Heart Disease
04 Jan Metformin Associated With Lower Mortality in CKD, CHF and Chronic Liver Disease
Posted at 01:33h
in Annals Thoracic Surgery, Author Interviews, Diabetes, Duke, Heart Disease, Hepatitis - Liver Disease, Pharmacology
MedicalResearch.com Interview with:
[caption id="attachment_30926" align="alignleft" width="156"]
Dr. Matthew Crowley[/caption]
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.
04 Jan Biomarker sST2 Predicts All-Cause and Cardiac Death in Heart Failure Patients
MedicalResearch.com Interview with: [caption id="attachment_30915" align="alignleft" width="188"]
Prof. Michele Emdin[/caption]
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.
02 Jan More Than Moderate Alcohol Not Good For The Heart
MedicalResearch.com Interview with: [caption id="attachment_30841" align="alignleft" width="166"]
Dr. Gregory M Marcus[/caption]
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.
02 Jan Children Who Survive Congenital Heart Disease Still Face Increased Mortality Risks
MedicalResearch.com Interview with: Zacharias Mandalenakis MD, PhD Internist, Cardiologist GUCH-centrum, Cardiology section, Emergency, Geriatric & Internal Medicine Department Sahlgrenska University Hospital Gothenburg, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: According to our national registry data in Sweden, the survivorship in children and young adults with congenital heart disease has been...
31 Dec Cardiac Disease Linked To Elevated Risk of Shoulder Pain and Rotator Cuff Tendinitis
MedicalResearch.com Interview with: [caption id="attachment_30872" align="alignleft" width="142"]
Dr. Kurt Hegmann[/caption]
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.
29 Dec Some Type 2 Diabetics May Benefit From Adding Fenofibrate To Statins
MedicalResearch.com Interview with: [caption id="attachment_30835" align="alignleft" width="170"]
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.
25 Dec Familial Hypercholesterolemia Diagnosed Through EHR and Genetics Data
Posted at 21:04h
in Author Interviews, Electronic Records, Genetic Research, Heart Disease, Lipids, Science
MedicalResearch.com Interview with:
[caption id="attachment_30763" align="alignleft" width="133"]
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.
20 Dec Genetic Calcification Disorder May Lead To Better Treatment of Atherosclerosis
MedicalResearch.com Interview with: [caption id="attachment_30662" align="alignleft" width="106"]
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.
17 Dec Annual Report of Transcatheter Valve Therapy Registry
MedicalResearch.com Interview with: [caption id="attachment_30605" align="alignleft" width="132"]
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.
16 Dec Young Smokers Have Drastic Increase in Heart Attack Risk
MedicalResearch.com Interview with: [caption id="attachment_30578" align="alignleft" width="133"]
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.
09 Dec How Heart-Healthy Cereals Reduce Cholesterol
MedicalResearch.com Interview with: [caption id="attachment_30382" align="alignleft" width="200"]
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.
09 Dec Who Benefits from an Implantable Defibrillator?
MedicalResearch.com Interview with: [caption id="attachment_30321" align="alignleft" width="161"]
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.
09 Dec Predicting Unsuccessful Electrical Cardioversion for Acute Atrial Fibrillation
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.04 Dec Delayed Epinephrine Linked To Worse Survival From In-Patient Cardiac Arrest
Posted at 23:04h
in AHA Journals, Author Interviews, Heart Disease, Outcomes & Safety, UT Southwestern
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.
04 Dec High Intensity Statins Increase For High Risk Atherosclerotic Patients, But Lagging in Women and Minorities
MedicalResearch.com Interview with: [caption id="attachment_30181" align="alignleft" width="166"]
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.
03 Dec Non-Exercise Algorithm Predicts Fitness and Lifestyle-Related Disease
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.02 Dec CT Angiography Study Finds No Association Between Alcohol and Coronary Artery Disease
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.30 Nov Which Sports Reduce Risk of Mortality?
MedicalResearch.com Interview with: [caption id="attachment_30012" align="alignleft" width="133"]
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.
27 Nov Association Between Statin Use and Ischemic Stroke or Hemorrhage in Patients Taking Dabigatran for A Fib
MedicalResearch.com Interview with: [caption id="attachment_29867" align="alignleft" width="200"]
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.
27 Nov STEMI Outcomes Improve For Both Genders, But More So For Men
Posted at 01:13h
in AHA Journals, Author Interviews, Gender Differences, Heart Disease, Surgical Research
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.
25 Nov Some Saturated Fatty Acids Linked To Risk of Coronary Artery Disease
MedicalResearch.com Interview with: [caption id="attachment_29966" align="alignleft" width="190"]
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.
25 Nov Inflammatory Biomarkers Found Linked to Risk of Mortality
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.22 Nov Cardiac Stress Testing Increases Modestly in Commercially Insured Patients
MedicalResearch.com Interview with: [caption id="attachment_29970" align="alignleft" width="200"]
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.
21 Nov Emergency Department Use High Among CKD Patients, Primarily for Heart Failure
Posted at 17:58h
in Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease, Kidney Disease
MedicalResearch.com Interview with:
[caption id="attachment_29537" align="alignleft" width="144"]
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).
21 Nov Women Undergoing Stent Surgery for Total Coronary Occlusions Tend To Be Older and Have More Complications
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.21 Nov USPSTF Updates Recommendation of Statins for Prevention of Heart Disease
MedicalResearch.com Interview with: [caption id="attachment_29860" align="alignleft" width="200"]
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.
20 Nov Increased Risk of Heart Disease in Postmenopausal Women With History of Weight Cycling
Posted at 20:46h
in Author Interviews, Heart Disease, Menopause, Weight Research, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_29651" align="alignleft" width="195"]
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.
18 Nov The Health ABC Study: Simple Exercise Test Predicts Heart Failure
Posted at 00:49h
in Author Interviews, Emory, Exercise - Fitness, Geriatrics, Heart Disease, Lifestyle & Health
MedicalResearch.com Interview with:
[caption id="attachment_29745" align="alignleft" width="150"]
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.
17 Nov Fully Magnetized HeartMate 3 LVAD Eliminates Pump Clots
Posted at 21:28h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, NEJM, Surgical Research
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
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.