Author Interviews, Diabetes, Heart Disease, JACC, Stanford / 27.01.2017

MedicalResearch.com Interview with: Fumiaki Ikeno M.D. Program Director (U.S.) Japan Biodesign Stanford Biodesign Medical Director/Research Associate Experimental Interventional Laboratory Division of Cardiology Stanford University MedicalResearch.com: What is the background for this study? What are the main findings? Response: We sought to determine whether the extent of coronary disease in terms of the number of lesions and their complexity in Type 2 Diabetes patients could predict major cardiovascular events, and hypothesized that revascularization would have greater effectiveness relative to medical therapy among patients with more number of lesions and higher complexity in coronary artery disease. Coronary bypass surgery, catheter-based treatment, and medical therapy all had similar cardiovascular outcomes among patients with less complexity of coronary artery disease who had type 2 diabetes mellitus, stable ischemic heart disease, and no prior coronary revascularization. Among patients with mid or high complexity coronary artery disease, coronary revascularization with bypass surgery significantly reduced the rate of major cardiovascular events during 5 years of follow-up. (more…)
Author Interviews, Heart Disease, Lipids, Omega-3 Fatty Acids / 21.01.2017

MedicalResearch.com Interview with: Dominik D Alexander, PhD, MSPH Principal Epidemiologist EpidStat Institute Ann Arbor, MI Seattle, WA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years, the body of scientific literature on n-3 LCPUFA (EPA/DHA) intake and coronary heart disease (CHD) risk has exploded with mixed results. It was only logical to conduct a comprehensive meta-analysis of randomized controlled trials (RCTs) to estimate the effect of EPA+DHA on CHD, and to conduct a comprehensive meta-analysis of prospective cohort studies to estimate the association between EPA+DHA intake and CHD risk. Among RCTs, there was a nonstatistically significant reduction in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85-1.05). Subgroup analyses of data from RCTs indicated a statistically significant CHD risk reduction with EPA+DHA provision among higher-risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72-0.98) and elevated low-density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76-0.98). Meta-analysis of data from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74-0.92) for higher intakes of EPA+DHA and risk of any CHD event. (more…)
Author Interviews, Heart Disease / 21.01.2017

MedicalResearch.com Interview with: Dr. Elena Arbelo MD PhD Department of Cardiology, Cardiovascular Institute Hospital Clínic de Barcelona University of Barcelona Barcelona, Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: Almost 20 years after its first description, catheter ablation is a widely-used treatment strategy for patients with symptomatic atrial fibrillation (AF) (AFib) resistant to antiarrhythmic drugs (AAD). If we look at the results of the ESC Pilot Atrial Fibrillation General Registry1, which included about 3000 consecutive in- and outpatients with AF presenting to cardiologists in nine participating countries in Europe, catheter ablation had previously attempted 7.6% overall, most often in those with paroxysmal AF (15.6%). A further 7.8% were prescribed an ablation as part of their management, which went up to a 19.3% in the case of paroxysmal AFib. On the other hand, several randomised clinical trials (RCTs) have shown better results of AFib ablation compared to antiarrhythmic drugs (AADs)2-6. However, these studies had a rather small sample size of selected patients, and interventions were undertaken by experienced operators with clearly pre-specified protocols. With rising prevalence of AFib and increasingly available treatment options, it was of utmost importance to have an accurate picture of contemporary AFib ablation and its outcomes which will allow the identification of practice gaps and assist evidence-based guidelines for the management of these patients. (more…)
Author Interviews, BMJ, Gender Differences, Heart Disease, Social Issues / 20.01.2017

MedicalResearch.com Interview with: Sanne Peters, PhD Research Fellow in Epidemiology The George Institute for Global Health University of Oxford Oxford United Kingdom MedicalResearch.com: What is the background for this study? Response: People from disadvantaged backgrounds are, on average, at greater risk of cardiovascular diseases than people with more affluent backgrounds. Some studies have suggested that these socioeconomic inequalities in cardiovascular disease are more consistent and stronger in women than in men. However, the literature is inconsistent. (more…)
Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity / 20.01.2017

MedicalResearch.com Interview with: Fatima Rodriguez, MD, MPH Chief Cardiovascular Medicine Fellow Stanford University MedicalResearch.com: What is the background for this study? Response: Hispanics are the largest minority group in the U.S. Although cardiovascular disease (CVD) is the leading cause of death for Hispanics, most studies exploring disparities focus on Black and White differences. Additionally, Hispanics are often aggregated into one homogenous group, which masks important differences. There is also an interesting epidemiological phenomenon known as the “Hispanic paradox” that states that although Hispanics have greater risk factors for CVD, they experience lower mortality. (more…)
Author Interviews, Diabetes, Heart Disease / 13.01.2017

MedicalResearch.com Interview with: Dr. Abhinav Sharma MD Duke Clinical Research Institute, Duke University, Durham, NC Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada Renato D. Lopes, MD, PhD, MHS Duke Clinical Research Institute Durham, NC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Impaired fasting glucose (IFG) has been demonstrated to be a risk factor for cardiovascular death; however, there is growing research suggesting that IFG also increases the risk of non-cardiovascular deaths such as cancer. The data on the distribution of causes of death among patients with impaired fasting glucose and cardiovascular risk factors have not been described. Our analysis used data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. We identified that while myocardial death is the most common adjudicated cause of death, overall, non-cardiovascular deaths were more common that cardiovascular deaths. Among non-cardiovascular, cancer deaths were the most common cause of death. Furthermore, the burden of non-cardiovascular deaths increases relative to cardiovascular death over time. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, Lancet, Medical Imaging, MRI, Social Issues / 12.01.2017

MedicalResearch.com Interview with: Dr Ahmed Tawakol MD Co-Director, Cardiac MR PET CT Program Massachusetts General Hospital and Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: While the link between stress and heart disease has long been established, the mechanism mediating that risk hasn’t been clearly understood. Animal studies showed that stress activates bone marrow to produce white blood cells, leading to arterial inflammation.  This study suggests an analogous path exists in humans. Moreover, this study identifies, for the first time in animal models or humans, the region of the brain (the amygdala) that links stress to the risk of heart attack and stroke. The paper reports on two complementary studies. The first analyzed imaging and medical records data from almost 300 individuals who had PET/CT brain imaging, primarily for cancer screening, using a radiopharmaceutical called FDG that both measures the activity of areas within the brain and reflects inflammation within arteries.  All participants in that study had no active cancer or cardiovascular disease at the time of imaging and each had information in their medical records on at least three additional clinical visits after imaging. The second study enrolled 13 individuals with a history of post-traumatic stress disorder, who were evaluated for their current levels of perceived stress and received FDG-PET scanning to measure both amygdala activity and arterial inflammation. (more…)
Author Interviews, Heart Disease, Nutrition, Red Meat / 11.01.2017

MedicalResearch.com Interview with: Wayne W. Campbell PhD Center on Aging and the Life Course Purdue University MedicalResearch.com: What is the background for this study? Response: Organizations that promote healthy eating often recommend consuming no more than 3.5-4.5 2-3 ounce servings of red meat per week. This recommendation is mainly based on data from epidemiological studies that observe a cohort of peoples’ eating habits over time and relate those habits to whether or not they experience a cardiovascular event, such as a heart attack or stroke, or cardiovascular-related death. These studies show associations between dietary choices and health but are unable to determine if a dietary choice is actually causing the disease. Randomized controlled clinical trials are able to determine causality by isolating one dietary variable to see the effects of that variable on certain health risk factors. Therefore, our lab compiled data from randomized controlled trials assessing the consumption of ≤ vs >3.5 servings of total red meat per week on blood lipids and lipoproteins and blood pressures, since these are common measures taken by clinicians to determine the risk for developing cardiovascular disease. (more…)
Author Interviews, Heart Disease / 10.01.2017

MedicalResearch.com Interview with: Dr. Mohammed Qintar, MD Cardiovascular Fellow St Luke’s Health System Kansas City MedicalResearch.com: What is the background for this study? What are the main findings? Response: One in four patients experience recurrent chest pain after acute myocardial infarction, but not all patients present with cardiac chest pain secondary to coronary ischemia. The frequency of non-cardiac chest pain re-hospitalitzation after acute myocardial infarction and its impact on patients’ health status has not been described after acute myocardial infarction (AMI). Both providers evaluating these patients and patients who have recently suffered an AMI are understandably concerned about any recurrent chest pain symptoms, and often present for urgent evaluation of these symptoms. In the first year after acute myocardial infarction, we found that a third of patients hospitalized for evaluation of chest pain actually presented with non-cardiac chest pain. Compared with patients not hospitalized with chest pain, non-cardiac chest pain hospitalization was associated with worse angina-related quality of life and general mental and physical health status. The quality of life for patients hospitalized with non-cardiac chest pain was similar to patients hospitalized with cardiac chest pain, suggesting a significant impact on their quality of life even though their pain did not reflect underlying coronary ischemia. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Surgical Research / 10.01.2017

MedicalResearch.com Interview with: Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC Executive Director of Interventional Cardiovascular Programs, Brigham and Women’s Hospital Heart & Vascular Center Professor of Medicine, Harvard Medical School Boston, MA 02115 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cangrelor is a potent, fast on, fast off, intravenous ADP receptor antagonist that is now available for use during PCI. Glycoprotein IIb/IIIa inhibitors are intravenous antiplatelet agents that work by a different mechanism. Doctors have asked whether there is any advantage to combining them or whether one class is preferable to the other during PCI. We analyzed close to 25,000 patients from the CHAMPION trials. Cangrelor’s efficacy in reducing peri-procedural ischemic complications in patients undergoing PCI was present irrespective of glycoprotein IIb/IIIa inhibitor administration. However, glycoprotein IIb/IIIa inhibitor use resulted in substantially higher bleeding rates, regardless of whether the patient was randomized to cangrelor or to clopidogrel. Thus, in general, cangrelor and glycoprotein IIb/IIIa inhibitors should not routinely be combined. If an operator wishes to use a potent intravenous antiplatelet during PCI, cangrelor is similarly efficacious as glycoprotein IIb/IIIa inhibitors, but with less bleeding risk. (more…)
Author Interviews, Heart Disease, HIV / 05.01.2017

MedicalResearch.com Interview with: Heidi M. Crane MD, MPH Associate Professor of Medicine Associate Director Clinical Epidemiology and Health Services Research Core Center for AIDS Research University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Studies have suggested that rates of myocardial infarction (MI) are higher in those with HIV, likely for a variety of reasons. However, prior studies have not been able to distinguish MIs by type. The Universal Definition of MI has been recommended by cardiology societies and classifies MIs into types with Type 1 MIs resulting spontaneously from atherosclerotic plaque instability and Type 2 MIs occurring secondary to causes other than atherosclerotic plaque rupture, including hypotension, hypoxia, and stimulant induced spasm resulting in increased oxygen demand or decreased supply. Understanding MI types is likely important as they may indicate a different prognosis and need for different prevention approaches. (more…)
Annals Thoracic Surgery, Author Interviews, Diabetes, Duke, Heart Disease, Hepatitis - Liver Disease, Pharmacology / 04.01.2017

MedicalResearch.com Interview with: Matthew J. Crowley, MD, MHS Assistant Professor of Medicine Member in the Duke Clinical Research Institute Duke University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although metformin is widely considered to be the first-line drug for type 2 diabetes, concerns about lactic acidosis have traditionally limited its use in some populations. However, FDA now indicates that metformin may be used safely for patients with mild-moderate chronic kidney disease and other historical contraindications like congestive heart failure. With the lactic acidosis question addressed for these groups, this review asked “what do we know about how metformin affects mortality and other outcomes for patients with historical contraindications and precautions?” The main take-home message is that metformin appears associated with lower mortality in patients with mild-moderate chronic kidney disease, congestive heart failure, and chronic liver disease. (more…)
Author Interviews, Biomarkers, Heart Disease, JACC / 04.01.2017

MedicalResearch.com Interview with: Prof. Michele Emdin, MD, PhD, FESC Associate Professor of Cardiovascular Medicine Director, Cardiology & Cardiovascular Medicine Division Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica CNR-Regione Toscana with the collaboration of Dr. Alberto Aimo, MD Institute of Life Sciences Scuola Superiore Sant'Anna - Sant'Anna School of Advanced Studies Pisa, Italy MedicalResearch.com: What is the background for these meta-analyses? Response: Soluble suppression of tumorigenicity 2 (sST2) is a novel and promising biomarker of heart failure (HF). It has been extensively studied in both stable chronic (CHF) and acute HF (AHF), demonstrating substantial potential as a predictor of prognosis in both settings (Dieplinger et al., 2015). An International Consensus Panel (Januzzi et al., 2015) and latest American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines (Yancy et al., 2013) support the use of sST2 assay for risk stratification in both CHF and AHF patients. By contrast, European Society of Cardiology guidelines do not provide specific recommendations on sST2 (Ponikowski et al., 2016). Because of ambiguity due to discordant conclusions and to the absence of a thorough revision of the literature and of rigorous meta-analyses of published studies up-to-date, we felt it worthwhile to carefully examine and meta-analyze evidence supporting measurement of sST2, in order to assess the prognostic role of this biomarker in CHF and AHF. Most of the groups originally publishing on the topic all over the world and representing the Gotha of clinical research on cardiovascular biomarker, accepted to directly contribute allowing the main Authors to achieve novel information by a guided statistical reappraisal, The final results furnish clinically significant support to the use of sST2 as a risk stratification tool either in the acute or in the chronic heart failure setting. (more…)
Alcohol, Author Interviews, Heart Disease, JACC, UCLA / 02.01.2017

MedicalResearch.com Interview with: Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption. In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships. (more…)
Author Interviews, Heart Disease, Occupational Health, Orthopedics / 31.12.2016

MedicalResearch.com Interview with: Kurt T. Hegmann, M.D., M.P.H. Director, Rocky Mtn. Center for Occupational and Environmental Health Chief, Division of Occupational and Environmental Health The University of Utah Health Care MedicalResearch.com: What is the background for this study? Response: This line of work for us began approximately 20 years ago. Normal tendons never rupture, as the weak point when loading the muscle-tendon unit is either the muscle-tendon junction (i.e., a true muscle strain) or bone-tendon junction. Researchers in the 1960s reported there is poor blood supply in the area of rotator cuff tendon tears, providing one of the two main etiological theories of rotator cuff tears. The other main theory is “impingement syndrome” or a biomechanical impingement in the shoulder joint. Though who experience this might find that they need something similar to this shoulder dislocation surgery. Naturally, both theories could co-exist. Next, we noted rotator cuff tendinitis and shoulder risks from tobacco in other studies. We also reported prior research of increased risks with obesity. These led us to the theory that these rotator cuff tears are likely vascular in etiology. The next problem was to show this. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Lipids / 29.12.2016

MedicalResearch.com Interview with: Marshall B. Elam PhD MD Professor Pharmacology and Medicine (Cardiovascular Diseases) University of Tennessee Health Sciences Center Memphis MedicalResearch.com: What is the background for this study? What are the main findings? Response: This manuscript presents the findings of extended follow up of patients with Type 2 Diabetes who were treated with fenofibrate, a member of a group of triglyceride lowering medications known as fibrates or PPAR alpha agonists, as part of the Action to Control Cardiovascular Risk in T2DM (ACCORD) study. ACCORD was designed to test the effect of intensive treatment of cardiovascular risk factors including blood glucose, blood pressure and lipids on risk of heart attack, stroke and cardiac death in patients with Type 2 Diabetes. The lipid arm of ACCORD tested the hypothesis that adding fenofibrate to statin therapy would further reduce risk of these cardiovascular events. (more…)
Author Interviews, Electronic Records, Genetic Research, Heart Disease, Lipids, Science / 25.12.2016

MedicalResearch.com Interview with: Michael F. Murray MD Geisinger Health System Danville, PA 17822 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The DiscovEHR cohort was formed as a result of a research collaboration between Geisinger Health System and Regeneron Pharmaceuticals. There are over 50,000 patient participants in the cohort who have volunteered to have their de-identified genomic sequence data linked to their de-identified EHR data for research purposes. We report in this paper findings around the identification of 229 individuals (1:256) with pathogenic or likely pathogenic variants in one of the three genes (LDLR, APOB, PCSK9) associated with Familial Hypercholesterolemia (FH). The study found that these individuals are unlikely to carry a diagnosis of FH and are at risk for early coronary artery disease. (more…)
Author Interviews, Heart Disease, NIH / 20.12.2016

MedicalResearch.com Interview with: Manfred Boehm M.D. Senior Investigator Laboratory of Cardiovascular Regenerative Medicine Center for Molecular Medicine NHLBI-NIH Bethesda, MD 20892 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Common atherosclerosis (hardening of blood vessels) is the leading cause for vascular diseases worldwide. Vascular calcification is a critical component of atherosclerosis and an indicator of negative outcomes. This process is highly regulated and dynamic. However, the underlying mechanism is poorly understood and no direct treatment is available to stop or reverse this devastating buildup of calcium crystals in the vessel wall. Arterial calcification due to deficiency of CD73 is a rare inherited vascular disease characterized by extensive calcification of blood vessels caused by mutation in a gene encoding an enzyme that generates a compound called Adenosine outside of cells. The lack of this important enzyme, CD73, activates a compensatory mechanism to generated Adenosine by an alternative enzyme. Unfortunately, increased activity of this other enzyme is causing accelerated vascular calcification. By using the patient’s own cells, this study characterized the compensatory signaling pathway and discovered several new treatment strategies. (more…)
Author Interviews, Heart Disease, JACC, Surgical Research / 17.12.2016

MedicalResearch.com Interview with: Frederick L. Grover, M. D. Professor, Division of Cardiothoracic Surgery Past Chair, Department of Surgery University of Colorado School of Medicine-Anschutz Medical Campus Aurora, CO Past President, Society of Thoracic Surgeons Vice Chair, Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry MedicalResearch.com: What is the background for this study? What are the main findings? Response: Following approval of the first transcatheter aortic heart valve late in 2011 the TVT-R was established and data entry was mandated by CMS for all patients who were undergoing transcatheter valve therapy.  Data is currently collected on transcatheter aortic valves (TAVR) from two companies, transcatheter mitral clip procedures (TMC), transcatheter mitral valve in valve or valve in ring procedures and aortic valve in valve procedures.  A report is published annually jointly in the Journal of the American College of Cardiology (JACC) and the Annals of Thoracic Surgery (ATS).  This report contains data from the beginning of 2012 through December 31, 2015.  Peoperative risk factors, operative details and outcomes data are collected prior to procedures, during the hospitalization, 30 days post procedure and at one year and later data can be collected by linking to CMS administrative data. For this annual report we concentrated on touching on some of the highlights since the length of the manuscript is limited. We discussed the trends in TAVR, since this is the most common procedure performed, the last two years’ experience in mitral clips since a very detailed paper was published on this last year, and the mitral valve in valve and ring since the results for this procedure were impressively good. In regard to TAVR, 418 sites perform this procedure and the number of cases in 2015 increased from 16,295 in 2014 to 24,808.  Very importantly, mortality and complications have been decreasing each year, probably related to improvements in the technology with smaller catheter and sheath sizes leading to less vascular complications, greater experience of those doing the procedures, a less sick group of patients going initially from those too ill to do an open operation on, to very high risk to high risk according to approval criteria.    The age of the patients however is most often in the 80s. (more…)
Author Interviews, BMJ, Heart Disease, Smoking / 16.12.2016

MedicalResearch.com Interview with: Dr. Kevin Campbell MD FACC Wake Heart and Vascular Assistant Professor of Medicine,  UNC School of Medicine Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson North Carolina  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study, data was analyzed from nearly 1800 patients who had ST elevation MI.  Findings were published in Heart.  They found that younger  smokers (age under the age of 50)  had an 8-fold increased risk of acute STEMI , when compared to ex- and never smokers. In addition, researchers found that current smokers of all ages were 3.26 times more likely to have STEMI than ex- and never-smokers—suggesting that if you stop smoking, you can reduce your risk for heart attack. (more…)
Author Interviews, Heart Disease / 09.12.2016

MedicalResearch.com Interview with: Dr Nima Gunness, PhD Australian Research Council Centre of Excellence in Plant Cell Walls Centre For Nutrition and Food Sciences The University of Queensland Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Soluble dietary fibres (SDFs) such as B-glucan from oat are known to lower blood cholesterol, however their mechanisms of action are unknown. It has previously been hypothesised that they bind to bile acids in the small intestine causing an excess excretion in the faeces. To replenish this loss the body synthesises more bile acid from blood cholesterol, its sole precursor. However, evidence for this mechanism is not convincing. In our study we’ve used pigs, as a model to study human digestion and relate the findings to diet related diseases such as obesity, type 2 diabetes and cardiovascular disease. We found that the SDF lowered blood total and LDL cholesterol but with a decrease in the circulating levels of bile acids. We also measured a decrease in the diffusion of cholesterol and bile acids across small intestinal epithelial tissue. In the colon we saw enhanced production of a therapeutic ursodeoxycholic acid, suppression of toxic lithocholic acid and transformation of cholesterol into coprostanol, a non-absorbable sterol. (more…)
Author Interviews, Heart Disease, JACC / 09.12.2016

MedicalResearch.com Interview with: Wayne C. Levy, MD Division of Cardiology University of Washington Seattle, Washington MedicalResearch.com: What is the background for this study? Response: There is uncertainty how effective ICDs are outside of clinical trials in real world patients who are often older with more comorbidities. The recent DANISH ICD only reiterates provider and patient concerns regarding the effectiveness of an ICD, that may be life saving, but does not improve heart failure symptoms or reduce hospitalizations. Many patients die without ever having an ICD shock, so the ICD was not necessary for the patient. We postulated that the effectiveness of an ICD is not driven by the absolute risk of sudden death (event rate/year) but rather the proportion of all deaths that are due to sudden death vs non sudden death. If a patient has a 3% annual risk of sudden death and this is decreased to 1% with an ICD (a 67% reduction in sudden death), the patient benefit will be much greater if the non sudden death rate is 1%/year than if it is 12%/year. In the first scenario the absolute mortality is decreased from 4% to 2% (a 50% reduction) whereas in the second patient, the mortality would be decreased from 15% to 13% (a 13% benefit). We developed the Seattle Proportional Risk Model (SPRM) using 10 clinical variables that had a differential impact on the mode of death, sudden vs. non sudden, in ~10,000 patients with ~2,500 deaths. Sudden death was more common in younger patients, male, without diabetes mellitus, NYHA 1 or 2 vs. 3 or 4, lower EF, SBP closer to 140, normal sodium and creatinine, higher BMI, and digoxin use. (more…)
Author Interviews, Heart Disease / 09.12.2016

MedicalResearch.com Interview with: Juhani Airaksinen, MD, PhD Professor, Chief of Cardiology Directork Heart Center Turku University Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Electrical cardioversion (ECV) is an essential part of rhythm control strategy in patients with paroxysmal atrial fibrillation (AF). There is limited information on unsuccessful outcome of ECV (i.e. failure of cardioversion or early recurrence of AF) for acute AF. Our study shows that the risk of unsuccessful outcome of ECV can be predicted using five simple clinical variables. These variables were used to derivate and validate a novel risk stratification tool (the AF-CVS Score) for predicting unsuccessful ECV outcome. Study patients with high AF-CVS Score points (>5) had a high incidence of ECV failure or early AF recurrence. (more…)
AHA Journals, Author Interviews, Heart Disease, Outcomes & Safety, UT Southwestern / 04.12.2016

MedicalResearch.com Interview with: Rohan Khera, MD Cardiology Fellow, T32 Clinical-Investigator Pathway UT Southwestern Medical Center Dallas, TX MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nearly 200 thousand people have an in-hospital cardiac arrest in the US each year. Of these, the vast majority have a non-shockable initial rhythm – either pulseless electric activity (PEA) or asystole. The survival of this type of arrest remains poor at around 12-14%. Moreover, even after accounting for differences in case mix, there is a wide variation in survival across hospitals – and this serves as a potential avenue for targeting quality improvement strategies at poor performing hospitals. Recent data suggest that a shorter time from the onset of cardiac arrest to the first dose of epinephrine is independently associated with higher survival. Against this background of wide hospital variation in cardiac arrest survival, and patient-level data suggesting an association between time to epinephrine and patient survival, we wanted to assess (A) if there were differences in time to epinephrine administration across hospitals, and (B) if a hospital’s rate of timely epinephrine use was associated with its cardiac arrest survival rate. Within Get With The Guidelines-Resuscitation, we identified nearly 104-thousand adult patients at 548 hospitals with an in-hospital cardiac arrest attributable to a non-shockable rhythms. delays to epinephrine, We found that (a) proportion of cardiac arrests with delayed epinephrine markedly across hospitals, ranging from no arrests with delay (or 0%) to more than half of arrests at a hospital (54%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge and survival with functional recovery - compared to a low-performing hospitals, survival and recovery was 20% higher at hospitals that performed best on timely epinephrine use. (more…)
Author Interviews, Heart Disease, Lipids, Stanford / 04.12.2016

MedicalResearch.com Interview with: Fatima Rodriguez, MD, MPH Division of Cardiovascular Medicine and Cardiovascular Institute Stanford University Stanford, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The 2013 ACC/AHA cholesterol management guidelines emphasized that high-risk patients with atherosclerotic disease should be on high-intensity statins. We sought to determine how these guidelines are being adopted at the Veterans Affairs (VA) Health System and to identify treatment gaps. Our main findings were that the use of high-intensity statins increased from 23 to 35% following the guideline release for these high-risk patients. However, high-intensity statin use was lowest in Hispanics and Native Americans. Women, older adults, and patients with peripheral arterial and cerebrovascular disease were also less likely to undergo statin intensification after the release of the guideline. We also noted geographic and institutional differences across VA hospitals in rates of high-intensity statin use for secondary prevention. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 03.12.2016

MedicalResearch.com Interview with: Bjarne M. Nes, PhD K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim, Norway. MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that cardiorespiratory fitness is an important predictor of future cardiovascular disease risk. Still, fitness levels are rarely measured in clinical practice, likely because of costly and time-consuming procedures that requires quite a lot of training. Therefore, we wanted to test the ability of a simple estimation of fitness, from a so-called non-exercise algorithm, to identify individuals at high and low risk of cardiovascular mortality. We tested fitness alone and in combination with traditional risk factors such as high blood pressure, cholesterol, smoking and family history of heart disease and diabetes, among 38,480 men and women from the Nord-Trondelag Health Study in Norway. We found that estimated fitness strongly predicts premature deaths from all causes and that traditional clinical risk factors added little above and beyond fitness in terms of predicting risk. (more…)
Alcohol, Author Interviews, CT Scanning, Heart Disease / 02.12.2016

MedicalResearch.com Interview with: Pál Maurovich-Horvat MD, PhD, MPH, FSCCT Assistant Professor of Cardiology Director of the MTA-SE Cardiovascular Imaging Research Group Heart and Vascular Center, Semmelweis University Budapest, Hungary MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several studies have been published on alcohol consumption and its association with the presence of coronary artery disease, however the data remains controversial. Some studies suggested that moderate alcohol consumption reduces the risk of heart disease and others found no protective effect. Our study is the first investigation that aims to assess the effect of alcohol on the coronary arteries using coronary CT angiography. We found no association between regular alcohol consumption and the presence of coronary disease. (more…)
Author Interviews, BMJ, Exercise - Fitness, Heart Disease / 30.11.2016

MedicalResearch.com Interview with: Dr. Emmaneul Stamatakis PhD, MSc, BSc Associate Professor | NHMRC Senior Research Fellow Charles Perkins Centre, Prevention Research Collaboration School of Public Health, Sydney Medical School The University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: We examined the association between participation in different sports and risk of death during subsequent decade in a large sample of >80k adults aged 30 and over who lived in Scotland and England between 2994 and 2008 . We found the following significant reduction in risk of dying from all causes among participants compared with non-participants: cycling 15%, aerobics 27%, swimming 28%, racquet balls 47%; there was no significant reduction in mortality for running/jogging and football/rugby. We also found the following significant reduction in risk of dying from cardiovascular diseases: aerobics 36%, swimming 41%, racquet balls 56%; there were no significant reduction in mortality for running, cycling and football/rugby. Results in both cases were adjusted for the potential confounders: age, sex, chronic conditions, alcohol drinking and smoking habits, mental health, obesity, education level, doctor-diagnosed CVD, cancer, weekly volume of other physical activity besides the sport (including walking and domestic activity. (more…)
Author Interviews, CMAJ, Heart Disease, Stroke / 27.11.2016

MedicalResearch.com Interview with: Dr. Tony Antoniou, PhD Research Scholar Department of Family and Community Medicine and a Scientist Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital Assistant Professor in the Department of Family and Community Medicine and Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, Ontario MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate. (more…)