Author Interviews, Gender Differences, Heart Disease, Surgical Research / 21.11.2016 Interview with: Dr James Spratt Bsc, MD, FRCP, FESC, FACC Spire Edinburgh Hospitals and Spire Murrayfield Edinburgh Spire Shawfair Park Hospital What is the background for this study? Response: Gender differences exist between male and female patients following routine PCI but data regarding these differences in Chronic Total Occlusions (CTO) Percutaneous Coronary Intervention (PCI) is limited. We maintain a dedicated national (United Kingdom) prospective CTO database contributed to by dedicated CTO PCI operators (lifetime CTO PCI >300). We retrospectively analysed this database from 2011-2015 to compare outcomes and characteristics of male versus female patients undergoing CTO PCI. We attempted to limit the bias of this observational study by propensity matched analysis. (more…)
Author Interviews, Heart Disease, JAMA / 21.11.2016 Interview with: Dr. Doug Owens MD former USPSTF Task Force member Professor at Stanford University Henry J. Kaiser, Jr. Professor Director of the Center for Health Policy Freeman Spogli Institute for International Studies Center for Primary Care and Outcomes Research Department of Medicine and School of Medicine Stanford What is the background for review and statement? Response: Cardiovascular disease is serious—it can lead to heart attacks and strokes, and is responsible for one in every three adult deaths in the U.S. People with no signs or symptoms and no past history of cardiovascular disease can still be at risk. Fortunately, some people can benefit from taking a medication called statins to reduce that risk. (more…)
Author Interviews, Heart Disease, Menopause, Weight Research, Women's Heart Health / 20.11.2016 Interview with: Somwail Rasla, MD Internal Medicine Resident Memorial Hospital of Rhode Island Brown University What is the background for this study? Response: Weight cycling has been studied as a possible risk factors for all-cause mortality and was found to be insignificant in some studies and significant in other studies when adjusted to age and timing of when the weight cycling occurred. It was proposed that weight cycling may increase risk of chronic inflammation by which weight cycling was considered to be a risk factor for increased morbidity and all cause mortalities. Other studies have reported that frequent weight cycling was associated with shorter telomere length, which is a risk factor for several comorbidities including CHD. Earlier studies showed that weight cycling has an association with increase in size of adipocytes as well as fluctuation of serum cholesterol, triglycerides, glucose, insulin, and glucagon which may contribute to the increased incidence of diabetes. Alternatively, in the nurses’ health study , weight cycling was not predictive of cardiovascular or total mortality. (more…)
Author Interviews, Emory, Exercise - Fitness, Geriatrics, Heart Disease, Lifestyle & Health / 18.11.2016 Interview with: Vasiliki Georgiopoulou MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine What is the background for this study? What are the main findings? Response: Although existing evidence suggests that more exercise capacity is associated with lower risk of CV disease and death, we don’t know whether more exercise capacity would lead to lower risk for heart failure also. This would be especially important for older adults, who are the group with the highest risk to develop heart failure. We used the data of a cohort study to test this association. The exercise capacity was evaluated by a walking test that is easy to perform – the long-distance corridor walk test. We observed that older adults who were able to complete the test had the lowest risk to develop heart failure and the lowest mortality rates, when compared with those who were not able to complete the test and those who could not do the test for medical reasons. We also observed that changes in exercise capacity 4 years later did not predict subsequent heart failure or mortality – perhaps because less fit older patients had already developed heart failure or had died. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, NEJM, Surgical Research / 17.11.2016 Interview with: Mandeep R. Mehra, MD, FACC, FESC, FHFSA, FRCP Medical Director, Brigham and Women’s Hospital Heart and Vascular Center Executive Director, Center for Advanced Heart Disease Professor of Medicine, Harvard Medical School Editor in Chief, The Journal of Heart and Lung Transplantation Brigham and Women's Hospital Boston, MA Mandeep R. Mehra, MD, FACC, FESC, FHFSA, FRCP Medical Director, Brigham and Women’s Hospital Heart and Vascular Center Executive Director, Center for Advanced Heart Disease Professor of Medicine, Harvard Medical School Editor in Chief, The Journal of Heart and Lung Transplantation Brigham and Women's Hospital Boston, MA What is the background for this study? Response: 10% of patients with heart failure and a reduced ejection fraction transition into Advanced Stages of disease where they become unresponsive to life prolonging traditional medications. Such patients typically require intravenous inotropic therapy to preserve cardiac function but most remain profoundly limited in their quality of life. In such cases a heart transplant is desirable but this is an option for only a few patients. Left Ventricular Assist Devices (LVADs) have become the mainstay for treating such patients either while they await a transplant or as a permanent option. However, there are challenges leading to infections, strokes, bleeding and most importantly pump malfunction due to thrombosis of the LVAD itself. The HeartMate 3 LVAD is a centrifugal pump that is designed to overcome the problem of pump thrombosis by virtue of 3 engineering attributes: (a) A frictionless rotor that is based on a fully magnetically levitated platform (b) wide blood flow passages that reduce red cell destruction and (c) an artificial intrinsic pulse that prevents stasis of blood within the pump. (more…)
Author Interviews, CT Scanning, Heart Disease, JAMA, Women's Heart Health / 16.11.2016 Interview with: Maryam Kavousi MD, PhD, FESC Assistant Professor Department of Epidemiology Erasmus University Medical Center Rotterdam The Netherlands What is the background for this study? What are the main findings? Response: The most recent American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular disease (CVD) prevention guidelines recommend statins for a larger proportion of populations. Notably, a large group of women are categorized as low CVD risk by the guidelines and would therefore not typically qualify for intensive management of their standard risk factors. Coronary artery calcium (CAC) scanning allows for the detection of subclinical coronary atherosclerosis and is viewed as the vessel’s memory of lifetime exposure to risk factors. We therefore aimed to address the utility of CAC as a potential tool for refining CVD risk assessment in asymptomatic women at low CVD risk based on the new guidelines. This study involved data on 6,739 low-risk women from 5 population-based cohort studies across the United States and Europe. We found that CAC was present in 36% of low-risk women and was associated with increased risk of CVD. (more…)
Author Interviews, Heart Disease / 16.11.2016 Interview with: Dragana Radovanovic, MD Head of AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute (EBPI) University of Zurich Zurich Switzerland What is the background for this study? Response: Although patients presenting with new or presumed new left bundle branch block (LBBB) represent a minority of the patients admitted with suspected acute myocardial infarction (AMI), they remain a challenging and unresolved diagnostic and therapeutic dilemma in routine clinical practice. Large trials such as PLATO or SHOCK have evaluated AMI therapy and considered ST-elevation MI (STEMI) and new LBBB as a single diagnostic group. Currently, European and American guidelines differ. European guidelines recommend that reperfusion therapy should be considered promptly, preferably using emergency coronary angiography with a view to primary PCI in patients with clinical suspicion of ongoing myocardial ischemia and new or presumed new LBBB. However, the ACCF/AHA guidelines are much less enthusiastic and recommend that patients with new or presumed new LBBB should not be considered as diagnostic of AMI in isolation and consequently provide little guidance on how to react if biomarkers are elevated. Routine clinical practice documentation of prior ECGs, which would confirm whether the LBBB was new or not, is often missing increasing the uncertainty on how to treat these patients. (more…)
Accidents & Violence, Author Interviews, Heart Disease / 16.11.2016 Interview with: Anand M. Irimpen MD Associate Professor of Clinical Medicine Tulane University Medical Center New Orleans, LA What is the background for this study? What are the main findings? Response: We did this study to look at the incidence of heart attacks post Katrina. There had been no long-term data on patients having heart attacks post major disaster and hence we decided to investigate this issue. The main findings are that there is a three-fold increase in heart attacks post Katrina compared to pre - Katrina. There was a higher incidence of hypertension, diabetes, hypercholesterolemia and smoking in the post-Katrina group compared to the pre-Katrina group. (more…)
Author Interviews, Diabetes, Heart Disease, Rheumatology / 16.11.2016 Interview with: Prof.dr. M.T. Nurmohamed, MD, PhD and Rabia Agca MD Dept. of Rheumatology | VU University Medical Center Amsterdam Rheumatology & immunology Center EULAR center of excellence in rheumatology What is the background for this study? Response: About 20 years ago the increased mortality in rheumatoid arthritis (RA) was well known, but not the causes. In daily clinical practice it seemed that RA patients more frequently suffered from myocardial infarctions than general population persons. Therefore, we started this study more than 15 years ago as at that time there were only sparse data with respect to cardiovascular morbidity in rheumatoid arthritis. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Pharmacology / 16.11.2016 Interview with: Paul J. Hauptman, MD Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health What is the background for this study? What are the main findings? Response: We decided to evaluate the cost of generic heart failure medications after an uninsured patient of ours reported that he could not fill a prescription for digoxin because of the cost for a one month's supply: $100. We called the pharmacy in question and confirmed the pricing. At that point we decided to explore this issue more closely. We called 200 retail pharmacies in the bi-state, St. Louis metropolitan area, 175 of which provided us with drug prices for three generic heart failure medications: digoxin, carvedilol and lisinopril. We found significant variability in the cash price for these medications. Combined prices for the three drugs ranged from $12-$400 for 30 day supply and $30-$1,100 for 90 day supply. The variability was completely random, not a function of pharmacy type, zip code, median annual income, region or state. In fact, pricing even varied among different retail stores of the same pharmacy chain. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Education, Heart Disease, Outcomes & Safety / 15.11.2016 Interview with: Dr. Sean van Diepen, MD, FRCPC Assistant Professor of Critical Care Medicine and Cardiology Coronary Intensive Care Unit Co-Director University of Alberta Hospital What is the background for this study? What are the main findings? Response: Studies have documented a wide variation in CCU admission rates for patients hospitalized with acute coronary syndromes (ACS) or heart failure (HF). The reasons underpinning these differences are incompletely understood and little is known about the associations between hospital type, resource utilization, and clinical outcomes among patients admitted to the CCU with an ACS or HF. In a national cohort of 220,759 patients, we observed that CCU admission rates varied by hospital type: 41% in teaching hospitals, 29.9% in large teaching hospitals, 42.6% in medium community hospitals and13.7% in small community hospitals. The percentage of patients that did not receive critical care therapies within the first 2 days of admission were: 35.5%, 58.0%, 83.3% and 95.6%, respectively. Compared large community hospitals, community hospitals all had higher adjusted in hospital mortality rates. (more…)
Author Interviews, Heart Disease, JACC, Surgical Research / 15.11.2016 Interview with: Opeyemi O. Fadahunsi, MBBS, MPH Department of Medicine Reading Health System West Reading, Pennsylvania What is the background for this study? What are the main findings? Response: Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to managing symptomatic severe aortic stenosis in patients who have a high surgical risk or are deemed to be inoperable. One of the most frequent complications is development of conduction abnormalities requiring permanent pacemaker placement. We compared clinical outcomes in patients requiring permanent pacemaker placement post-TAVR to those not requiring a pacemaker using a large US database called the STS/ACC TVT RegistryTM . We used real-world data of patients undergoing TAVR in the US at 229 sites between November 2011 and September 2014. The frequency of pacemaker placement within 30 days post-TAVR was 6.7% (651 of 9,785 patients). Those who needed a pacemaker within 30 days post-TAVR had longer hospital and intensive care unit stays compared to those who did not. Furthermore, those who needed a pacemaker had a higher risk of death from any cause at one year compared to those who did not get a pacemaker. (more…)
Author Interviews, Cannabis, Gender Differences, Heart Disease / 14.11.2016 Interview with: Amitoj Singh MD Chief Cardiology Fellow St. Luke’s University Health Bethlehem, Pennsylvania What is the background for this study? Response: Marijuana use in steadily increasing and it is the most commonly used illicit drug in the US and worldwide. There has been a recent increase in reports of heart and vascular complications associated with its use. These include Myocardial infarctions, stroke and takotsubo. We had two questions that we wanted to answer with our study: a) Is there an association between marijuana use and development of Transient Regional Ventricular Ballooning [TVRB] (aka Stress Cardiomyopathy /Broken Heart Syndrome/ Takotsubo)? b) If the above is true, what are the differences between Marijuana users (MU) and Non Marijuana Users (NMU) who developed Stress Cardiomyopathy. (more…)
Author Interviews, Heart Disease, Lipids, NEJM, Pharmacology / 14.11.2016 Interview with: Kevin Fitzgerald, Ph.D. Alnylam Pharmaceuticals Cambridge, MA 02142 What is the background for this study? Response: Inclisiran (ALN-PCSsc) is a subcutaneously administered RNAi therapeutic targeting PCSK9 in development for the treatment of hypercholesterolemia. The Phase 1 trial of inclisiran was conducted in the U.K. as a randomized, single-blind, placebo controlled, single ascending-and multi-dose, subcutaneous dose-escalation study in 69 volunteer subjects with elevated baseline LDL-C (≥ 100 mg/dL). The primary objective of the study was to evaluate the safety, side effect profile, and pharmacodynamics effects of inclisiran. (more…)
Author Interviews, Heart Disease, Pediatrics, University of Pennsylvania / 14.11.2016 Interview with: Maryam Y. Naim, MD Pediatric Cardiac Intensive Care Physician The Cardiac Center The Children’s Hospital of Philadelphia Perelman School of Medicine The University of Pennsylvania, Philadelphia What is the background for this study?  Response: In adults bystander compression only CPR has similar outcomes to bystander conventional COR therefore the The American Heart Association recommends untrained lay rescuers perform compression only CPR in adults that have an out of hospital cardiac arrest. In children respiratory arrests are more common therefore conventional CPR with chest compressions and rescue breaths are recommended for out of hospital cardiac arrest. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Race/Ethnic Diversity, UT Southwestern / 13.11.2016 Interview with: Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center Dallas, TX 75390-8586 What is the background for this study? What are the main findings? Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors. (more…)
Author Interviews, Exercise - Fitness, Heart Disease, Lifestyle & Health / 31.10.2016 Interview with: Ulrik Wisløff, PhD Professor, Head of K.G. Jebsen Center for Exercise in Medicine Department of Circulation and Medical Imaging Norwegian University of Science and Technology Norway What is the background for this study? What are the main findings? Response: Prolonged time spent sedentary on a daily basis is detrimental for general health and is associated with increased risk of developing and dying from lifestyle related diseases such as cardiovascular disease – even in those following todays advice for physical activity given by health authorities worldwide. Number of hours spent inactive tend to increase with increased age. A person’s fitness level is regarded the best predictor of future health. We tested, in older adults (aged 70-77 years old) whether meeting physical activity recommendations and/or having high age-specific fitness level attenuated the adverse effect of prolonged sedentary time on cardiovascular risk factor clustering. Main finding was that high age-specific fitness level fully attenuated the adverse effect of prolonged sedentary time on clustering of cardiovascular risk factors, independent of meeting the physical activity recommendation in older adults. (more…)
Author Interviews, Heart Disease, Surgical Research / 30.10.2016 Interview with: Prof. Lars Wallentin MD Department of Medical Sciences, Cardiology Uppsala Clinical Research Center Uppsala University, Uppsala, Sweden What is the background for this study? Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. Still there are remaining controversies concerning the long-term effects, the appropriate selection of patients for this approach and the opportunities for a more personalised approach to early invasive procedures. (more…)
Author Interviews, Heart Disease, JACC, Medical Imaging / 29.10.2016 Interview with: Kristina H. Haugaa, MD, PhD, FESC Ida Skrinde Leren MD, PhD Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet Oslo, Norway What is the background for this study? Response: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inheritable cardiomyopathy, predisposing to life-threatening arrhythmias. Ventricular arrhythmias are frequent in ARVC patients and importantly, arrhythmias may occur also before evident structural changes are seen, making risk stratification challenging. Additional tools are needed to detect early disease and to optimize medication and timing of implantation of a cardioverter defibrillator (ICD). We aimed to explore early markers of ARVC disease and their association with previous ventricular arrhythmias. (more…)
Author Interviews, Heart Disease, JACC, Surgical Research / 28.10.2016 Interview with: Anna Franzone, MD and Prof.Thomas Pilgrim, MD Department of Cardiology Bern University Hospital INSELSPITAL Bern, Switzerland What is the background for this study? What are the main findings? Response: Surgical aortic valve replacement is the therapeutic standard for patients with pure native aortic regurgitation (AR). However, transcatheter aortic valve implantation (TAVI) is emerging as a novel treatment option for patients deemed inoperable or at high-risk for surgery because of advanced age and multiple comorbidities. We performed a systematic review and meta-analysis including 237 patients with pure native AR undergoing TAVI across 13 studies. The primary study endpoint, all-cause mortality at 30-day, ranged from 0% up to 30% with a summary estimate rate of 7% . The occurrence of complications such as the need for a second valve implantation was relatively low as well as the rates of other endpoints (cerebrovascular events, major bleeding and vascular complications). (more…)
Author Interviews, Heart Disease, Psychological Science / 28.10.2016 Interview with: Xiaoyan Fang and Sophia Hoschar Institute of Epidemiology II Mental Health Research Unit Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg What is the background for this study? What are the main findings? Response: Time to treatment is a crucial determinant of survival in patients who have suffered an acute myocardial infarction. During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). Indeed, some small exploratory studies, mainly performed over 10 years ago, provided a preliminary evidence that denial contributes to decreased adherence to effective cardiac treatment by disavowing of the diagnosis and by minimizing the perceived symptom burden and symptom severity. Thus, the object of Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study is to find the effect of denial on patients’ prehospital delay. Our study contributes important new findings to the role of denial in the face of an AMI in an extended data set of STEMI patients.
  • First, the psychological coping mechanism of denial in the face of an AMI turned out to have more beneficial than adverse effects: denial contributed to less suffering from heart-related symptoms and negative potentially traumatizing affectivity without leading the patients to maladaptive behavior (e.g. waiting for the symptoms to resolve).
  • In addition, from an overall perspective, denial only minimally increased the delay time, whereas in the time window of 3-24hrs, denial led to a clinical significant longer delay. Apparently denial did not function in the most favorable time window presumably because of an extreme painful symptom pattern which overcame the effect of denial on prehospital delay. In this case, denial might be an intervention point for those who are without severe symptoms.
Author Interviews, Chocolate, Heart Disease, Nutrition / 27.10.2016 Interview with: Xiaochen Lin, PhD Student and Simin Liu MD ScD MPH Professor of Epidemiology and Medicine Department of Epidemiology and Center for Global Cardiometabolic Health Brown University Providence, RI What is the background for this study? What are the main findings? Response: There have been quite a few studies implicating cocoa as a beneficial nutritional strategy to improve cardiometabolic health, and we and others have done work indicating that cocoa flavanol may be the active compound responsible for the beneficial effects. Therefore, we conducted this systematic review and meta-analysis of randomized trials that we could identify in studying cocoa flavanol and a variety of circulating cardio-metabolic biomarkers. The meta-analysis of 19 RCTs, involving 1,139 participants, shows that flavanol intake from cocoa products may reduce dyslipidemia, insulin resistance and systemic inflammation, and therefore improve cardiometabolic health. Through this research, we also identify the additional gaps in the current knowledge and potential target for future investigations. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Thromboembolism / 27.10.2016 Interview with: Truven Health AnalyticsJay Margolis, PharmD Sr. Research Scientist Truven Health What is the background for this study? What are the main findings? Response: Vitamin K antagonists (VKAs), most commonly warfarin, had been the only orally available anticoagulants available for the last 60 or so years. While highly effective, use of these agents was often problematic due to their narrow therapeutic index, need for routine coagulation monitoring, and interactions with food and other drugs. Recently introduced new oral anticoagulants (NOACs), particularly rivaroxaban, had been shown in clinical trials to provide comparable efficacy to the VKAs without the need for routine coagulation monitoring. There have been few studies outside of clinical trials showing benefits that translate to real-world populations. In our study using real-world data from a large sample of geographically and demographically diverse US hospitals, patients hospitalized for incident venous thromboembolisms (VTE) initiating oral anticoagulant treatment with rivaroxaban had significantly shorter hospital stays and lower hospitalization costs compared with warfarin-treated patients. (more…)
Author Interviews, BMJ, CT Scanning, Heart Disease / 27.10.2016 Interview with: Professor Marc Dewey Heisenberg professor of radiology Vice Chairman of the Department of Radiology at Charité (Campus Mitte) Berlin Germany What is the background for this study? Response: Over 3.5 million cardiac catheterisations are performed in Europe each year. This study, jointly conducted by radiologists and cardiologists at Charité – Universitätsmedizin Berlin and published in today’s issue of The BMJ, compares computed tomography (CT) with cardiac catheterisation in patients with atypical chest pain and suspected coronary artery disease (CAD). What are the main findings? Response: CT reduced the need for cardiac catheterisation from 100% to 14% in the group of patients who received CT first instead of catheterisation. If catheterisation was needed in the CT group, the proportion of catheterisations showing obstructive CAD was 5 times higher than in the catheterisation group. Over a period of 3.3 years, the patients in the CT group neither had more cardiac catheterisations nor an increase in cardiovascular events. Moreover, CT shortened the length of stay by 23 hours and 79% of patients said they would prefer CT for future examinations of the heart. Overall, the results of the BMJ study show that CT is a gentle test for reliably ruling out CAD in patients with atypical chest pain who are currently being referred for cardiac catheterisation in routine clinical practice. (more…)
AHA Journals, Author Interviews, Heart Disease / 20.10.2016 Interview with: Joseph A. Ladapo, MD, PhD Division of General Internal Medicine and Health Services Research David Geffen School of Medicine UCLA Los Angeles, CA 90024 What is the background for this study? What are the main findings? Response: Four million adults in the U.S. undergo stress testing or coronary computed tomographic angiography (CTA) each year because of suspected coronary disease. These patients are high risk for adverse cardiovascular events, but they are often not treated with the right medications after testing. Little is known about how CTA or stress testing affect physician and patient decisions about cardiovascular medications and preventive lifestyle choices like exercise and weight loss. Using data from patients in the PROMISE trial (PROspective Multicenter Imaging Study for Evaluation of chest pain), we found that patients who underwent CTA for suspected coronary artery disease were more likely to start a statin and aspirin and more likely to eat better and lose weight. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Gender Differences, Heart Disease, Social Issues / 19.10.2016 Interview with: Adam L. Beckman Yale College, New Haven, CT (at the time this work was completed) Erica S Spatz MD MHS Assistant Professor, Section of Cardiovascular Medicine Center for Outcomes Research and Evaluation Yale-New Haven Hospital Yale University School of Medicine What is the background for this study? Beckman: Despite the expansion of insurance coverage, young adults face major challenges to obtaining affordable healthcare. We suspected women may experience greater challenges than men — they often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young women have worse outcomes following a heart attack as compared with similarly-aged men. (more…)
Author Interviews, Biomarkers, Heart Disease / 18.10.2016 Interview with: Susan Stienen, MD Department of Cardiology Academic Medical Center University of Amsterdam Amsterdam, the Netherland What is the background for this study? Response: Prognosis of patients admitted for and discharged after acute decompensated heart failure (ADHF) is poor, with a readmission and mortality rate of up to 50% of patients at 6 months. Previous studies demonstrated that a ≤30% NT-proBNP reduction from admission to discharge for ADHF is a strong predictor of HF readmissions and mortality, while those patients with a > 30% reduction in NT-proBNP had a far better prognosis. We conducted a randomized clinical trial in ADHF patients to study the effect of NT-proBNP-guided treatment with a target of NT-proBNP reduction of >30% from admission to discharge, versus conventional treatment. The guided arm used a therapy algorithm that included HF medication, review of rhythm problems and possible ischemia, and had a reminder of a possible indication for CRT-D. A total of 405 patients were randomized after an initial period of clinical stabilization, to receive NT-proBNP-guided or conventional therapy. Intention-to-treat analyses were performed in 404 patients. (more…)
AHA Journals, Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Clots - Coagulation, Heart Disease / 18.10.2016 Interview with: Eric A. Secemsky, MD MSc Interventional Cardiology Fellow Massachusetts General Hospital Harvard Medical School Fellow, Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center What is the background for this study? Response: Use of oral anticoagulant (OAC) therapy prior to coronary stenting is a significant predictor of post-procedural bleeding events. Previous studies have estimated that the frequency of chronic OAC use among patients undergoing percutaneous coronary intervention (PCI) is between 3% to 7%. Yet many of these analyses examined select patient populations, such as those admitted with acute myocardial infarction or atrial fibrillation, and preceded the market approval of non-vitamin K antagonist oral anticoagulants (NOACs). As such, the contemporary prevalence of OAC use among all-comers undergoing PCI, as well as associated risks of adverse events, are currently unknown. Therefore, we used PCI data from a large, integrated healthcare system to determine current use of  oral anticoagulant use among all-comers undergoing coronary stenting and the related short- and long-term risks of therapy. (more…)
Author Interviews, FASEB, Heart Disease, Imperial College, Pain Research, Pharmacology / 17.10.2016 Interview with: Dr Nicholas Kirkby BHF Intermediate Fellow | Vascular Biology National Heart & Lung Institute | Imperial College London London What is the background for this study? What are the main findings? Response: We know drugs like ibuprofen, called ‘non-steroidal anti-inflammatory drugs’ cause an increase in the risk of heart attacks. These side effects cause very real concerns for the many millions of people who rely on them. They are also the reason why there are no new drugs in this class and why they have been withdrawn (2011) for use as a preventative treatment for colon cancer. Previous research from our group suggests that L-arginine supplements may prevent the cardiovascular side effects caused by these drugs. Our findings here suggest that a particular formulations of ibuprofen, called ibuprofen arginate, which is already available in many parts of the world, can act like an L-arginine supplement and that this could potentially protect the cardiovascular system. (more…)
Author Interviews, Coffee, Heart Disease, JAMA / 17.10.2016 Interview with: Luis E. Rohde, MD, ScD Postgraduate Program in Health Science: Cardiology and Cardiovascular Sciences, Medical School, Federal University of Rio Grande do Sul, Cardiovascular Division, Hospital de Clínicas de Porto Alegre What is the background for this study? Response: Caffeine-rich beverages have been implicated as a common cause of several cardiac-related symptoms, such as palpitations, tachycardia, or irregular heartbeats. Because of this “intuitive” assumption, counseling to reduce or avoid caffeine consumption is still widely recommended in clinical practice by most physicians for patients with any heart disease. (more…)