with: 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. (more…)
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. (more…)
Author Interviews, Heart Disease, JAMA / 25.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, MRI, NEJM / 25.02.2017

MedicalResearch.com Interview with: 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. (more…)
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. (more…)
Author Interviews, Cancer Research, Heart Disease, JAMA / 24.02.2017

MedicalResearch.com Interview with: 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. (more…)
AHA Journals, Author Interviews, Heart Disease, Menopause, University of Pittsburgh, Women's Heart Health / 23.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, Microbiome, Nutrition, Race/Ethnic Diversity / 23.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, JAMA, Testosterone, UCLA / 23.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Environmental Risks, Heart Disease, Radiology / 22.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, JAMA, Testosterone / 21.02.2017

MedicalResearch.com Interview with: T. Craig Cheetham, PharmD, MS Southern California Permanente Medical Group Department of Research & Evaluation Pasadena, CA 91101 MedicalResearch.com: What is the background for this study? Response: Concerns have been raised about the cardiovascular safety of testosterone replacement therapy. Patient selection criteria may have been a factor in the findings from studies reporting an increased cardiovascular risk with testosterone replacement therapy. Many men who were receiving testosterone replacement therapy don’t fall into the categories of ‘frail elderly’ or ‘high cardiovascular risk’. We therefore studied testosterone replacement therapy in a population of androgen deficient men within Kaiser Permanente Northern and Southern California. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA / 17.02.2017

MedicalResearch.com Interview with: James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine   MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.”   We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation” (more…)
AHA Journals, Author Interviews, Cost of Health Care, Geriatrics, Heart Disease / 15.02.2017

MedicalResearch.com Interview with: Olga Khavjou RTI International MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cardiovascular disease (CVD) is the leading cause of death in the United States and is one of the costliest chronic diseases. As the population ages, CVD costs are expected to increase substantially. To improve cardiovascular health and control health care costs, we must understand future prevalence and costs of CVD. In 2015, 41.5% (more than 100 million people) of the U.S population was estimated to have some form of CVD. By 2035, the number of people with CVD is projected to increase to over 130 million people, representing a 30% increase in the number of people with CVD over the next 20 years. Between 2015 and 2035, real total direct medical costs of CVD are projected to more than double from $318 billion to $749 billion and real indirect costs (due to productivity losses) are projected to increase from $237 billion to $368 billion. Total costs (medical and indirect) are projected to more than double from $555 billion in 2015 to $1.1 trillion in 2035. (more…)
Author Interviews, Heart Disease, JACC, Pharmacology / 15.02.2017

MedicalResearch.com Interview with: Gavin Y Oudit, MD, PhD, FRCPC Associate Professor, Department of Medicine, University of Alberta Clinician-Scientist Mazankowski Alberta Heart Institute Canada Research Chair in Heart Failure Division of Cardiology Edmonton, Alberta Heart specialist Gavin Oudit and his research team discovered a molecule — angiotensin converting enzyme 2 (ACE2)—that works to restore balance to the pathways responsible for chronic and acute heart failure, including in hearts from patients with advanced heart failure who underwent heart transplants. In developing the new drug, Oudit and his team discovered to an extent not seen before how the renin-angiotensin system (RAS), which regulates the body’s sodium balance, fluid volume, and blood pressure, is at play in both acute and chronic heart failure. In collaboration with Dr. Oudit, recombinant human ACE2 was made by Apeiron Biologics, purchased by GlaxoSmithKline, and has recently completed phase II clinical trial. (more…)
Author Interviews, Environmental Risks, Gender Differences, Heart Disease / 14.02.2017

MedicalResearch.com Interview with: Nathalie Auger MD MSc FRCPC Montréal, Québec MedicalResearch.com: What is the background for this study? Response: Snow shoveling is a challenging cardiovascular activity. Some studies suggest a link between snowfall and myocardial infarction, but use aggregate data which are limited. We used health data for individuals in the province of Quebec, Canada to analyze the association between snowfall and likelihood of hospital admission or death due to myocardial infarction. (more…)
AHA Journals, Author Interviews, Columbia, Heart Disease, Immunotherapy, Lipids / 13.02.2017

MedicalResearch.com Interview with: Henry N. Ginsberg, MD Irving Institute for Clinical and Translational Research Columbia University Columbia College of Physicians and Surgeons New York, NY MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies in mice and cells have identified increased hepatic low density lipoprotein (LDL) receptors as the basis for LDL lowering by PCSK9 inhibitors, but there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism, particularly effects on very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL) or LDL metabolism. This study in 18 healthy subjects, found that alirocumab decreased the number of IDL and LDL particles in the circulation, and their associated cholesterol and apoB levels by increasing efficiency of the clearance of IDL and LDL. There were not effects on VLDL metabolism. The increased clearance of IDL meant that less LDL was produced from IDL, which is the precursor of LDL. Thus, the dramatic reductions in LDL cholesterol resulted from both less LDL being produced and more efficient clearance of LDL. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition. (more…)
Author Interviews, Heart Disease, JAMA, Neurological Disorders, Stroke / 13.02.2017

  Christopher Chen, FRCP Department of Pharmacology Yong Loo Lin School of Medicine Memory Aging and Cognition Center National University Health System Singapore Saima Hilal, PhD Department of Pharmacology, National University of Singapore Department of Radiology, Epidemiology and Nuclear Medicine Erasmus Medical Center, Rotterdam, the Netherlands     MedicalResearch.com Interview with: Christopher Chen, FRCP Department of Pharmacology Yong Loo Lin School of Medicine Memory Aging and Cognition Center National University Health System Singapore Saima Hilal, PhD Department of Pharmacology, National University of Singapore Department of Radiology, Epidemiology and Nuclear Medicine Erasmus Medical Center, Rotterdam, the Netherlands MedicalResearch.com: What is the background for this study? Response: Cerebral microinfarcts (CMIs) are defined as small (usually <1 mm) regions of ischemic change found in the brain which are not readily visible on gross examination or on standard 1.5-T magnetic resonance imaging (MRI). On microscopy they appear as foci of neuronal loss, gliosis, pallor, or cysts. Previous post mortem studies have shown that the presence of CMIs is relatively common in elderly individuals without dementia (24%) but more common in patients diagnosed with Alzheimer disease (43%) or vascular dementia (62%). Whilst a single CMI is likely to be “silent” as the region of brain affected is probably too small to produce symptoms or neurologic deficits, however, as a large number of CMIs exist in many individuals, especially in the cerebral cortex and watershed areas, the overall effect has clinical importance – as shown by neuropathologic studies which demonstrate an important role of CMIs in cognitive dysfunction and dementia. However in vivo studies have been hampered by the inability to detect CMIs reliably on neuroimaging, leading to CMIs being termed “invisible” during life. The advent of high spatial-definition 7-T MRI enabled the identification of cortical  Cerebral microinfarcts in-vivo and importantly a study that directly compared 7-T and 3-T MRIs in the same patients reported that 3-T MRI detected about 1/3 of the lesions found on 7-T MRIs, suggesting that 3-T MRIs, which are more accessible than 7-T, may be able to detect larger cortical CMIs with a lower limit of approximately 1 mm in diameter. Our group has made major contributions recently on the clinical associations of 3T MRI detected cortical CMIs in patients from memory clinics as well as in community based subjects. Associations were found with age, vascular risk factors, other MRI markers of cerebrovascular disease as well as cognition. However, the causes of CMIs remain unclear and may be heterogeneous with microembolism, microthrombosis, and foci of inflammation as possible causative factors. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 12.02.2017

MedicalResearch.com Interview with: Frederick L. Ruberg, MD Director, Cardiovascular Medicine Fellowship Training Program Director, Pilot Grants Program, Boston University Clinical and Translational Science Institute Director, Advanced Cardiac Imaging Program Section of Cardiovascular Medicine Department of Medicine Department of Radiology Boston Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: ATTR cardiac amyloidosis is an under-recognized cause of congestive heart failure in older adults that results from the deposition of misfolded TTR protein in the heart. One cause of ATTR cardiac amyloidosis is a genetic abnormality, inherited from an affected patient’s parent, that causes the protein TTR to misfold. The most common genetically inherited cause of ATTR amyloidosis in the US is called Val122Ile (V122I), named for the specific mutation in the TTR gene, that is seen in approximately 3.5% of US African Americans. ATTR cardiac amyloidosis was once an untreatable disease, but now new drugs are in different stages of clinical trial testing. Thus, recognition is important to get patients on the right treatments. One of the principal reasons why the disease is under-recognized is that doctors don’t have proven and available diagnostic tests that can be applied in the outpatient clinic. This study demonstrated that a new point-of-care diagnostic test, using measurement of a blood protein called retinol binding protein 4 (RBP4) and other standard of care test information, can accurately diagnose ATTR cardiac amyloidosis. We demonstrated the validity of this test in two separate cohorts of patients with proven ATTR cardiac amyloidosis due to the Val122Ile mutation and control patients with heart failure but without amyloidosis. (more…)
Author Interviews, Cancer Research, Heart Disease, PNAS, UT Southwestern / 09.02.2017

MedicalResearch.com Interview with: Lawrence Lum, Ph.D. Associate Professor Virginia Murchison Linthicum Scholar in Medical Research UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Scarring of the adult heart due to excessive fibrotic responses is common after a heart attack, or following radiation therapy for the treatment of certain cancers. We have identified an anti-cancer agent currently in clinical development called WNT-974 that decreases fibrotic responses and improves heart function following myocardial infarction in mice. This unexpected observation was the outcome of a study focused on identifying unwanted adult tissue toxicities associated with this class of chemicals. (more…)
Author Interviews, Heart Disease, Surgical Research, Vitamin C / 06.02.2017

MedicalResearch.com Interview with: Harri Hemilä, MD, PhD Department of Public Health University of Helsinki MedicalResearch.com: What is the background for this study? Response: I have a long term interest in vitamin C. Previously I have shown that it alleviates exercise-induced bronchoconstriction (EIB) (http://dx.doi.org/10.1186/1710-1492-10-58 ) and shortens the duration of colds ( http://dx.doi.org/10.1371/journal.pmed.0020168 ). Now I had been following the literature and I noted that a number of randomized trials were being published about vitamin C for preventing post-operative atrial fibrillation (POAF). Therefore I reasoned that it is worthwhile to analyze that set of trials (more…)
Author Interviews, Heart Disease, JACC / 06.02.2017

MedicalResearch.com Interview with: Dan Hu (Helen), MD. PhD. FAHA. FACC. FHRS. Research Scientist II, Associate Professor Clinical Consultant of Molecular Genetic Department SCRO Chair of Stem Cell Center Masonic Medical Research Laboratory Utica, NY 13501 MedicalResearch.com: What is the background for this study? Response: Short QT Syndrome (SQTS) is a rare genetic disease characterized by an abnormally short QT interval in subjects with structurally normal hearts. It is a recognized cause of cardiac rhythm disorders, including both atrial and ventricular arrhythmias, and sudden cardiac death (SCD). As an inherited channelopathy, the molecular basis for SQTS has been associated with mutations in 6 genes: KCNH2 (IKr, SQTS1), KCNQ1 (IKs, SQTS2), and KCNJ2 (IK1, SQTS3), which encode different potassium channels; CACNA1C, CACNB2b and CACNA2D1 (SQTS4-6), which encode the L-type calcium channel (ICa). This study sought to evaluate the phenotypic and functional expression of an apparent hotspot mutation associated with SQTS. (more…)
Author Interviews, Heart Disease, JAMA, Tobacco Research, UCLA / 01.02.2017

MedicalResearch.com Interview with: Holly R. Middlekauff, MD Professor UCLA Division of Cardiology David Geffen School of Medicine UCLA MedicalResearch.com: What is the background for this study? What are the main findings? Response: E-cigarettes are the fastest rising tobacco product in the US today, but almost nothing is known about their cardiovascular effects. Rather than wait decades for epidemiological data in e-cigarette users to become available, we reasoned that investigations into the known mechanisms by which tobacco cigarettes increase heart disease would provide insights into the health risks of e-cigarettes. We focused on 2 critical mechanisms: 1) cardiac adrenaline activity, and 2) oxidative stress, measured in chronic e-cigarrete users compared to matched, healthy controls. The major findings were that, compared to healthy controls, e-cig users had increased cardiac adrenaline activity (measured by a technique called "heart rate variability"). Furthermore, compared to healthy controls, the e-cig users had increased susceptibility to oxidative stress. (more…)