Author Interviews, Dermatology, Heart Disease, Rheumatology / 04.05.2016 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 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 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 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. 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 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 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 Interview with: Tanush Gupta, MD Chief Resident & Instructor of Medicine Department of Medicine New York Medical College & Westchester Medical Center Valhalla, NY 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 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 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 Interview with: Professor Ralph Stewart MBChB (Otago), FRACP, FCSANZ, MD Auckland City Hospital University of Auckland, New Zealand 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 Interview with: Hans Van Brabandt, M.D. Brussel, Belgium 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. 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 Interview with: Dr. Fredrik Björck, MD Umea University Umea, Sweden 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…)
Author Interviews, Heart Disease, Rheumatology / 22.04.2016 Interview with: Nicola Veronese, MD University of Padova Department of Medicine (DIMED)-Geriatrics Section Padova, Italy What is the background for this study? What are the main findings? Dr. Veronese: Osteoarthritis (OA) is the most common rheumatic disease. Although an increasing research is showing that OA, particularly of lower limbs, is associated with an increased risk of cardiovascular diseases (CVD) the association with overall mortality seems to be less clear. (more…)
Author Interviews, Cognitive Issues, Heart Disease, JAMA / 22.04.2016 Interview with: Thomas H. Marwick, MBBS, PhD, MPH Baker IDI Heart and Diabetes Institute Melbourne, Australia What is the background for this study? What are the main findings? Dr. Marwick: Readmission for heart failure (HF) remains common and the risk of this remains hard to predict. It's possible that existing risk scores don't cover all important patient features. We confirmed that cognitive impairment was an unmeasured contributor and incorporated this measurement in a prediction model. The resulting model was the most reliable reported to date and could be used to identify patients who need the closest follow up to avoid readmission. (more…)
Author Interviews, BMJ, Heart Disease, Social Issues, Stroke / 20.04.2016 Interview with: Nicole Valtorta NIHR Doctoral Research Fellow Department of Health Sciences University of York, UK Medical Research: What is the background for this study? What are the main findings? Response: Lonely and socially isolated adults are at increased risk of mortality. The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear. We systematically reviewed the evidence from prospective cohort studies to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke. We identified 23 papers reporting data from 16 longitudinal datasets, for a total of 4,628 CHD and 3,002 stroke events. Reports of eleven studies (CHD) and eight studies (stroke) provided data suitable for meta-analyses, the results of which indicated that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. People who were lonely or isolated had, on average, a 29% greater risk of incident CHD; similarly, the risk of developing stroke was 32% greater among isolated individuals. (more…)
Author Interviews, Heart Disease / 19.04.2016 Interview with: Yoosoo Chang MD PhD Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University Seoul, Korea What is the background for this study? What are the main findings? Dr. Chang: Sugar-sweetened carbonated beverage consumption has been linked to obesity, metabolic syndrome, type 2 diabetes, and clinically manifest coronary heart disease (CHD), but its association with subclinical CHD has been largely unexplored. We performed a cross-sectional study of 22,210 apparently healthy, asymptomatic Korean adults who underwent image scans to determine how much calcium had built up in their heart arteries. We found that people who drank 5 cups or more of sugar-sweetened carbonated beverage per day on average had the greater prevalence and higher degree of calcium deposits in the arteries compared to non-drinkers. This association persisted after controlling other factors and was observed across various subgroups, supporting an independently harmful effect of sugar-sweetened carbonated beverage on the cardiovascular health. (more…)
Author Interviews, Heart Disease / 18.04.2016 Interview with: Gjin Ndrepepa, MD Deutsches Herzzentrum München München, Germany Medical Research: What is the background for this study? Dr. Ndrepepa: Prevention of atherosclerosis or promotion of its regression when it had developed, are among the greatest problems in clinical medicine. Recent imaging studies have shown that high-intensity statin therapy slows progression and may even result in regression of atherosclerosis. Despite the positive results in terms of retardation of progression or regression of atherosclerosis, the number of clinical events in these studies was too small to allow meaningful analysis of the relationship between slow progression or regression of atherosclerosis and morbidity or mortality and to date no specifically designed studies have been performed to investigate the association of progression or regression of the atherosclerosis with the long-term mortality. In the current study we addressed this clinically relevant problem. Medical Research: What are the main findings? Dr. Ndrepepa: In brief, the main findings of current study may be summarized as follows:
  • 1) Progression of atherosclerosis in patients with coronary artery disease treated with statins and other secondary prevention measures was associated with 2.5-fold increase in the adjusted risk of 8-year cardiac mortality compared to patients with no progression/regression of atherosclerosis.
  • 2) Regression of atherosclerosis was associated with a significant decrease in the risk of 8-year all-cause and cardiac mortality (75% and 80% reduction, respectively).
  • 3) Diabetes mellitus increased the odds of progression and decreased the odds of regression of coronary artery atherosclerosis.
Author Interviews, CT Scanning, Heart Disease, Lifestyle & Health / 16.04.2016 Interview with: Jacquelyn Kulinski, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin Milwaukee, WI 53226 What is the background for this study? What are the main findings? Dr. Kulinski: Sedentary behavior, or “sitting disease”, is increasingly recognized as a risk factor for cardiovascular disease, diabetes, cancer and early death.  Many of these associations appear to be independent of exercise activity. The mechanisms through which sedentary behavior influences cardiovascular risk are largely unknown.  Therefore, we investigated the association between accelerometer measured sedentary behavior and coronary artery calcium (CAC), a marker of subclinical heart disease, in over 2,000 participants using data from the Dallas Heart Study (DHS) population. We found a significant association between increasing sitting time and CAC in a population without prior history of cardiovascular disease.  This association was independent of measured exercise activity, traditional risk factors, and even socioeconomic factors.  Each hour of sedentary time was associated with a 16% increase in CAC burden.  Interestingly, the association between exercise and CAC was not significant in the fully-adjusted model.  (more…)
Author Interviews, Gender Differences, Heart Disease, JACC, Women's Heart Health / 15.04.2016 Interview with: Dr. Neha J. Pagidipati Duke Clinical Research Institute Duke University School of Medicine Durham, North Carolina Medical Research: What is the background for this study? What are the main findings? Dr. Pagidipati: Women and men experience coronary artery disease differently, and a great deal of literature has shown that these differences extend to the diagnostic performance of various noninvasive testing modalities. However, little is known about the sex-specific prognostic value of computed tomographic angiography (CTA) and functional stress testing. We used data from the recent PROMISE trial to address this question. The PROMISE trial enrolled 10,003 patients (53% women) with stable symptoms suggestive of coronary artery disease to a diagnostic strategy of CTA vs stress testing, and found no differences in outcomes overall or by sex. We found that in women, a CTA is less likely to be positive, but when it is positive, it appears to have greater predictive value for a future cardiovascular event (all cause death, myocardial infarction, or unstable angina hospitalization) than stress testing. In men, a stress test is less likely to be positive, and though stress testing trended towards being more predictive of future events, there was no statistically significant difference in the prognostic value of either test type. (more…)
Author Interviews, Heart Disease / 15.04.2016 Interview with: Dr. Charles Pollack MD MA Thomas Jefferson University Philadelphia, PA 19107 What is the background for this study? What are the main findings? Dr. Pollack:: We are continuing research on PRAXBIND in the ongoing global phase III patient study, RE-VERSE AD™. RE-VERSE AD includes two groups of dabigatran patients: those who had serious bleeding or those who required an urgent procedure. At ACC, we presented results from an updated interim analysis from 123 patients enrolled in RE-VERSE AD™, which showed a single 5g of PRAXBIND immediately reversed the anticoagulant effect of dabigatran in all patients evaluated. (more…)
Author Interviews, Heart Disease, JACC / 14.04.2016 Interview with: Vincent Roolvink, MD Isala hospital, Department of Cardiology Zwolle, The Netherlands Medical Research: What is the background for this study? Dr. Roolvink: The goal of the trial was to assess the safety and efficacy of early administration of intravenous (IV) metoprolol in patients presenting with ST-elevation myocardial infarction (STEMI) and scheduled for primary percutaneous coronary intervention (PCI). (more…)
AHA Journals, Author Interviews, Heart Disease / 08.04.2016 Interview with: Luigi Di Biase, MDPhD, FACC, FHRS Section Head Electrophysiology Director of Arrhythmia Services Associate Professor of Medicine, Department of Medicine (Cardiology) Albert Einstein College of Medicine at Montefiore Hospital Moses and Weiler Campuses Montefiore-Einstein Center for Heart & Vascular Care Bronx, NY 10467 What is the background for this study? What are the main findings? Dr. Di Biase: The superiority of catheter ablation of atrial fibrillation (AF) over antiarrhythmic drugs (AADS) has been tested and demonstrated in several randomized clinical trial in patients with normal ejection fraction and paroxysmal AF. Only a few studies are available for patients with heart failure and persistent AF. In this multicenter randomized trial we compared the most utilized AAD for heart failure patients to achieve a rhythm control strategy (Amiodarone) vs ablation of atrial fibrillation in patients with heart failure, persistent AF and ICD. Catheter ablation was superior to Amiodarone to achieve long term freedom from AF. In addition patients undergoing ablation had a lower re-hospitalization rate and importantly a lower mortality. (more…)
Author Interviews, Baylor College of Medicine Houston, Heart Disease, JACC / 07.04.2016 Interview with: Dr. William Frank Peacock MD, FACEP Baylor College of Medicine, Houston What is the background for this study? What are the main findings? Dr. Peacock: ​Patients with atrial fibrillation get strokes but can take anticoagulation which is very effective at preventing strokes. Patients on anticoagulation bleed, to the point that a very few die. The higher the CHADSVASC score, the more likely you are to have a stroke.​ ​Also the more likely ​you are to bleed. But the risk of stroke ALWAYS exceeds the risk of bleeding. We studied diabetics with atrial fibrillation as a subset, because diabetes is significant predictor for both stroke and bleeding and we wanted to determine if our understanding of the risks and benefits were maintained in real world trial. What we found was the risk of a fatal major bleed for a diabetic with atrial fibrillation who was taking rivaroxaban was 0.09/100 patient years of treatment. We know that the risk of having a stroke in a patient with a CHADS score of 2 is about 3% per year (that is 3/100 patients will stroke). Put in a similar denominator as our study, failing to treat an Afib diabetic will results 300 strokes for every 100 patient years, which compares to the effect of treatment, which will significantly prevent stroke, at the cost of 0.1 major bleed fatality per 100 patient years. Even if the effect of treatment was as low as 50% (which it is not), that is still preventing 150 strokes. 0.1 dead, to prevent 150 strokes seems like easy math to me.  ​ (more…)
Author Interviews, Heart Disease, JACC / 07.04.2016 Interview with: Laura Mauri, MD,MSc Professor, Harvard Medical School Brigham and Women Hospital What is the background for this study? Dr. Mauri: The Dual Antiplatelet Therapy (DAPT) Study, the largest randomized controlled trial to date comparing different durations of dual antiplatelet therapy (thienopyridine plus aspirin) after coronary stenting, found that patients who were free from major ischemic or bleeding events at 1 year after coronary stenting with either drug-eluting or bare metal stents, and who were compliant with their antiplatelet therapy, experienced significant reductions in stent thrombosis and myocardial infarction (MI) but increases in moderate or severe bleeding when treated with 30 months of thienopyridine plus aspirin, as compared with 12 months.  In this analysis of the DAPT Study, we wanted to determine whether the subset of patients who had a MI before the study or at the time of the index stenting procedure had different risks or benefits with long-term dual antiplatelet therapy compared to patients with no history of MI prior to or at the time of the index stenting procedure.  We also wanted to evaluate whether the use of a clinical decision tool to identify patients expected to derive benefit vs. harm from continuing thienopyridine beyond one year after coronary stenting (the DAPT Score), would aid in the individualized prescription of dual antiplatelet therapy duration among these populations. (more…)
Author Interviews, BMJ, Heart Disease, Social Issues / 07.04.2016 Interview with: Dr. Simon Graff Department of Public Health Aarhus University What is the background for this study? What are the main findings?  Dr. Graff: We knew that a substantial amount of evidence have accumulated, linking our mental wellbeing to our body. With that in mind we wanted to examine one of the (if not the most) most stressful life event; the loss of a partner! Former studies have ranked bereavement of a life partner as the most stressful life event we humans can experience. Our study reports that spousal bereavement is followed by a transiently increased risk of new onset of atrial fibrillation (AF). The risk was highest 8-14 days after the loss and remains elevated for one year. (more…)
Author Interviews, Cost of Health Care, Heart Disease, NYU / 06.04.2016 Interview with: Joseph A. Ladapo, MD, PhD Assistant Professor of Medicine and Population Health Section on Value and Effectiveness Department of Population Health NYU Langone School of Medicine New York NY 10016 What are the main findings? Dr. Ladapo: While cardiac implantable electronic devices (CIEDs) are increasingly used to treat patients with arrhythmias, heart failure, and other risk factors for sudden cardiac death, these implantable devices require life-long follow-up to assess their performance and functionality. This need for continuous monitoring has galvanized the development of remote monitoring technologies for patients with CIEDs. Although randomized studies have shown that remote monitoring may reduce healthcare utilization and expenditures when compared to in-office monitoring, little is known about whether these findings generalize to day-to-day clinical practice. We aimed to address this uncertainty by evaluating healthcare utilization and expenditures in a cohort of patients with newly-implanted CIEDs who were followed remotely or with in-office monitoring. What is the background for this study? Dr. Ladapo: Remote monitoring is associated with a reduction in patients’ utilization of ambulatory and acute care and a reduction in expenditures associated with this utilization—at least over 24 months. This reduction was most pronounced among remotely monitored patients with implantable cardioverter defibrillators (ICDs).  Although many of our comparisons between remote and office monitoring were not statistically significant, they trended toward favoring remote monitoring. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Stroke / 06.04.2016 Interview with: Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London UK What is the background for this study? What are the main findings? Dr. Kario: The relationship between out-of-office blood pressure (BP), such as ambulatory BP and home BP, and cardiovascular events has been investigated in several studies. However, there is insufficient evidence as yet regarding which BP measurement predicts coronary artery disease (CAD) events most strongly. The HONEST Study is the largest prospective observational study in the world, which enrolled >20,000 hypertensive patients. The study observed cardiovascular events, monitoring both clinic BP and home BP on treatment of antihypertensive agent. The present analysis shows that home BP measured in morning (morning home BP) is a strong predictor of both CAD and stroke events in future, and may be superior to clinic BP in this regard. Furthermore, there does not appear to be a J-curve in the relationship between morning home BP and CAD or stroke events. (more…)
Author Interviews, Heart Disease, Nutrition / 06.04.2016 Interview with: Man-tian Mi Research Center for Nutrition and Food Safety, Chongqing Key Laboratory of Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University Chongqing  China What is the background for this study? What are the main findings? Reply: Cardiovascular diseases remain the leading cause of death in industrialized societies including the United States, and the incidence is growing in developing countries (1). In recent years, researchers have learned that the gut microbiome plays a role in the build up of plaque inside arteries, otherwise known as atherosclerosis (2, 3). Resveratrol, a polyphenol found in red wine, is thought to have antioxidant properties that protect against conditions such as heart disease (4). Just how resveratrol, a plant compound, does this, however, is unclear. Therefore, we sought to determine whether the anti-atherosclerosis effects of resveratrol were related to changes in the gut microbiota. We found that resveratrol attenuated trimethylamine-N-oxide (TMAO)-induced  atherosclerosis by decreasing TMAO levels and increasing hepatic bile acid (BA) neosynthesis via gut microbiota remodeling, and the BA neosynthesis was partially mediated through the enterohepatic farnesoid X receptor-fibroblast growth factor 15 axis. These results offer new insights into the mechanisms responsible for resveratrol’s anti-atherosclerosis effects and indicate that gut microbiota may become an interesting target for pharmacological or dietary interventions to decrease the risk of developing cardiovascular diseases. (more…)
Author Interviews, Gender Differences, Heart Disease, NYU, Women's Heart Health / 06.04.2016 Interview with: Nathaniel Smilowitz, MD Fellow, Cardiovascular Disease NYU Langone Medical Center MeicalResearch: What is the background for this study? What are the main findings? Dr. Smilowitz: Myocardial infarction (MI), commonly known as a heart attack, is a leading cause of death worldwide.  In the majority of patients with MI, examination of the coronary blood vessels by angiography reveals an obstruction that limits blood flow to the heart muscle.  However, some patients develop MI with non-obstructive coronary arteries (MINOCA) at angiography.  This condition is identified more commonly in younger patients and women, and in prior studies, in-hospital death after MINOCA was lower than for MI with obstructive coronary artery disease (MI-CAD).  Despite favorable outcomes associated with MINOCA, young women paradoxically have overall higher in-hospital death after MI in comparison to younger men.  Although sex differences in post-MI mortality are known to vary with age, the interaction between age, sex, and the presence of obstructive coronary artery disease at angiography on death post-MI had not been previously established. In this study, we confirmed that in-hospital mortality is lower after MINOCA than MI-CAD and that women are more likely to have MINOCA than men.  No sex difference in mortality was observed among patients with MINOCA, but women of all ages had significantly higher mortality after MI-CAD than men.  With advancing age, mortality increased to a greater degree in patients with MI-CAD than MINOCA and in men vs. women. (more…)
Author Interviews, Heart Disease, JACC, Vitamin D / 05.04.2016 Interview with: Dr Klaus Witte MD, FRCP, FESC, FACC Associate Professor and Consultant Cardiologist Lead Clinician for Cardiology University of Leeds and Leeds Teaching Hospitals NHS Trust What is the background for this study? What are the main findings? Dr. Witte: Chronic heart failure (CHF) is a condition of heart muscle weakness that despite optimal treatment often leaves patients with ongoing symptoms of breathlessness and fatigue. Vitamin D has a large number of effects in the body beyond its known effects on the skeleton. Patients with  Chronic heart failure are frequently deficient in vitamin D, but until now there were no data demonstrating a benefit from supplements. We conducted a randomised, placebo-controlled study of a non-calcium-based vitamin D supplement providing 4000IU or 100mcg per day of vitamin D3 (VINDICATE). Endpoints included 6-minute walk distance and cardiac function. We saw no improvement in 6 minute walk distance but a large and significant improvement in heart function (left ventricular ejection fraction) and heart size (left ventricular dimensions and volumes) after on year. We saw no significant adverse effects and the tablets were well tolerated. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JACC / 05.04.2016 Interview with: Dr. Jordan B. King Post Doctoral Fellow Pharmacotherapy Outcome Resctr, University of Utah What is the background for this study? What are the main findings? Response: The cornerstone of treatment in heart failure with reduced ejection fraction (HFrEF) revolves around low-cost generic medications such as angiotensin converting enzyme inhibitors (ACEIs) and beta-blockers (BBs). However, recently the dual-acting angiotensin receptor neprilysin inhibitor (ARNI) sacubitril-valsartan, demonstrated improved survival and reduction in heart failure hospitalizations relative to enalapril, an ACEI, and optimal background therapy. This creates a situation in which we have a new medication which improves outcomes, but carries a high price tag ($4,560 per year) compared with ACEIs, the standard of care over the last 20 years, and are available as generic medications for <$50 per year. We set out to determine the incremental cost-effectiveness ratio (ICER) per quality adjusted life year gained (QALY) from the perspective of a health care payer in the U.S. The ICER is a measure of how much we have to pay for sacubitril-valsartan to gain 1 unit of health relative to enalapril. In this case the unit of health is a year of life adjusted for quality. We used a Markov model to estimate the costs and effectiveness of the two treatment options over a lifetime. In the base case, the ICER for sacubitril-valsartan was $50,959 per QALY gained. Health care interventions which cost <$50,000 per QALY are generally considered cost-effective, but some argue that <$100,000 per QALY is a more appropriate threshold in the U.S. In a probabilistic sensitivity analysis, 57% and 80% of all simulations fell below the $50,000 and $100,000 per QALY thresholds, respectively. Sacubitril-valsartan was the less costly treatment arm in 5% of simulations, and enalapril dominated (less costly and more effective) in 17% of simulations. (more…)