Author Interviews, Diabetes, Heart Disease, JAMA, Lipids / 29.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30835" align="alignleft" width="170"]Marshall B. Elam PhD MD Professor Pharmacology and Medicine (Cardiovascular Diseases) University of Tennessee Health Sciences Center Memphis Dr. Marshall B. Elam[/caption] 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.
Author Interviews, Electronic Records, Genetic Research, Heart Disease, Lipids, Science / 25.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30763" align="alignleft" width="133"]Michael F. Murray MD Geisinger Health System Danville, PA 17822 Dr. Michael Murray[/caption] 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.
Author Interviews, Heart Disease, NIH / 20.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30662" align="alignleft" width="106"]Manfred Boehm M.D. Senior Investigator Laboratory of Cardiovascular Regenerative Medicine Center for Molecular Medicine NHLBI-NIH Bethesda, MD 20892 Dr. Manfred Boehm[/caption] 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.
Author Interviews, Heart Disease, JACC, Surgical Research / 17.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30605" align="alignleft" width="132"]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 Dr. Frederick Grover[/caption] 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.
Author Interviews, BMJ, Heart Disease, Smoking / 16.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30578" align="alignleft" width="133"]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. Dr. Kevin Campbell[/caption] 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.
Author Interviews, Heart Disease / 09.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30382" align="alignleft" width="200"]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 Dr Nima Gunness[/caption] 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.
Author Interviews, Heart Disease, JACC / 09.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30321" align="alignleft" width="161"]Wayne C. Levy, MD Division of Cardiology University of Washington Seattle, Washington Dr. Wayne Levy[/caption] 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.
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.
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.
Author Interviews, Heart Disease, Lipids, Stanford / 04.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30181" align="alignleft" width="166"]Fatima Rodriguez, MD, MPH Division of Cardiovascular Medicine and Cardiovascular Institute Stanford University Stanford, CA Dr. Fatima Rodriguez[/caption] 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.
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.
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.
Author Interviews, BMJ, Exercise - Fitness, Heart Disease / 30.11.2016

MedicalResearch.com Interview with: [caption id="attachment_30012" align="alignleft" width="133"]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 Dr. Emmaneul Stamatakis[/caption] 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.
Author Interviews, CMAJ, Heart Disease, Stroke / 27.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29867" align="alignleft" width="200"]Dr-Tony-Antoniou.jpg Dr. Tony Antoniou[/caption] 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.
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Surgical Research / 27.11.2016

MedicalResearch.com Interview with: Dr. Stefano Savonitto  Director, Division of Cardiology Manzoni Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the last 15 years, there has been a shift from fibrinolytic therapy for STEMI to primary angioplasty, which required a re-organization of the whole STEMI treatment network. Besides the higher reperfusion efficiency of primary angioplasty, as compared to lytic therapy, it has been a global upgrade of the STEMI care system that has reduced the rate of no reperfusion. Elderly patients and women (who are, on average, also older than men) had theoretically the most to gain from this shift, but little data were available to assess this benefit. In the present paper, we have shown that “lack of reperfusion” was reduced dramatically across all age groups and in both sexes, with a progressive and uniform increase in primary angioplasty, and a significant reduction in mortality. Almost as expected, elderly women were the category with the most relevant mortality benefit. Nevertheless, after adjustment for age and other confounders, women continue to experience a higher mortality as compared to men. In the discussion of the paper, we propose some hypotheses for this persistently higher mortality in women.
Author Interviews, BMJ, Brigham & Women's - Harvard, Heart Disease, Nutrition / 25.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29966" align="alignleft" width="190"]Dr. Qi Sun Sc.D, M.D., M.M.S. Assistant Professor in the Department of Nutrition Harvard T.H. Chan School of Public Heath Boston Dr. Qi Sun[/caption] Dr. Qi Sun Sc.D, M.D., M.M.S. Assistant Professor in the Department of Nutrition Harvard T.H. Chan School of Public Heath Boston MedicalResearch.com: What is the background for this study? What are the main findings? Response: Interpretation of existing human study data regarding saturated fat intake in relation to heart disease risk is quite confusing and distorted in certain publications. It is a fact that, depending on data analysis strategies, the effects of saturated fats may depend on which macronutrients they replace. For example, substituting saturated fats for refined carbohydrates will not lead to an elevated risk of heart disease because both nutrients are harmful whereas replacing saturated fats with good polyunsaturated fats results in risk reduction. In our current analysis, we clearly demonstrated that when total saturated fatty acids were replaced by polyunsaturated fatty acids, monounsaturated fatty acids, whole grain carbohydrates, and plant-based proteins, the diabetes risk would decrease. Furthermore, we showed that major individual saturated fatty acids were all associated with an elevated heart disease risk.
Author Interviews, Biomarkers, BMJ, Heart Disease / 25.11.2016

MedicalResearch.com Interview with: Archana Singh-Manoux, PhD Research Professor (Directeur de Recherche) Epidemiology of ageing & age-related diseases INSERM,France MedicalResearch.com: What is the background for this study? What are the main findings? Response: A recent metabolomics study examined 106 biomarkers and found alpha-1-acid glycoprotein (AGP), an acute phase protein, to be the strongest predictor of five-year mortality. It is also unknown how well AGP compares with other sensitive, dynamic, and commonly measured markers of systemic inflammation, such as CRP and IL-6, as a predictor of mortality. We examined the association of these three inflammatory markers with short- and long-term mortality in a large sample of middle-aged adults, followed for 17 years. Our analysis of all-cause, cancer and cardiovascular mortality suggests that for all these outcomes IL-6 may be a better prognostic marker, both in the short and the long-term.
Author Interviews, Heart Disease, JAMA / 22.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29970" align="alignleft" width="200"]Vinay Kini, MD, MS Division of Cardiovascular Medicine Hospital of the University of Pennsylvania The Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Dr. Vinay Kini[/caption] Vinay Kini, MD, MS Division of Cardiovascular Medicine Hospital of the University of Pennsylvania The Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent studies have shown that use of cardiac stress tests has declined by about 25% among Medicare beneficiaries and by about 50% in Kaiser Permanente over the last several years. However, the reasons for these declines is not well understood. Decreases in the use of stress testing could be due to dissemination of appropriate use criteria and other clinical practice guidelines, advances in preventive care, reductions in reimbursement for testing, or other health system organizational characteristics. Therefore, our goal was to determine whether similar declines in testing are observed among a nationally representative cohort of commercially insured patients. We identified over 2 million stress tests performed among 33 million members of the commercial insurance company, and found that there was a 3% increase in the overall use of stress testing in this cohort between 2005 and 2012. Declines in the use of nuclear SPECT tests were offset by increases in the use of stress echocardiography, exercise electrocardiography, and newer stress test modalities such as coronary computed tomography angiography. The largest increase in use of testing was seen among younger individuals - there was a 60% increase in use of testing among patients aged 25-34, and a 30% increase among individuals aged 35-44.
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease, Kidney Disease / 21.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29537" align="alignleft" width="144"]Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada Dr. Paul E Ronksley[/caption] Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada MedicalResearch.com: What is the background for this study? Response: Prior studies have observed high resource use among patients with chronic kidney disease (CKD), which is related to the medical complexity of this patient population. However, there has been limited exploration of how patients with CKD use the emergency department (ED) and whether utilization is associated with disease severity. While the ED is essential for providing urgent or emergent care, identifying ways of improving ED efficiency and decreasing wait times has been recognized as a priority in multiple countries. Improving coordination and management of care for patients with multiple chronic conditions (the norm for CKD) in an outpatient setting may meet health care needs and ultimately improve patient experience and outcomes while reducing the burden currently placed on the ED. However, this requires an understanding of ED use among patients with CKD and the proportion of use that is amenable to outpatient care. Using a large population-based cohort we explored how rates of ED use vary by kidney disease severity and the proportion of these events that are potentially preventable by high quality ambulatory care. We identified all adults (≥18 years) with eGFR<60 mL/min/1.73m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of ED encounters, and followed until death or end of study (March 31, 2013). Within each CKD category we calculated adjusted rates of overall  emergency departmentt use, as well as rates of potentially preventable ED encounters (defined by 4 CKD-specific ambulatory care sensitive conditions (ACSCs); heart failure, hyperkalemia, volume overload, malignant hypertension).
Author Interviews, Gender Differences, Heart Disease, Surgical Research / 21.11.2016

MedicalResearch.com Interview with: Dr James Spratt Bsc, MD, FRCP, FESC, FACC Spire Edinburgh Hospitals and Spire Murrayfield Edinburgh Spire Shawfair Park Hospital MedicalResearch.com: 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.
Author Interviews, Heart Disease, JAMA / 21.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29860" align="alignleft" width="200"]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 Dr. Doug Owens[/caption] 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 MedicalResearch.com: 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.
Author Interviews, Heart Disease, Menopause, Weight Research, Women's Heart Health / 20.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29651" align="alignleft" width="195"]Somwail Rasla, MD Internal Medicine Resident Memorial Hospital of Rhode Island Brown University Dr. Somwail Rasla[/caption] Somwail Rasla, MD Internal Medicine Resident Memorial Hospital of Rhode Island Brown University MedicalResearch.com: 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.
Author Interviews, Emory, Exercise - Fitness, Geriatrics, Heart Disease, Lifestyle & Health / 18.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29745" align="alignleft" width="150"]Vasiliki Georgiopoulou MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine Dr. Vasiliki Georgiopoulou[/caption] Vasiliki Georgiopoulou MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine MedicalResearch.com: 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.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, NEJM, Surgical Research / 17.11.2016

MedicalResearch.com 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 MedicalResearch.com: 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.
Author Interviews, CT Scanning, Heart Disease, JAMA, Women's Heart Health / 16.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29717" align="alignleft" width="180"]Dr-Maryam-Kavousi Dr. Maryam Kavousi[/caption] Maryam Kavousi MD, PhD, FESC Assistant Professor Department of Epidemiology Erasmus University Medical Center Rotterdam The Netherlands  MedicalResearch.com: 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.
Author Interviews, Heart Disease / 16.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29703" align="alignleft" width="180"]Dragana Radovanovic, MD Head of AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute (EBPI) University of Zurich Zurich Dr. Dragana Radovanovic[/caption] Dragana Radovanovic, MD Head of AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute (EBPI) University of Zurich Zurich Switzerland MedicalResearch.com: 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.
Accidents & Violence, Author Interviews, Heart Disease / 16.11.2016

MedicalResearch.com Interview with: Anand M. Irimpen MD Associate Professor of Clinical Medicine Tulane University Medical Center New Orleans, LA MedicalResearch.com: 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.
Author Interviews, Diabetes, Heart Disease, Rheumatology / 16.11.2016

MedicalResearch.com 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 MedicalResearch.com: 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.
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Pharmacology / 16.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29573" align="alignleft" width="149"]Paul J. Hauptman, MD</strong> Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health Dr. Paul Hauptman[/caption] Paul J. Hauptman, MD Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health MedicalResearch.com: 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.
Author Interviews, Critical Care - Intensive Care - ICUs, Education, Heart Disease, Outcomes & Safety / 15.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29515" align="alignleft" width="143"]Dr. Sean van Diepen, MD, FRCPC Assistant Professor of Critical Care Medicine and Cardiology Coronary Intensive Care Unit Co-Director University of Alberta Hospital Dr. Sean van Diepen[/caption] Dr. Sean van Diepen, MD, FRCPC Assistant Professor of Critical Care Medicine and Cardiology Coronary Intensive Care Unit Co-Director University of Alberta Hospital MedicalResearch.com: 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.