Author Interviews, End of Life Care, Heart Disease, JAMA / 24.05.2016

MedicalResearch.com Interview with: James N. Kirkpatrick, MD Director of the Echocardiography Laboratory Division of Cardiology Ethics Consultation Service University of Washington, Seattle MedicalResearch.com: What is the background for this study? Dr. Kirkpatrick: With significant advances in technology, implanted cardiac devices like pacemakers and defibrillators, replacement heart valves, and mechanical pumps which assist or replace the pumping function of the heart have become standard therapies for patients with severe cardiac disease. Many patients who would previously have died after living with severe symptoms live longer and with improved quality of life. This is particularly true for elderly patients who receive transcatheter aortic valve replacement (TAVR—valve replacement that doesn’t require open heart surgery) and ventricular assist device (VAD—a durable mechanical heart pump) implantation. However, like everyone, these patients will die, and some of the patients will experience device complications which will shorten their lives. Elderly patients, in particular, are at risk for device complications, high symptom burden, and loss of the ability to make healthcare decisions, due to illnesses like strokes or dementia. Symptom management and advance care planning are the hallmarks of the medical specialty of Palliative Care and are particularly important in patients with TAVR and VADs, yet patients and clinicians don’t often think of Palliative Care when considering high tech, life-prolonging therapies. The Palliative Care Working Group of the American College of Cardiology’s Geriatrics Section therefore sought to gather data on the attitudes toward Palliative Care among cardiovascular clinicians and the current state of involvement of Palliative Care in the care of patients with TAVR and VAD. (more…)
Author Interviews, Heart Disease / 23.05.2016

MedicalResearch.com Interview with: Ramzi Tabbalat, MD, FACC Khalidi Hospital and Medical Center Amman Jordan MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Tabbalat: Atrial fibrillation (AF) is the most common arrhythmia in patients undergoing open heart surgery. It occurs in about 26% of such patients and leads to increase morbidity and hospital cost. This makes prevention of AF a priority and several interventions have had variable success in this regards. Colchicine, a potent anti-inflammatory agent, has shown promise in AF prevention in the COPPS-1 trial. Our study aimed to determine if colchicine administered preoperatively and continued until hospital discharge can prevent AF in post open heart surgery patients. In our study of 360 patients, colchicine failed to significantly reduce the incidence of postoperative AF (RRR 29%, p=0.14). Its use was associated with significant diarrhea in 25% of patients. Diarrhea led to discontinuation of colchicine in more than half of affected patients. (more…)
Author Interviews, Heart Disease, Hospital Acquired, Infections, Surgical Research / 22.05.2016

MedicalResearch.com Interview with: Luis Nombela-Franco, MD, PhD Structural cardiology program. Interventional Cardiology department. Hospital Clínico San Carlos, Cardiovascular Institute Madrid, Spain (Dr. Nombela-Franco, has a special interest in interest on percutaneous treatment of structural heart disease and coronary interventions with special focus on chronic total occlusion) MedicalResearch.com: What is the background for this study? Dr. Nombela-Franco: In-hospital infections are one of the most common complications that may occur following medical and surgical admissions, significantly impacted length of hospital stay, costs and clinical outcomes. In addition, approximately one third of hospital-acquired infections are preventable. Transcatheter aortic valve replacement (TAVR) is currently the standard of care for symptomatic patients with severe aortic stenosis deemed at high surgical risk or inoperable. Patients undergoing TAVR have several comorbidities and the invasive (although less invasive the surgical treatment) nature of the procedure and peri-operative care confers a high likelihood in-hospital infections in such patients. This study analyzed the incidence, predictive factors and impact of in-hospital infections in patients undergoing transcatheter aortic valve implantation. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 19.05.2016

MedicalResearch.com Interview with: Yvan Devaux, PhD Associate Head of Laboratory Cardiovascular Research Unit Department of Population Health Luxembourg Institute of Health Luxembourg MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Devaux: Being able to predict outcome after cardiac arrest would allow tailoring healthcare and would represent a major step forward towards personalized medicine. However, available predictive tools suffer serious limitations and would benefit from novel biomarkers. The value of microRNAs (miRNAs) as biomarkers has been investigated in various clinical contexts and initial small-scale studies suggested that miRNAs might be useful indicators of outcome after cardiac arrest. Our work aimed at testing whether these molecules, and in particular the brain-enriched miR-124-3p, can be used to predict outcome after cardiac arrest. We found that, indeed, circulating levels of miR-124-3p measured 48h after cardiac arrest are robust predictors of neurological outcome and mortality. The strengths of the study are the use of a large multicenter international cohort (TTM-trial) and the collaboration between LIH and European partners (members of the TTM-trial and the Cardiolinc network) bringing complementary clinical and basic expertise. (more…)
Author Interviews, Heart Disease / 18.05.2016

MedicalResearch.com Interview with: Paul D. Loprinzi, PhD. Assistant Professor Health, Exercise Science & Recreation Management and Ovuokerie Addoh, MBBS. PhD Student: Health Behavior & Promotion. Graduate Asst: Cardiac Rehabilitation The University of Mississippi University, MS MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Pooled Cohort Risk (PCR) equations, developed by the American College of Cardiology/American Heart Association (ACC/AHA), were initially developed to predict an individual’s 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event. Individuals with a PCR score of 7.5% or higher are considered to have an elevated risk of a first ASCVD event within 10 years. The PCR equation takes into consideration an individual’s age, gender, race-ethnicity, total cholesterol level, high density lipoprotein (HDL) cholesterol, treated or untreated blood pressure, diabetes status, and smoking status. The PCR equations have previously been utilized to predict an individual’s 10-year risk of a first ASCVD event; however, less research has evaluated the extent to which the equations can predict an individual’s risk for early mortality. Adults 40-79 years and free of cardiovascular disease (CVD) who had a higher score from the PCR equations had an increased risk of CVD-specific and all-cause mortality risk. Adults with a higher PCR score had a 47% to 77% increased risk of all-cause mortality. (more…)
Author Interviews, Breast Cancer, Weight Research, Women's Heart Health / 18.05.2016

MedicalResearch.com Interview with: Julie M. Kapp, MPH, PhD Associate Professor 2014 Baldrige Executive Fellow University of Missouri School of Medicine Department of Health Management and Informatics Columbia, MO 65212 MedicalResearch.com: What is the background for this study? Dr. Kapp: For the past several decades the U.S. has had the highest obesity rate compared to high-income peer countries, and for many years people in the U.S. have had a shorter life expectancy. For female life expectancy at birth, the U.S. ranked second to last. At the same time, the U.S. has the third highest rate of mammography screening among peer countries, and the pink ribbon is one of the most widely recognized symbols in the U.S. While the death rate in females for coronary heart disease is significantly higher than that for breast cancer, at 1 in 7.2 deaths compared to 1 in 30, respectively, women have higher levels of worry for getting breast cancer. (more…)
Author Interviews, Heart Disease, JACC, Kidney Disease / 15.05.2016

MedicalResearch.com Interview with: Ambarish Pandey, MD Cardiology Fellow, PGY5 University of Texas Southwestern Medical Center Dallas, Texas MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Pandey: Previous studies have reported an underutilization of guideline based heart failure therapies among patients with heart failure (HF) and end-stage renal diseases. However, it is not known if the proportional use of these evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. In this study, we observed a significant increase in adherence to heart failure process of care measures over time among dialysis patients with no significant change in clinical outcomes over time. (more…)
AHA Journals, Author Interviews, Heart Disease, Lipids / 13.05.2016

MedicalResearch.com Interview with: Michael Miller, MD, FACC, FAHA Professor of Cardiovascular Medicine, Epidemiology & Public Health University of Maryland School of Medicine Staff Physician, Baltimore VAMC Director, Center for Preventive Cardiology University of Maryland Medical Center Baltimore, Maryland MedicalResearch.com: What is the background for this study? Dr. Miller: It has become an article of faith that HDL (the good cholesterol) is an independent risk factor for heart disease. However, previous studies did not examine the importance of HDL after accounting for both LDL (bad cholesterol) and triglycerides (blood fats).  This is important because HDL is associated with LDL and triglycerides. We hypothesized that if HDL is truly an independent risk factor, then low HDL levels in isolation would continue to be linked to an increased risk of heart disease while high HDL levels would continue to protect the heart even if LDL and triglycerides levels were elevated. (more…)
Author Interviews, Heart Disease, Transplantation / 12.05.2016

MedicalResearch.com Interview with: Jaimin Trivedi, MD, MPH Instructor Department of Cardiovascular and Thoracic Surgery University of Louisville Louisville, KY 40202 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Trivedi: There is a donor heart shortage in United States and certain donor hearts are likely to be turned down because the donors required cardiopulmonary resuscitation (CPR) prior to procurement. The rationale behind conducting the study was to identify impact of donor CPR and its duration on recipient survival after transplantation. Our findings show that presence of CPR and duration of CPR does not adversely impact the post heart transplant survival. The study also shows that ejection fraction and peak cardiac troponins between the CPR and non-CPR donors were comparable at time of transplant suggesting recovery of cardiac function. (more…)
Author Interviews, Heart Disease, JAMA, Social Issues / 12.05.2016

MedicalResearch.com Interview with: Erica Spatz, MD, MHS Assistant Professor, Section of Cardiovascular Medicine Center for Outcomes Research and Evaluation Yale University School of Medicine/Yale-New Haven Hospital New Haven, CT 06520 MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Spatz: Rates of heart attack have declined during the last 15 years. But whether communities of different economic status or in different geographic regions experienced similar declines is unknown, especially as efforts to prevent cardiovascular disease and manage heart attacks may not have been equally successful in communities with different resource capacity. Our study shows that trends in the incidence of and mortality from heart attack were similar in low, average and high income communities. However, low-income communities had higher hospitalization rates than average and high income communities throughout the 15 year study period. Interestingly mortality rates were similar. (more…)
Author Interviews, Heart Disease, Johns Hopkins, Nature, Technology / 11.05.2016

MedicalResearch.com Interview with: Natalia Trayanova PhD, FHRS, FAHA Murray B. Sachs Endowed Chair Professor of Biomedical Engineering Joint Appointment, Medicine Johns Hopkins University Institute for Computational Medicine Johns Hopkins University Baltimore, MD MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Trayanova: The methodology for modeling cardiac electrical function has matured sufficiently that we can now create computational models of the electrical functioning of the entire heart. My research is focused on translating this methodology into the clinic. The goal is to create, if you will, "a virtual heart for every patient", that will enable the physician to play our scenarios that manifest the heart dysfunction in the given patient, and to enable physicians to make personalized decisions about patient treatment. The present paper is the first application of this overall vision. The motivation for this particular paper was that determining which patients are at risk for sudden cardiac death represents a major unmet clinical need. Patients at risk receive life-saving implantable defibrillators (ICDs), but because of the low sensitivity and specificity of current approach (based on low ejection fraction), risk assessment is inaccurate. Thus, many patients receive ICDs without needing them, while others die of sudden cardiac death because they are not targeted for ICD therapy under the current clinical recommendations. Our goal was to develop a non-invasive personalized virtual-heart risk assessment tool that has the potential to ultimately prevent sudden cardiac death and avoid unnecessary ICD implantations. (more…)
Author Interviews, Heart Disease, Stem Cells / 11.05.2016

MedicalResearch.com Interview with: Timothy D. Henry, MD, MSCAI Director, Division of Cardiology Cedars-Sinai Heart Institute  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Henry: Heart failure it the #1 cause of morbidity, mortality and cost in the United States today.  Patients with Class 3 heart failure, despite optimal medical therapy and device therapy have limited options beyond heart transplantation and left ventricular cyst device. Transplantation and LVAD are expensive and are challenged by both availability and complications.  Therefore, treatment for patients with ongoing symptoms despite medical therapy is an admiral goal.  Stem cell therapy appears to be an attractive choice for these patients, in particular patients with ischemic cardiomyopathy. The ATHENA trial was designed to treat patients with ischemic cardiomyopathy and ongoing ischemia with autologous adipose-derived regenerative cells.  Patients would undergo liposuction with onsite processing of their stem cells in 1 ½ - 2 hours, followed by intramyocardial injection of adipose-derived regenerative cells (ADCRs) vs. placebo. (more…)
Author Interviews, Heart Disease, University Texas, Weight Research / 11.05.2016

MedicalResearch.com Interview with: Sanghamitra Mohanty, MD MS FHRS Director, translational research, Texas Cardiac Arrhythmia Institute and Associate Professor (affiliate) Dell Medical School What is the background for this study? What are the main findings? Dr. Mohanty:  In the last few years, several trials from a research group in Australia have generated tremendous interest in life-style modifications to manage AF more effectively. These studies reported significant decrease in arrhythmia burden and symptom severity and improvement in ablation outcome in patients with paroxysmal and persistent atrial fibrillation. We investigated the impact of weight-loss on procedure outcome in terms of arrhythmia burden, quality of life and arrhythmia-free survival in long-standing persistent (LSPAF) patients undergoing catheter ablation. Our main findings were the following;
  1. In patients with long-standing persistent atrial fibrillation, weight loss improved quality of life but had no impact on symptom burden and long-term ablation outcome
  2. No change in AF type or status was detected after the weight loss
  3. Extensive ablation including pulmonary vein (PV) isolation plus ablation of posterior wall and non-PV triggers resulted in comparable outcome in both groups at 1-year follow-up, irrespective of weight-loss interventions (63.8% vs 59.3%, p=0.68).
(more…)
Author Interviews, Heart Disease, Technology, University Texas / 11.05.2016

MedicalResearch.com Interview with: Sanghamitra Mohanty, MD MS FHRS Director, translational research, Texas Cardiac Arrhythmia Institute and Associate Professor (affiliate) Dell Medical School MedicalResearch.com: What is the background for this study? Dr. Mohanty: In patients with atrial fibrillation, Focal Impulse and Rotor Modulation (FIRM)-ablation alone or in combination with pulmonary vein (PV) isolation has been documented to possibly be a better alternative to PV isolation only. However, none of those trials had a randomized study design. The current study was the first attempt to compare 3 ablation strategies namely FIRM ablation alone (group 1), FIRM +PV isolation (group 2) and PV isolation combined with ablation of non-PV triggers (group 3) in a randomized controlled trial in persistent and long-standing persistent AF. MedicalResearch.com: What are the main findings? Dr. Mohanty: Our main findings were the following: 1)      Procedure time was significantly shorter in group 3 (no FIRM ablation) compared to group 1 and 2 (with FIRM ablation) 2)      FIRM-ablation alone had very poor outcome in terms of arrhythmia recurrence (86%) 3)      FIRM ablation plus PV isolation had significantly longer procedure time and lower efficacy than PV isolation + non-PV trigger-ablation (52.4% vs 76%, p=0.02). (more…)
Author Interviews, Heart Disease, Kidney Stones, UCSF / 10.05.2016

MedicalResearch.com Interview with: Dr. Ryan Hsi MD Clinical Fellow, UCSF Medical School and Mathew Sorensen, MD, MS Residency Program Director Department of Urology University of Washington Director, Comprehensive Metabolic Stone Clinic Puget Sound VA MedicalResearch.com: What is the background for this study? Response: Kidney stones affect 1 in 11 people, and the incidence is rising.  When kidney stones pass, they can be very painful, and if they obstruct urinary flow as they pass, they can be a cause of kidney injury and sepsis.  It is well-known that kidney stones are associated with diseases such as coronary artery disease, obesity, diabetes, and hypertension.  Less well established is the relationship with kidney stones and pre-clinical markers of these diseases.  That is, before a person has a heart attack, a person may develop atherosclerosis first - are kidney stones associated with these early warning signs of future disease? MedicalResearch.com: What are the main findings? Response: This study evaluated the association of coronary artery calcium and kidney stones.  Coronary artery calcium is a measure of calcification of the blood vessels that supply the heart, and it is a predictor of future cardiovascular events.  Our study of the Muli-Ethnic Study of Atherosclerosis evaluated individuals who had coronary artery calcium measured and compared those who had a history of none, one, or multiple kidney stones.  We found that individuals who had a history of multiple kidney stones were associated with higher levels of coronary artery calcium. (more…)
Author Interviews, Heart Disease, JACC, Race/Ethnic Diversity / 09.05.2016

MedicalResearch.com Interview with: Alan S. Go, MD, chief of Cardiovascular and Metabolic Conditions Research at the Kaiser Permanente Northern California Division of Research Jamal S. Rana, MD, PhD, cardiologist at Kaiser Permanente Oakland Medical Center and adjunct investigator with the Division of Research MedicalResearch.com: What is the background for this study? Response: In 2013, the American College of Cardiology and American Heart Association published the Pooled Cohort risk equation for estimating the likelihood of atherosclerotic cardiovascular disease events. However, the equation was developed from several groups of enrolled volunteers primarily conducted in the 1990s with limited ethnic diversity and age range, so its accuracy may vary in current community-based populations. To determine whether the risk equation might be improved by being recalibrated in “real world” clinical care, we examined a large, multi-ethnic, community-based population of Kaiser Permanente members in Northern California whose cholesterol levels and other clinical measures could theoretically trigger a discussion about whether to consider starting cholesterol-lowering therapy based on estimated risk using the ACC/AHA Pooled Cohort tool. The study followed a population of 307,591 men and women aged 40 to 75 years old, including non-Hispanic whites, non-Hispanic blacks, Asian, Pacific Islanders and Hispanics, from 2008 through 2013 and had complete five-year follow-up. The study population did not include patients with diabetes, prior atherosclerotic cardiovascular disease or prior use of lipid-lowering therapy such as statins, as the application of this risk tool is meant for primary prevention of heart disease and stroke. (more…)
Author Interviews, Brigham & Women's - Harvard, Gender Differences, Heart Disease, PLoS, Women's Heart Health / 09.05.2016

MedicalResearch.com Interview with: Alexander Turchin, MD, MS Associate Physician, Brigham and Women's Hospital Associate Professor of Medicine, Harvard Medical School Brigham and Women's Hospital Department of Medicine Endocrinology Boston, MA 02115  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Turchin: It is known that fewer women than men at high risk for cardiovascular disease are treated with statins. However, the reasons for this sex disparity are not fully understood. Our study identified 4 factors that accounted for over 90% of the difference in statin therapy between women and men with coronary artery disease:
  • Age (women were older than men),
  • Amoking (men were more likely to smoke),
  • Evaluation by a cardiologist (men were more likely to have been seen by a cardiologist) and
  • History of adverse reactions to statins (women were more likely to have experienced an adverse reaction). This is the first time that a near-complete explanation for the sex disparities in statin therapy was found.
(more…)
Alzheimer's - Dementia, Author Interviews, Heart Disease / 06.05.2016

MedicalResearch.com Interview with: T. Jared Bunch, MD Director of Heart Rhythm Research Medical Director for Heart Rhythm Services Intermountain Healthcare System MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Bunch: Approximately 6 years ago we found that patients with atrial fibrillation experienced higher rates of all forms of dementia, including Alzheimers disease.  At the time we started to ask the questions of why this association existed.  We know that atrial fibrillation patients experience higher rates of stroke.  These patients are placed on blood thinners, most commonly warfarin, to lower risk of stroke which at the same time expose that patient to a higher risk of intracranial bleeding.  One possibility to explain the association was that perhaps dementia in the manifestation of many small clots or bleeds in the brain that in total lead to cognitive decline.  If this is the case, then the efficacy and use of anticoagulation is very important in atrial fibrillation patients. We conducted additional studies that showed this to be the case.  In patients with no history of dementia, managed long-term with warfarin anticoagulation, those that had levels that were frequently too higher or too low that resulted in poor times in therapeutic range, experienced significantly higher rates of dementia.  The risk was highest in younger atrial fibrillation patients that were less than 80 years of age.  We then found that in atrial fibrillation patients that were frequently over anticoagulated and also use an antiplatelet agent, aspirin or plavix, the dementia rates nearly doubled.  At this point we raised the question if atrial fibrillation increased the risk beyond anticoagulation, or does anticoagulation efficacy drive most of the risk.  This question formed the background of the current study. (more…)
Author Interviews, Compliance, Heart Disease, JACC / 05.05.2016

MedicalResearch.com Interview with: Dr. Kevin Curl, MD Sidney Kimmel Medical College Jefferson University  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Curl: If left untreated, half of coronary bypass vein grafts will become occluded within 10 years of surgery.  We reviewed the health records of over 350 patients who had a previous coronary artery bypass graft (CABG) a minimum of three years prior.  Our goal was to identify the long-term trends with medication adherence in this high risk population, namely aspirin and statin medications.  The American College of Cardiology and the American Heart Association recommend both statins and aspirin medications unless they are unsafe for the individual patient. The mean age of the study population was 69 years, most patients had previously undergone "triple bypass" with 3 grafts, and the mean time from surgery was 11 years.  We found that only 52 percent of patients were taking both aspirin and a statin medication. In addition, patients not taking a statin had higher (22 percent) low-density lipid or “bad” cholesterol. (more…)
Author Interviews, Emergency Care, Heart Disease, Opiods / 05.05.2016

MedicalResearch.com Interview with: William Eggleston, PharmD Fellow in Clinical Toxicology/Emergency Medicine Upstate Medical University Upstate New York Poison Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Eggleston: The case series describes two deaths associated with loperamide abuse with supportive post-mortem findings. It adds to the growing body of literature reporting cardiac toxicity after loperamide abuse and demonstrates the deadly consequences. It also highlights the growing trend of loperamide abuse amongst opioid addicted patients looking to get high or stave off withdrawal symptoms. MedicalResearch.com: What should readers take away from your report? Dr. Eggleston: Readers should recognize that loperamide is an OTC opioid medication that acts similarly to morphine or heroin in the body after high doses. The drug is easily abused due to its low cost, ease of accessibility, legal status, and lack of social stigma associated with its possession. Most importantly, loperamide is a cardiac toxin that causes conduction disturbances in high doses and can produce deadly dysrhythmias. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Heart Disease, Kaiser Permanente / 04.05.2016

MedicalResearch.com Interview with: Reina Haque, PhD MPH Research scientist Kaiser Permanente Southern California Department of Research & Evaluation MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Haque: The study fills an important knowledge gap about the long-term association of aromatase inhibitors on cardiovascular disease risk in breast cancer survivors. This was a retrospective cohort study that included a cohort of 13,273 postmenopausal breast cancer survivors who were diagnosed with breast cancer, either estrogen or progesterone receptor positive, from 1991 to 2010. The patients were followed through 2011, or a maximum of 21 years. The study participants were divided into four groups based on the drugs they received: 31.7 percent were treated only with tamoxifen; 28.6 percent only with aromatase inhibitors; 20.2 percent used both; and 19.4 percent did not use any of these drugs. These oral drugs are used to combat breast cancer recurrence, but may have long-term side effects on other organs. The study determined that the risk of cardiac ischemia (which can lead to a heart attack) and stroke were not elevated in patients who only took aromatase inhibitors compared to those who only took tamoxifen. These results provide reassurance that aromatase inhibitors may not increase risk of the potentially fatal cardiovascular outcomes compared to tamoxifen. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 04.05.2016

MedicalResearch.com Interview with: Dr. Ben Freedman OAM  Deputy Director Research Strategy, Heart Research Institute/Charles Perkins Centre Professor of Cardiology, Sydney Medical School Head Vascular Biology Anzac Research Institute Honorary VMO, Concord Repatriation General Hospital University of Sydney MedicalResearch.com: What is the background for this study? Dr. Freedman: Guidelines recommend that patients with atrial fibrillation (AF) at high enough risk for stroke should be treated with anticoagulant. Anticoagulant drugs are remarkably effective in reducing stroke risk by about two thirds, and death by between a quarter and a third. Unfortunately, strokes can still occur when patients are prescribed anticoagulant for Atrial Fibrillation, and it is often presumed this residual risk of stroke represents treatment failure, though there are few data about this important issue. MedicalResearch.com: What are the main findings? Dr. Freedman: We were able to compare the risk of stroke in a cohort of patients with AF commenced on anticoagulant, with a very large closely-matched cohort seen in general practice at the same time but without AF. This is a unique comparison. We found that the residual risk of stroke in such anticoagulant-treated patients was virtually identical to that in the matched control cohort. The implication is that the residual risk of stroke may not be treatment failure, but the risk of non-cardioembolic stroke in people of a similar age and stroke risk profile but without Atrial Fibrillation. The residual risk of death in those on anticoagulant was higher than the matched controls, and intermediate between the control rate and the mortality rate for untreated AF. (more…)
Author Interviews, Dermatology, Heart Disease, Rheumatology / 04.05.2016

MedicalResearch.com Interview with: Lihi Eder, MD, PhD Assistant Professor of Medicine University of Toronto Scientist, Women’s College Research Institute,Room  6326 Women’s College Hospital Toronto, ON, Canada  MedicalResearch.com: What is the background for this study? Dr. Eder: Psoriasis is a chronic immune-mediated skin disease affecting 2-3% of the general population. Psoriatic arthritis (PsA) affects 15-30% of patients with psoriasis. Until recently, only few studies assessed the risk of developing cardiovascular events in patients with PsA and while most studies found a higher cardiovascular risk in these patients, others reported cardiovascular rates that were similar to the general population. (more…)
AHA Journals, Author Interviews, Duke, Geriatrics, Heart Disease, Surgical Research / 03.05.2016

MedicalResearch.com Interview with: Jessica J. Jalbert PhD From the Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA LASER Analytica New York, NY MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Jalbert: Landmark clinical trials have demonstrated that carotid artery stenting (CAS) is a safe and efficacious alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. Clinical trials, however, tend to enroll patients that are younger and healthier than the average Medicare patient. We therefore sought to compare outcomes following CAS and CEA among Medicare patients. MedicalResearch.com: What are the main findings? Dr. Jalbert: We found that outcomes among real-world Medicare patients undergoing CAS and CEA were similar. While our results were inconclusive due to small sample size, we also found some evidence suggesting that patients over the age of 80 and those with symptomatic carotid stenosis may have better outcomes following carotid endarterectomy than CAS. (more…)
Author Interviews, Compliance, Gender Differences, Heart Disease / 28.04.2016

MedicalResearch.com Interview with: Sherry L. Grace, PhD Professor, School of Kinesiology and Health Science York University Sr. Scientist, Cardiorespiratory Fitness Team Toronto Rehabilitation Institute, University Health Network Toronto Western Hospital Toronto, ON MedicalResearch.com: What is the background for this study? Dr. Grace: Cardiac rehabilitation is an outpatient chronic disease management program. It is a standardized model of care, comprised of risk factor assessment and management, exercise training, patient education, as well and dietary and psychosocial counseling. Patients generally attend two times a week for several months. Participation in cardiac rehab has been shown to reduce death and disability. This is a dose-response association, such that more cardiac rehab participation is associated with even less death, etc. Therefore, it is important that patients adhere to the program, or participate in all the prescribed sessions. No one has ever reviewed patient adherence to cardiac rehab in a systematic way. It has always been assumed that patients only attend about half of prescribed sessions. Also, many studies have shown that women attend fewer sessions than men. However, this has been known for some time, so we would hope that in the current era, this sex difference would not exist. No study has ever aggregated and analyzed sex differences in program adherence, so we set out to do this. (more…)
AHA Journals, Author Interviews, Heart Disease, Tobacco Research / 28.04.2016

MedicalResearch.com Interview with: Tanush Gupta, MD Chief Resident & Instructor of Medicine Department of Medicine New York Medical College & Westchester Medical Center Valhalla, NY  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Gupta: Cigarette smoking is the leading preventable cause of premature death in the United States (U.S.). Approximately one-third of all coronary artery disease related deaths in the U.S. annually can be attributed to cigarette smoking. However, studies from the pre-thrombolytic and thrombolytic eras have shown that mortality in smokers with ST-segment elevation myocardial infarction (STEMI) may be lower than in nonsmokers, a phenomenon called the “smoker’s paradox.” The majority of STEMI patients in contemporary practice are treated with primary percutaneous coronary intervention (pPCI). Data on the association of smoking with outcomes in STEMI patients undergoing pPCI are limited and also conflicting as to whether the smoker’s paradox exists in this population. Hence, the purpose of our study was to examine the association of smoking status with in-hospital outcomes in a nationwide cohort of STEMI patients undergoing pPCI, included in the U.S. National Inpatient Sample, over a 10-year time period from 2003 to 2012. Our primary outcome of interest was in-hospital mortality and secondary outcomes were post-procedure hemorrhage, in-hospital cardiac arrest, and average length of stay. Of 985,174 STEMI patients who underwent pPCI in the U.S. over this time period, 438,954 (44.6%) were smokers. Smokers were on an average 8 years younger than nonsmokers and had lower prevalence of most cardiovascular comorbidities. Smoking status was associated with lower risk-adjusted in-hospital mortality (2.0% vs. 5.9%, adjusted OR 0.60, p<0.001), lower incidence of post-procedure hemorrhage (4.2% vs. 6.1%, adjusted OR 0.81, p<0.001) and in-hospital cardiac arrest (1.3% vs. 2.1%, adjusted OR 0.78, p<0.001), and shorter average length of stay (3.5 days vs. 4.5 days, p<0.001). To assess whether younger age of smokers was influencing the association with in-hospital mortality, we also performed an age-stratified analyses in different age groups. The smoker’s paradox largely persisted in age-stratified analyses suggesting that younger age of smokers was not the sole explanation for this paradox. We performed additional assessment for confounding to explore whether the paradoxically lower risk-adjusted in-hospital mortality in smokers with STEMI was driven by differences in baseline demographics and comorbidities between hospitalized smokers and nonsmokers in general. To test for such confounding, we examined the association of smoking with in-hospital mortality in 2 conditions in which this association has not been previously studied – hip fractures and severe sepsis – using similar statistical regression models. In both these study populations, smokers were on average younger than nonsmokers and had lower risk-adjusted in-hospital mortality, but, the paradoxical association in both these conditions was weaker in magnitude than in STEMI patients. Since there is no cogent biological hypothesis to explain the lower mortality in smokers with sepsis or hip fractures, it is likely that the smoker’s paradox in STEMI is also at least partly driven by residual confounding due to inadequate adjustment for the biological effects of age. However, as this paradox was stronger in STEMI patients than in patients with hip fractures or severe sepsis, we believe that additional true biological differences between smokers and nonsmokers with STEMI also contribute to the paradoxically lower in-hospital mortality. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Lifestyle & Health / 27.04.2016

MedicalResearch.com Interview with: Dr. Céline Vetter,  Dr.Phil. Instructor in Medicine Harvard Medical School Associate Epidemiologist Channing Division of Network Medicine Brigham and Women's Hospital Boston, MA, 02115 MedicalResearch.com: What is the background for this study? Response: Heart Disease is still the leading cause of death in the US, with 1 in every 4 deaths being attributed to heart disease. On the other hand, it is estimated that approximately 15 millions Americans work evening shifts, night shift, rotating shifts or any other kind of irregular schedule that is arranged by the employer. The link between shift work and coronary heart disease has been studied for decades now, but because shift work can take so many forms, results have not been consistent. Another contributing factor to this inconsistency might be that few studies could actually track individuals over long periods of time, so that some studies might have missed when participants did actually develop coronary heart disease. Our study was based on the Nurses' Health Studies I and II, where women about 189,000 registered female nurses completed every two years mailed questionnaires that comprise items about their health status, medical history, and known or suspected risk factors for cancer and heart disease. They also reported their lifetime history of rotating night shift work in 1988 and 1989, respectively. Across the 24 years of the study periods, we observed more than 10,000 cases of coronary heart disease (i.e. myocardial infarction, CHD death, angiogram-confirmed angina pectoris, and procedures related to coronary heart disease, i.e. angioplasty, coronary artery bypass graft surgery or stents). (more…)
Author Interviews, Heart Disease, Stroke / 25.04.2016

MedicalResearch.com Interview with: Professor Ralph Stewart MBChB (Otago), FRACP, FCSANZ, MD Auckland City Hospital University of Auckland, New Zealand MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Stewart: A number of studies have suggested a favorable effect of a Mediterranean dietary pattern on the risk of heart disease, but few large studies have evaluated this dietary pattern in a global population of patients with known coronary heart disease.  We assessed a Mediterranean diet score based on frequency of consumption of common foods using a very simple questionnaire.  Globally this included a very broad range of diets – showing the benefits of this dietary pattern  can be achieved with many different foods. We founds that greater adherence to this diet was associated with a lower risk of recurrent heart attacks, strokes and deaths from any cause.  In contrast a western diet score, which measured more consumption of foods thought to be unhealthy, including processed carbohydrates, sweetened foods and drinks and deep fried foods were not associated with the risk of cardiovascular events. (more…)
Author Interviews, BMJ, Heart Disease, Pediatrics / 25.04.2016

MedicalResearch.com Interview with: Hans Van Brabandt, M.D. Brussel, Belgium MedicalResearch.com: What is the background for this study? Dr. Van Brabandt: We have been asked by the Belgian government to assess the benefits and harms of pre-participation screening of young athletes. A number of Belgian cardiologists and screening physicians are intensely promoting such screening through mass media and were asking governmental support. MedicalResearch.com: What are the main findings? Dr. Van Brabandt:  There is no solid evidence on the benefit of cardiovascular pre-participation screening, and certainty of harms it induces through numerous false-positives, making that such screening in young athletes cannot be defended. -          Italian investigators assert they have provided evidence for the benefit of screening. The single study on which they base their claim however is far from convincing. Unfortunately, more than 10 years after their first paper, they still did not make the majority of their data publicly available. (more…)
Author Interviews, Heart Disease, JAMA / 25.04.2016

MedicalResearch.com Interview with: Dr. Fredrik Björck, MD Umea University Umea, Sweden MedicalResearch.com: What is the background for this study? Dr. Björck: Vitamin K antagonist (eg, warfarin) use is nowadays challenged by the non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in non-valvular atrial fibrillation (AF). NOAC studies were however based on comparisons with warfarin arms with times in therapeutic range (TTRs) of 55.2% to 64.9%, making the results less credible in health care systems with higher TTRs. Historically Sweden has had the best international normalized ratio (INR) control in the world. By this study we wanted to evaluate the efficacy and safety of real life well-managed warfarin therapy in patients with non-valvular AF, the risk of complications, especially intracranial bleeding, in patients with concomitant use of aspirin, and the impact of INR control. We therefore performed a retrospective, multicenter cohort study based on Swedish registries, especially AuriculA, a quality register for AF and oral anticoagulation. A total of 40 449 patients starting warfarin therapy owing to non-valvular AF during the study period were monitored until treatment cessation, death, or the end of the study. The study was conducted from January 1, 2006, to December 31, 2011.  By associating complications with risk factors and individual INR control, we evaluated the efficacy and safety of warfarin treatment in patients with concomitant aspirin therapy and those with no additional antiplatelet medications. (more…)