Heart Disease
12 Aug Factors Identifying Risk of Poor Weight Loss After Bariatric Surgery Identified
MedicalResearch.com Interview with: [caption id="attachment_26834" align="alignleft" width="143"]
Dr. Michelle Lent[/caption]
Dr. Michelle R. Lent, PhD
Geisinger Obesity Institute
Geisinger Clinic
Danville, Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than one-third of adults in the United States live with obesity. Currently, the most effective treatment for obesity is bariatric surgery. Bariatric surgery patients are expected to lose 30 to 40 percent of their body weight, but not all patients are able to lose this amount of weight and others experience weight regain. Why some patients succeed in weight loss over time, while others are less successful, remains unclear.
In this study, we evaluated over 200 patient characteristics in relation to long-term weight loss after bariatric surgery (7 years or longer), including gender, age and weight at the time of surgery, lab tests, medical conditions and medications, among others. We found that patients who used insulin, had a history of smoking, or used 12 or more medications before surgery lost the most weight, while patients with high cholesterol, older patients and patients with higher body mass indexes at the time of surgery lost the least amount of weight after surgery.
12 Aug New Onset Atrial Fibrillation Strongest Predictor of Stroke After TAVR
MedicalResearch.com Interview with: [caption id="attachment_21314" align="alignleft" width="120"]
Dr. Josep Rodés-Cabau[/caption]
Josep Rodés-Cabau, MD
Director, Catheterization and Interventional Laboratories
Quebec Heart and Lung Institute
Professor, Faculty of Medicine, Laval University
Quebec City, Quebec, Canada
MedicalResearch.com: What is the background for this study?
Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future.
While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR.
10 Aug Apical Periodontitis Significantly Associated With Cardiovascular Diseases
MedicalResearch.com Interview with: [caption id="attachment_26880" align="alignleft" width="100"]
Dr. John Liljestrand[/caption]
John Liljestrand, DDS
Department of Oral and Maxillofacial Diseases
University of Helsinki
MedicalResearch.com: What is the background for this study?
Response: There is an increased amount of evidence supporting the hypothesis that oral inflammations increase the risk for cardiovascular diseases (CVDs). The association between marginal periodontitis, a common inflammatory disease in the tooth supporting tissues, and CVDs is well established. The link is thought to depend on transient but repeated bacteremia, endotoxemia and an increased systemic inflammatory burden.
Apical periodontitis is a common manifestation of an endodontic infection, most often caused by dental caries. It is an inflammatory reaction surrounding the root tip of a tooth and it restrains the dental infection from spreading into the bone. Apical periodontitis is similar to marginal periodontitis regarding its microbial profile and ability to increase systemic inflammatory markers. Therefore, it is justified to suggest that apical periodontitis might also increase the risk for CVDs. There is only a minor amount of publications on this topic and further research is still needed.
09 Aug ACEI and ARBs Had Similar Outcomes in Study of PD Dialysis Patients
MedicalResearch.com Interview with: [caption id="attachment_26841" align="alignleft" width="200"]
Dr. Jenny Shen[/caption]
Jenny Shen, MD, MS
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA
Los Angeles Biomedical Institute at Harbor-UCLA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: With cardiovascular disease being the No. 1 cause of death in end-stage kidney disease patients on peritoneal dialysis, we examined two classes of medications commonly prescribed to prevent cardiovascular events in these patients and found no significant difference in outcomes.
The two classes of medications, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB), have slightly different mechanisms and could theoretically have differing outcomes. Previous studies had suggested that ACEI may lead to a kinin-mediated increase in insulin sensitivity not seen with ARB. This could potentially lower the cardiovascular risk in patients on peritoneal dialysis because they are exposed to high glucose loads in their dialysate that may lead to insulin resistance and its associated cardiovascular risk.
Using a national database, the U.S. Renal Data System, we surveyed records for all patients enrolled in Medicare Part D who initiated maintenance peritoneal dialysis from 2007 to 2011. Of those, we found 1,892 patients using either drug class. Surveying their medical records, we found no difference in cardiovascular events or deaths between the users for each class of medication.
08 Aug Newly Diagnosed Brugada Syndrome Have a Different Prognosis
MedicalResearch.com Interview with: Ruben Casado-Arroyo, MD, PhD Heart Rhythm Management Center Cardiovascular Division, UZ Brussel–Vrije Universiteit Brussel, Cardiology Department, Arrhythmia Section Erasmus Hospital, Université Libre de Bruxelles Brussels, Belgium MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study is to evaluate the evolution of the presentation of Brugada Syndrome (BrS) during the last 30 years. Only the first diagnosed patient of each family was included. The database was divided in two periods (early and latter group) in relation to the consensus conference of 2002. Aborted sudden death as the first manifestation of the disease occurred most frequently in the earlier period 12.1% versus 4.6% of the latter group. Inducibility (induction of ventricular fibrillation) during programmed electrical stimulation was achieved in 34.4% (earlier) and 19.2% (latter) of patients, respectively. A spontaneous type 1 electrocardiogram pattern that is a coved type ST elevation with at least 2 mm (0.2 mV) J-point elevation a gradually descending ST segment followed by a negative T-wave was presented at diagnosis 50.3% (earlier) versus 26.2% (latter patients). Early group patients had a higher probability of a recurrent arrhythmia (sudden cardiac death or ventricular arrhythmias) during follow-up (19%) than those of the latter group (5%). All these difference were significative. Overall, the predictors of recurrent arrhythmias were previous sudden cardiac death and inducibility. In the latter period, only previous sudden cardiac death was a predictor of arrhythmic events.06 Aug EKG Plus Framingham Score Improves Risk of Cardiovascular Disease
MedicalResearch.com Interview with: [caption id="attachment_26683" align="alignleft" width="133"]
Dr. Amit Shah[/caption]
Dr. Amit J. Shah MD MSCR
Research Assistant Professor
Assistant Professor of Epidemiology
Rollins School of Public Health
Emory University
Adjunct appointment in Medicine (Cardiology)
Atlanta VA Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Nearly ½ of sudden cardiac deaths occur in individuals who were not aware that they had heart disease; this increases the need for primary prevention. We studied whether the electrocardiogram could be a useful tool in helping to measure risk of cardiovascular disease in approximately 10,000 community-based adults aged 40-74 with a simple risk equation that is based on age, sex, and 3 numbers from the ECG: heart rate, T-axis, and QT interval. We found that such an equation estimates risk as well as the Framingham risk equation, which is the standard of care (based on traditional risk factors like smoking and diabetes). When combining both the Framingham and ECG risk assessments together, the accuracy improved significantly, with a net 25% improvement in the risk classification of cardiovascular death compared to using the Framingham equation alone.
04 Aug Obesity Raises Risk of Diabetes But Not Heart Attacks in Twins
MedicalResearch.com Interview with: [caption id="attachment_26704" align="alignleft" width="150"]
Prof. Peter Nordstrom[/caption]
Prof. Peter Nordström PhD
Department of Community Medicine and Rehabilitation
Geriatrics, Umeå University
Umeå, Sweden
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Numerous studies has shown an association between BMI, CVD and death. However, it is not known to what extent genetic factors influence this relationship. We used over 4000 monozygous twin pairs that had different BMI. This mean that the difference in BMI must be due to environmental factors since the genetic setup is similar in monozygous twins.
Since the fatter twin did not have a higher risk of myocardial infarction (MI) or death, environmental factors that increase BMI is very unlikely to increase the risk of myocardial infarction or death. By inference the strong association between BMI, MI and death must be explained by the fact that the same genes control both obesity, MI and death. By contrast, the fatter twin had a higher risk of diabetes.
02 Aug Omega-3 fatty Acids May Reduce Cardiac Scarring After Heart Attack
Posted at 11:11h
in AHA Journals, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Omega-3 Fatty Acids
MedicalResearch.com Interview with:
[caption id="attachment_26637" align="alignleft" width="120"]
Dr. Raymond Kwong[/caption]
Raymond Y. Kwong, MD MPH
Director of Cardiac Magnetic Resonance Imaging
Associate Professor of Medicine
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: In the past several decades, Omega-3 fatty acids (O3FA) primarily from fish oil have been reported to have many beneficial effects, either directly on the heart or through other effects that indirectly help the heart. However, when it was tested on patients who suffered an acute heart attack by looking at whether patients can live longer by taking omega-3 fatty acids early after the heart attack, there has been some conflicting data in some of the large clinical trials.
There are several major factors that inspired the designs of the current OMEGA-REMODEL study:
a) Over recent years, many highly effective treatments to improve the survival of heart attack victims have become routine.
b) The studies in the past used a relatively lower dose of Omega-3 fatty acids (1g per day).
c) Some have also raised the question whether just patient mortality should be the only/best way we should considered in assessing new treatments for heart attack patients.
d) Cardiac remodeling: after a heart attack, heart muscle not damaged by the initial heart attack insult has to overwork to compensate for the damage from the heart attack. Over time scarring may form in the overworked heart muscle, in addition to weakened heart function, may lead to the heart to fail.
e)New imaging method: a MRI of the heart, can precisely determine the heart function and the amount of scarring of the overworked heart muscle not damaged from the heart attack.
30 Jul Higher Mortality Risk in Older Patients Readmitted After Heart Failure
MedicalResearch.com Interview with: Cherinne Arundel, MD Washington DC VA Medical Center and Phillip H. Lam, MD Georgetown University Hospital/Washington Hospital Center, Washington, DC MedicalResearch.com: What is the background for this study? What are the main findings? Drs. Arundel and Lam: Over 1 million Medicare beneficiaries are hospitalized every year for heart failure, and about a quarter of...
29 Jul Poor Fitness Second Only To Smoking As Mortality Risk
MedicalResearch.com Interview with: [caption id="attachment_26655" align="alignleft" width="155"]
Dr. Ladenvall[/caption]
Dr Per Ladenvall
Department of Molecular and Clinical Medicine
Sahlgrenska Academy
University of Gothenburg
Sweden
MedicalResearch.com: What is the background for this study?
Response: Aerobic capacity has been shown in other studies with shorter duration to be of importance for mortality. In the 1963 a population based study including every third man living in Gothenburg started. These men have since been followed up repeatedly until 100 years. For the present analysis men were invited to do a bicycle exercise test in 1967 and were followed up to 99 years.
27 Jul Coronary Artery Disease Testing Underutilized in Heart Failure Patients
MedicalResearch.com Interview with: [caption id="attachment_26379" align="alignleft" width="132"]
Dr. Ajay Kirtane[/caption]
Ajay J. Kirtane, MD, SM, FACC, FSCAI
Associate Professor of Medicine at Columbia University Medical Center
Chief Academic Officer, Center for Interventional Vascular Therapy
Director, NYP/Columbia Cardiac Catheterization Laboratories
New York, NY 10032
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients with inpatient heart failure are a higher-risk patient population who can benefit from the identification and treatment of coronary artery disease. We sought to identify how frequently these patients in fact underwent testing for coronary artery disease.
27 Jul Adding Black Race To Scoring System Improves Stroke Prediction in AFib
MedicalResearch.com Interview with: [caption id="attachment_26293" align="alignleft" width="151"]
Dr. Mary Vaughan Sarrazin[/caption]
Dr. Mary Vaughan Sarrazin PhD
Associate Professor
Department of Internal Medicine
University of Iowa Roy and Lucille Carver College of Medicine, and
Iowa City VA Medical Center, Center for Comprehensive Access & Delivery
Research and Evaluation (CADRE)
Iowa City
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation is associated with a higher risk of stroke. The CHA2DS2VASc score (congestive heart failure, hypertension, age 75 or older, diabetes, previous stroke, vascular disease, age 65-74, female sex) reflects stroke risk and is used to guide decisions regarding anticoagulation. Our prior work suggests that African Americans have a higher risk of stroke compared to other patients with atrial fibrillation, even after risk factor adjustments. In the current study, we used Medicare data to test whether addition of black race to CHA2DS2VASc score improves stroke prediction in patients with atrial fibrillation.
27 Jul Moderate Exercise Lowers Heart Disease risk in Young Women
Posted at 19:51h
in AHA Journals, Author Interviews, Exercise - Fitness, Gender Differences, Heart Disease
MedicalResearch.com Interview with:
[caption id="attachment_26317" align="alignleft" width="133"]
Dr. Andrea K. Chomistek[/caption]
Andrea K. Chomistek, MPH, ScD
Assistant Professor
Department of Epidemiology and Biostatistics
School of Public Health
Indiana University-Bloomington
MedicalResearch.com: What is the background for this study?
Response: Previous studies of exercise and coronary heart disease have been primarily conducted in middle-aged and older adults, so we thought it was important to examine this association in younger women as mortality rates in young women have not declined in recent years like they have in other age groups.
22 Jul Maintaining Aerobic Fitness Linked Decreased Risk of Premature Death
MedicalResearch.com Interview with: [caption id="attachment_26275" align="alignleft" width="180"]
Dr. Jari Laukkanen[/caption]
Jari Laukkanen MD, PhD
Cardiologist
Institute of Public Health and Clinical Nutrition
University of Eastern Finland
Kuopio Finland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In this population-based study we found a strong inverse association between long-term change in directly measured cardio-respiratory fitness (CRF), using maximal oxygen uptake (VO2peak) and all-cause mortality. A small decrease in CRF over 11-years was associated with a lower risk of all-cause death in a graded fashion. The observed association was independent of risk factors. This population-based study with repeated and direct assessment of CRF using a very similar time-interval for all participants, whereas some previous studies showing the value of CRF were constructed on participants referred to exercise testing at varying time-intervals between two repeated tests using only indirect cardio-respiratory fitness assessment or other exercise scores.
Cardiorespiratory fitness was assessed at baseline and follow-up using respiratory gas analyzer which is a golden standard for assessing aerobic fitness level. A single assessment of CRF predicts outcomes, however, no previous studies using directly measured VO2max have shown the association between long term changes in VO2max (i.e. 10 years) and its association with mortality. In the recent study VO2max defined from respirator gases with similar time-interval between two separate assessments of VO2max (=directly measured). This is a very novel finding in the field of exercise sciences, as well as in cardiovascular prevention and rehabilitation.
Although cardio-respiratory fitness is recognized as an important marker of functional ability and cardiovascular health, it is currently the major risk factor that is not routinely and regularly assessed in either the general or specialized clinical setting, although it is suggested that an individual’s CRF level has been even a stronger or similar predictor of mortality than the traditional risk factors, including smoking, hypertension, high cholesterol, and type 2 diabetes mellitus.
21 Jul Non-Diabetics With High Blood Sugar May Face Increased Heart Disease Risk
MedicalResearch.com Interview with: Dr Fiona Bragg Clinical Research Fellow Clinical Trial Service Unit and Epidemiological Studies Unit Nuffield Department of Population Health University of Oxford MedicalResearch.com: What is the background for this study? Response: Diabetes is known to be a risk factor for cardiovascular disease. It is less clear, however, whether higher blood glucose levels in individuals without diabetes are also associated with higher risk for cardiovascular diseases. It is important to examine this association because it may help us to understand the mechanisms underlying these diseases as well as appropriate approaches to preventing them. We therefore looked at this association in the China Kadoorie Biobank study of 0.5 million Chinese adults, examining the relationship between blood glucose levels and the subsequent risk for cardiovascular diseases among participants with no history of diabetes at the time of recruitment to the study.19 Jul Diabetes Medications: No Clear Difference in Effect on Life Expectancy or Heart Disease
[caption id="attachment_26204" align="alignleft" width="143"]
Dr. Suetonia Palmer[/caption]
MedicalResearch.com Interview with:
Principal investigator A/Prof Suetonia Palmer PhD
University of Otago, New Zealand
[caption id="attachment_26202" align="alignleft" width="142"]
Dr. Giovanni Strippoli[/caption]
Senior investigator
Prof. Giovanni Strippoli
MD, PhD, MPH, MM
University of Sydney, Australia and Diaverum, Sweden
MedicalResearch.com: What is the background for this study?
Response: Network meta-analysis is a new technique that allows us to evaluate ALL medical therapies for a specific clinical problem. We wondered whether any of the usual drugs used to treat glucose levels in people with diabetes were safest or most effective.
18 Jul Selection Bias Does Not Explain White Prevalence of Prevalence of Atrial Fibrillation
MedicalResearch.com Interview with: [caption id="attachment_26228" align="alignleft" width="137"]
Dr. Evan Thacker[/caption]
Evan L. Thacker, PhD.
Assistant Professor
College of Life Sciences
Brigham Young University
Provo, UT
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation (AF) is diagnosed more commonly in whites than blacks in the United States. This seems paradoxical because blacks have higher prevalence of many risk factors for AF. Various explanations for this paradox have been proposed, including biological explanations as well as potential biases in research studies. We investigated one such bias – selection bias – as a potential explanation for the paradox. We did this by comparing the racial difference in atrial fibrillation prevalence among people who enrolled in an epidemiologic study versus people who were eligible to enroll in the study but did not enroll.
18 Jul Niacin-Laropiprant Reduced Quality of Life-Adjusted Survival and Increased Hospital Costs in HPS2-THRIVE
MedicalResearch.com Interview with: Seamus Kent, MSc, Research Fellow and Borislava Mihaylova, MSc DPhil, Associate Professor Health Economics Research Centre, Nuffield Department of Population Health University of Oxford, UK MedicalResearch.com: What is the background for this study? Response: Niacin lowers the LDL cholesterol and increases the HDL cholesterol and it was hoped this would translate into reduced risks of vascular events. This hypothesis was assessed in the Heart Protection Study 2 – Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) trial in which over 25,000 adults aged 50 to 80 years with prior cardiovascular disease were randomised to either niacin-laropiprant or placebo, in addition to effective LDL-cholesterol lowering therapy, and followed for about 4 years. Previously published results from the study demonstrated that niacin-laropiprant did not significantly reduce the risk of major vascular events but did significantly increase the risk of various adverse events including infections, bleeding, gastrointestinal, musculoskeletal, skin, and diabetes-related events.13 Jul Coronary CT Able To Exclude Significant CAD in Patients Scheduled for Valve Surgery
MedicalResearch.com Interview with: [caption id="attachment_26076" align="alignleft" width="150"]
Dr. Maksymilian Opolski[/caption]
Dr Maksymilian P. Opolski
Department of Interventional Cardiology and Angiology
Institute of Cardiology
Warsaw, Poland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Valvular heart disease (VHD) that requires surgery is increasingly encountered in industrialized countries. Of particular interest, the presence of concomitant coronary artery disease (CAD) in patients with VHD is related to worse clinical outcomes, and various clinical studies suggested that combined valve and bypass surgery reduces early and late mortality. Consequently, in the majority of such patients, pre-operative evaluation for coronary artery disease (CAD) with invasive coronary angiography is recommended. However, provided that most patients with valvular heart disease are found to have no significant coronary stenoses, coronary computed tomography angiography (coronary CTA) appears as an extremely appealing noninvasive alternative to invasive coronary angiography for exclusion of significant CAD. This is further justified when the risks of angiography outweigh its benefits (e.g. in cases of aortic dissection or aortic vegetation).
12 Jul Black Heart Failure Patients Have More Readmissions and Lower Mortality Than Whites
Posted at 11:39h
in Author Interviews, Heart Disease, Hospital Readmissions, JACC, NYU/NYMC, Race/Ethnic Diversity
MedicalResearch.com Interview with:
Matthew Durstenfeld MD
Department of Medicine
Saul Blecker, MD, MHS
Department of Population Health and Department of Medicine
New York University School of Medicine
NYU Langone Medical Center
New York, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Racial and ethnic disparities continue to be a problem in cardiovascular disease outcomes. In heart failure, minority patients have more readmissions despite lower mortality after hospitalization for heart failure. Some authors have attributed these racial differences to differences in access to care, although this has never been proven.
Our study examined patients hospitalized within the municipal hospital system in New York City to see whether racial and ethnic disparities in readmissions and mortality were present among a diverse population with similar access to care. We found that black and Asian patients had lower one-year mortality than white patients; concurrently black and Hispanic patients had higher rates of readmission. These disparities persisted even after accounting for demographic and clinical differences among racial and ethnic groups.
12 Jul Does Eating More Often Important Improve Cardiovascular Health?
MedicalResearch.com Interview with: [caption id="attachment_26078" align="alignleft" width="200"]
Dr. Hsin-Jen Chen[/caption]
Hsin-Jen Chen, PhD MS
Assistant Professor
Institute of Public Health
National Yang-Ming University
Taipei City
MedicalResearch.com: What is the background for this study?
Response: The number of eating occasions may affect health. Laboratory experiments have been showing that splitting daily food consumption into more eating occasions could improve metabolic profiles, such as healthier blood glucose and lipids levels. However, such kinds of experiments usually design a highly controlled diet for the participants in the lab. It is questionable whether such metabolic benefits remain in our daily life (namely, no controlled diets) where we can eat at anytime when we want to eat.
11 Jul Statins Reduces But Don’t Eliminate Risk of CAD In Familial Hypercholesterolemia
MedicalResearch.com Interview with: Joost Besseling, PhD-student Academic Medical Center Dept. of Vascular Medicine Amsterdam MedicalResearch.com: What is the background for this study? Response: It was unkown to what extent statin therapy reduces the risk for coronary artery disease and mortality in patients with heterozygous familial hypercholesterolemia (FH). One previous study found that the relative risk reduction was 76%, but the study population in this study consisted of with a very severe FH phenotype. This result is therefore an overestimation of the risk reduction in the general heterozygous familial hypercholesterolemia population.11 Jul Dramatic Increase in the Number of US Adults Living With Congenital Heart Defects
MedicalResearch.com Interview with: [caption id="attachment_25748" align="alignleft" width="200"]
Dr. Suzanne Gilboa[/caption]
Suzanne Meredith Gilboa, PhD
Epidemiologist at the Centers for Disease Control and Prevention’s
National Center on Birth Defects and Developmental Disabilities
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Because of advancements in care, there has been a decline in mortality from congenital heart defects (CHD) over the last several decades. However, there are no current empirical data documenting the number of people living with CHD in the United States (US).
The purpose of this study was to estimate the congenital heart defects prevalence across all age groups in the US for the year 2010. Using prevalence data from Québec, Canada in the year 2010 as a foundation for a mathematical model, we estimated that approximately 2.4 million people (1.4 million adults, 1 million children) were living with CHD in the US in the year 2010. Nearly 300,000 subjects had severe CHD. Overall, there was a slight predominance of females compared to males.
09 Jul Diets High In Subsidized Foods May Raise Risk of Diabetes and Heart Disease
MedicalResearch.com Interview with: [caption id="attachment_25950" align="alignleft" width="184"]
Dr. Edward Gregg[/caption]
Edward Gregg, PhD
Chief of the Epidemiology and Statistics Branch
Division of Diabetes Translation
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The research was led by the lead author, Karen R. Siegel, PhD, as part of her PhD graduate studies at Emory for her dissertation. Although subsidized foods are intended to ensure adequate availability of storable, staple foods, studies at the population level have linked these subsidies to risk of cardiovascular disease and type 2 diabetes. This study is the first of its kind to examine these relationships at the individual level – specifically, the relationship between diets made up of more subsidized foods, and an individual’s personal risks for developing cardiovascular disease and type 2 diabetes.
The study design that was used here does not allow us to say that these subsidized foods specifically cause type 2 diabetes and cardiovascular disease. Rather, people whose diets contain more corn, soybean, wheat, rice, sorghum, dairy, and livestock products are at greater risk for type 2 diabetes and cardiovascular disease.
According to this research, people whose diets contained more subsidized foods were on average younger, less physically active and more likely to be smokers. They also had much less income, education and food security - or the ability to get enough safe and healthy food to meet their dietary needs.
07 Jul Familial Hypercholesterolemia, Widely Under-Diagnosed, Raises Risk of Atherosclerotic Cardiovascular Disease
MedicalResearch.com Interview with: [caption id="attachment_26134" align="alignleft" width="141"]
Dr. Perak[/caption]
Amanda M. Perak, MD
Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, and
Department of Preventive Medicine
Northwestern University Feinberg School of Medicine
Donald M Lloyd-Jones, MD/ScM (senior author)
Senior Associate Dean for Clinical and Translational Research; Chair, Department of Preventive Medicine
Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) and Eileen M. Foell Professor
Professor in Preventive Medicine-Epidemiology and Medicine-Cardiology
MedicalResearch.com: What is the background for this study?
Response: Heterozygous familial hypercholesterolemia, or FH, affects up to 1 in 200 individuals in the United States. FH is a genetic disorder that should be suspected in individuals with very high levels of low-density lipoprotein cholesterol (LDL-C; at least 190 mg/dL) plus a first-degree relative with similar degree of high cholesterol or with premature coronary heart disease. Individuals with FH are exposed to high levels of "bad" cholesterol from birth, so if they are not treated with cholesterol-lowering therapy, they are at elevated risk for atherosclerotic cardiovascular disease (ASCVD; diseases related to hardening of the arteries, including heart attack and stroke). However, these risks previously had not been well quantified in untreated individuals with familial hypercholesterolemia in the general US population.
06 Jul Omega-3 Fatty Acids from Fish May Benefit Those At Risk of CAD
MedicalResearch.com Interview with: Dr. Marcus E. Kleber Fifth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim University of Heidelberg Mannheim, Germany MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many epidemiological studies found inverse associations between the concentration of omega-3 fatty acids, especially EPA and DHA, and cardiovascular disease and mortality. On the other hand, most clinical trials that investigated the effect of omega-3 supplementation on cardiovascular risk failed to show a benefit. Therefore, the role of omega-3 fatty acids is still debated controversially. One problem with clinical trials is that they usually do not screen their participants for their initial omega-3 status. In our study we measured the omega-3 status of our participants using a very reliable and validated method and found an inverse association of EPA and DHA with all-cause and cardiovascular mortality.04 Jul Salt-Retaining Drug First Biomedical Treatment for Vasovagal Fainting
MedicalResearch.com Interview with: Robert Sheldon, MD, PhD Division of Cardiology, Department of Cardiac Sciences University of Calgary, Calgary, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: Vasovagal syncope is very common and more debilitating than most people appreciate. Probably up to 50% of people faint from this in their lives, making it the most common cardiovascular symptom. Around 15-20 years ago we had learned that the recurrence rates for vasovagal syncope were quite high, and that quality of life was correspondingly low. From the results of our earlier Vasovagal Pacemaker Study II and Prevention of Syncope Trial I (POST I) we knew that neither pacemakers nor beta blockers helped most patients with vasovagal syncope. However there was ample evidence that a reduction in venous return and cardiac preload were important early steps in the vasovagal cascade. Florinef is a salt-retaining mineralocorticoid that is successful in treating orthostatic hypotension with tantalizing early evidence that it might prevent vasovagal syncope induced by tilt tests. We therefore set out to test whether it prevented vasovagal syncope in a randomized placebo-controlled clinical trial. One important early part of designing a clinical trial is estimating the event rate in the untreated and treated arms. Based on our earlier work we could predict the untreated event rate but there were no data on which we could estimate the treated outcome rate. We therefore surveyed numerous colleagues for what they considered a Minimal Clinically Important Difference, and the answer was a 40% relative risk reduction. That is, to make fludrocortisone appealing to clinicians it should cause a relative risk reduction of 40%. We used this estimate to design the study. There are two main conclusions.- First, we studied the right population, people who would clearly be considered for active biomedical treatment. They had fainted 15-20 times in their lives and 3-4 times in the preceding year.
- Second, we found that fludrocortisone reduced syncope by 31%, and this narrowly missed conventional statistical significance. However when we adjusted for the first two weeks that were allotted for dose adjustment we found that fludrocortisone reduced syncope by up to 50% in people who were taking 0.2 mg daily. This is quite a low dose, deliberately picked to be safe in this young and predominantly female population.
04 Jul Supply of Technetium-99m For Cardiac Stress Testing Constricted By Regulations and Aging Reactors
MedicalResearch.com Interview with: [caption id="attachment_25587" align="alignleft" width="200"]
Dr. Venkatesh Murthy[/caption]
Venkatesh Locharla Murthy MD,
PhD, FACC, FASNC
Assistant Professor, Internal Medicine
Frankel Cardiovascular Center
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Technetium-99m, which is very commonly used for cardiac stress testing, has had multiple supply disruptions due to aging nuclear reactors where it is produced coupled with changing regulations to minimize the risk of nuclear proliferation. The most severe of these disruptions occurred over six months in 2010.
We asked whether this disruption lead to changes in patterns of care among Medicare beneficiaries. We found that during this time, use of technetium-99m in nuclear stress testing fell from 64% to 49%, reflecting a shift towards thallium-201, which has higher radiation exposure and lower diagnostic specificity. This was reflected in a 9% increase in the rate of cardiac catheterization after a nuclear stress test during the study period, implying nearly 6,000 additional, possibly unnecessary, catheterizations during that time.
01 Jul Abca1 Deficiency Protects the Heart Against Myocardial Infarction-Induced Injury
MedicalResearch.com Interview with: Dr. Mieke Louwe (1) and Prof. dr. Miranda van Eck (2) 1Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands 2Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands [caption id="attachment_25761" align="alignleft" width="110"]
Dr. Mieke Louwe[/caption]
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Prof. Miranda van-Eck[/caption]
MedicalResearch.com: What is the background for this study?
Response: ATP-binding cassette transporter A1 (Abca1) is a key protein facilitating the production of high-density lipoprotein (HDL) and the maintenance of macrophage cholesterol homeostasis. Patients and mice with mutations in the Abca1 gene have virtually no HDL in their circulation. Since HDL plays a key protective role in atherosclerosis, by exerting several cardioprotective functions, up regulation of Abca1 is considered as an important novel therapeutic strategy to prevent atherosclerotic cardiovascular disease. Although the role of Abca1 in atherosclerosis is extensively studied, the interplay between Abca1 and myocardial infarction, an acute cardiovascular event often resulting from rupture of advanced atherosclerotic plaques, has not yet been investigated.