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…)
Author Interviews, Heart Disease, JACC / 05.04.2016 Interview with: Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC Professor of Medicine (Cardiology) and Director, EPICORE Centre Faculty of Medicine and Dentistry University of Alberta EPICORE CENTRE Research Transition Facility University of Alberta Edmonton, AB What is the background for this study? What are the main findings? Response: As you know, most cardiovascular disease is caused by modifiable risk factors. However, the identification and control of these risk factors continues to elude us. Pharmacists in the community are the most accessible primary healthcare providers. That is being increasingly recognized and the scope of practice for pharmacists has been changing to meet these needs. In Alberta, Canada, pharmacists have one of the broadest scopes of practice - many can independently prescribe and order laboratory tests. We sought to test the effect of a pharmacist-based prescribing and care program in patients at high risk for cardiovascular events. We enrolled 723 patients at high risk for cardiovascular events (defined as those with diabetes, vascular disease (coronary, cerebrovascular, or peripheral arterial disease), chronic kidney disease, or high Framingham risk (>20%) primary prevention. All patients were recruited by their pharmacist and had to have at least one modifiable risk factor not well controlled. Patients were randomized to receive pharmacist intervention or usual care. Intervention patients received a Medication Therapy Management review, consisting of assessment of cardiovascular risk, patient education, and management of the patients' risk factors, according to the latest Canadian guidelines. Pharmacists conducted follow-up visits monthly. Usual care patients were the control (comparison) group and received usual pharmacist and physician care. Both groups were followed for 3 months. The primary outcome measure was the difference in estimated cardiovascular risk at 3 months, as calculated using validated risk engines such as Framingham, the International Risk Score, and the UKPDS risk. We found a 21% reduction in the risk for cardiovascular events in the pharmacist care group compared to control. There was also significant reductions in blood pressure, LDL cholesterol, glycated hemoglobin in those with diabetes, and 21% fewer smokers in the pharmacist care group compared to control. (more…)
Author Interviews, Heart Disease, Lancet / 05.04.2016 Interview with: Dr Henning Kelbæk MD Department of Cardiology Roskilde Hospital,Denmark What is the background for this study? What are the main findings? Dr. Kelbæk : In some patients with large acute myocardial infarcts, stent implantation has been connected with an increased risk of downstream embolization of thrombus material and disturbances in flow impairing the prognosis of the patients. In accordance, previous smaller studies have shown a benefit in angiographic and other parameters in patients having their stent implanted several hours after the artery was opened, allowing the infarct-related lesion to ’cool down’ and residual thrombus to dissolve under antithrombotic treatment, whereas larger randomised trials focusing on clinical data have been missing. Our trial demonstrates, a bit surprisingly, that delaying or deferring stent implantation does not improve the clinical outcome of these patients.  (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease / 04.04.2016 Interview with: Jacob Joseph, MD, FACC, FAHA Associate Professor of Medicine, Harvard Medical School Cardiology Consortium Lead, VA Clinical Trial Network, Associate Physician, Brigham & Women's Hospital What is the background for this study? What are the main findings? Dr. Joseph: The background for this study is the fact that heart failure with preserved ejection fraction (HFPEF) continues to be a challenge for cardiology. Clinical trials have thus far failed to give us a treatment. One of the major issues in clinical care and research is the marked heterogeneity of this condition.  Is an 80 year old woman with HFPEF, chronic kidney disease, and atrial fibrillation the same as a 50 year old hypertensive with left ventricular hypertrophy and HFPEF? In fact the recently reported TOPCAT study showed that the outcomes in patients enrolled in North and South America were significantly different from patients enrolled from Russia and Georgia, an effect that may have partly affected the results of the entire trial. In this study we examined whether a simple clinical tool like QRS duration measured on ECG could help to identify a subgroup of HFPEF patients who are at risk of adverse outcomes. When we analyzed the patients enrolled in the TOPCAT trial, we did in fact find that prolonged QRS duration is associated with worse outcomes in HFPEF. This association was independent of the region of enrollment and traditional cardiac risk factors. We also found that the association was seen in different types of conduction blocks. Furthermore the risk of adverse events started at QRS duration of approximately 100ms. (more…)
Author Interviews, Calcium, Heart Disease / 02.04.2016 Interview with: Dr. Chan Soo Shin MD PhD Professor of Medicine Seoul National University College of Medicine Seoul, 03080, Korea What is the background for this study? What are the main findings? Response: Recently, a series of secondary analyses on large clinical trials and meta-analysis have reveled increased rate of cardiovascular events in women allocated to calcium supplements. As most of these studies were conducted in Western countries where the dietary calcium intake is sufficient, we aimed to investigate the association between dietary calcium intake level and cardiovascular events or mortality in Korea where the average dietary calcium intake is as low as 470 mg per day. We have analyzed data from 4,866 adults aged at least 50 years without previous CDV or stroke history participating in the Ansung and Ansan cohort study, an ongoing, prospective, community-based study in Korea (2,690 women). Participants completed periodic food frequency questionnaires; CVD, stroke and fractures were recorded during interviews and examinations every 2 years. Researchers used proportional Cox regression analysis was used to determine HRs for all-cause mortality, CVD, cerebrovascular disease and fractures, adjusting for age, BMI, vegetable and fruit intake, protein and sodium intake, physical activity, smoking and drinking status, diabetes and hypertension history and total energy from diet. Researchers also adjusted for menopausal status and hormone replacement therapy in women. Women were followed for a mean of 9.2 years; men followed for a mean of 8.9 years. Within the cohort, 359 participants died (243 men); 340 developed CVD (153 men); 157 experienced stroke (59 men); 568 experienced incident fractures (212 men). In comparing the four quartiles for energy-adjusted calcium intake, women experienced an increased reduction in CVD risk with increasing dietary calcium intake. Women in the highest quartile saw the greatest reduced risk for CVD vs. the lowest quartile (HR = 0.53; 95% CI, 0.33-0.86), followed by women in the third (HR = 0.56; 95% CI, 0.36-0.85) and second quartiles (HR = 0.80; 95% CI, 0.55-1.17) when compared with women in the lowest quartile. We found no association between dietary calcium intake and stroke or fracture risk in women. Dietary calcium intake did not affect all-cause mortality, CVD risk, stroke risk or fracture risk in men. (more…)
Author Interviews, Genetic Research, Heart Disease, JAMA, UCSD / 01.04.2016 Interview with: H Kirk Hammond, MD Professor of Medicine (Cardiology) University of California San Diego Veterans Affairs San Diego Healthcare System San Diego, CA 92161 What is the background for this study? Dr. Hammond: Heart failure affects >28 million patients worldwide and is the only cardiovascular disease that is increasing in prevalence. Despite steady improvement in drug therapy for heart failure, recent hospitalization rates and mortality have changed little. New therapies are needed. Adenylyl cyclase type 6 (AC6), is a protein that catalyzes the conversion of ATP to cAMP and is an important determinant of heart function. The amount and function of AC6 are reduced in failing hearts, and preclinical studies have shown benefits of increased cardiac AC6 content on the heart. The aim of the trial was to determine safety and heart function gene transfer of AC6, achieved by intracoronary delivery of an inactivated virus carrying the gene for AC6 (Ad5hAC6) in patients with symptomatic heart failure and reduced ejection fraction. Our hypothesis was that AC6 gene transfer would safely increase function of the failing hearts of patients with heart failure. (more…)
Author Interviews, Heart Disease, Technology / 31.03.2016 Interview with: Dr. Nicola Gaibazzi Department of Cardiology Parma University Hospital Parma Italy What is the background for this study? What are the main findings? Dr. Gaibazzi: As clinical and research cardiologists we have never accepted that cardiac arrests are so frequently deadly throughout the world (sudden cardiac arrest is the world’s leading cause of death) because many of such events could be easily reversed by early defibrillation if only witnessed by a bystander who could quickly call emergency in place of the incapacitated subject. This would be lifesaving for most of them, gaining quick  access to defibrillation within the golden 8-10 minutes (in the Oregon state study 6.5 minutes is the average time from call to defibrillation). While this issue of early defibrillation access is not easy to be solved for cardiac arrest in the general population, it was surprising to us that there was no available tool to date to automatically alert emergency contacts for people who regularly practice outdoor sports alone, such as running or cycling, and may undergo sudden and unexpected sports-associated cardiac arrest. It is a rare event, but it may happen during exercise, when cardiac arrest is actually several times more frequent than during resting condition, both in sedentary and active subjects. It was surprising to us seeing all people practicing with their earbuds, listening to music from their last-generation smartphone, often used only as if it were an old music cassette “walkman”, while it is a powerful and wireless-connected portable computer with an incredible potential for emergency rescue. Consequently, in 2015 we founded a startup company ( or temporary new site and started building an app that could take advantage of the capabilities of modern smartphones to automatically detect sports-associated cardiac arrest, specifically aiming at recognizing ventricular tachycardia or ventricular fibrillation. This was not an easy task, since we wanted to use simple, cheap and commercially-available hardware, possibly already at hand for sportspeople; otherwise too few subjects would use it and you would not impact such infrequent disease with only few sportsmen using it, since sports-associated cardiac arrest is rare (2/100000 athletes/year) but not negligible, with 2450 deaths in US only each year. We finally chose to use as the only additional required hardware a BT+ heart rate monitor chest strap (a chest strap can be bought if not already owned at 40$), which is cheap, reliable, able to transmit heart rate with trivial battery drainage detected through cardiac electrical signal with trivial battery drainage, and much more reliable than pulse-plethysmographic methods which fully depend on the device contact with the arm or wrist skin to collect a correct signal. We could not afford in our lifesaving app that a wrong wrist or arm device contact would cause absence of pulse signal detection erroneouslytriggering a cardiac arrest alert or not doing so when a cardiac arrest is truly present. Chest straps on the contrary send heart rate sensed from electrical heart activity and are almost impossible to displace even in case of an unconscious subject falling down. We built and tested our Parachute app for the iPhone during 2015, through long testing in the outdoor field and with arrhythmia simulators and at the ACC congress we present just part of the data collected from such tests in athletes running and cycling and with advanced arrhythmia simulators. Parachute was incredibly accurate both to avoid false positives and false negatives, thanks to continuously combined chest strap heart rate data and motion or, better, detection of “no motion”, corresponding to a possible incapacitated subject. These two mechanisms act together and complete each other, they are synergic, since while our patent-pending algorithm using heart rate data is very sensitive for serious arrhythmias, motion detection can easily exclude false positives during outdoor sports, where motion is by definition almost continuous. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 30.03.2016 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? Response: 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 blood pressure 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  blood pressure and CAD or stroke events. (more…)
AHA Journals, Author Interviews, CDC, Heart Disease / 28.03.2016 Interview with: Michele Casper, PhD Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion CDC, Atlanta, GA 3034 What is the background for this study? What are the main findings? Dr. Casper: CDC closely monitors trends in heart disease and this study is the latest in that ongoing effort. Overall, we found substantial disparities in heart disease death rates based on geography, as well as a significant geographic shift in high death rates from heart disease since 1973. Initially, counties with the highest rates were concentrated in the Northeast. By the end of the study period, those high-rate clusters had shifted primarily to southern counties. In addition, our research revealed that the counties with the slowest declines were mostly found in Alabama, Mississippi, Louisiana, Arkansas, Oklahoma and Texas, while the fastest declines were largely in the northern half of the country. These findings are important because they reveal patterns that are masked at the national level and highlight the importance of examining geography – and the characteristics of where people live – in relation to heart disease mortality rates. The consistent progression southward over the past few decades suggests that the pattern is not random – and could be attributed to geographic differences in community-level prevention and treatment opportunities. (more…)
Author Interviews, Heart Disease, JACC / 27.03.2016 Interview with: Leonardo Calo', MD, FESC and Annamaria Martino, MD Policlinico Caslino, Rome, Italy What is the background for this study Response: Brugada syndrome is a genetic syndrome associated to an increased risk of sudden cardiac death. For years, dispersion of repolarization within the right ventricle has been considered the cause of arrhythmogenesis in Brugada syndrome. However, recent studies have suggested that the pathophysiologic basis of this syndrome is a conduction delay in the right ventricular outflow tract. The risk stratification of sudden cardiac death in patients affected by Brugada syndrome, especially those who are asymptomatic, is unclear. An S wave in lead I reflects the depolarization of the right ventricular outflow tract, and appears to be prominent when right ventricular enlargement and fibrosis are present (i.e in cor pulmonale or congenital cardiac diseases). Therefore we aimed at verify whether, a prominent S in DI lead could identify Brugada syndrome patients at risk of sudden cardiac death. (more…)
AHA Journals, Author Interviews, Heart Disease, PTSD / 27.03.2016 Interview with: S. Marlene Grenon, MDCM, MMSc, FRCSC Associate Professor of Surgery Division of Vascular and Endovascular Surgery University of California, San Francisco Veterans Affairs Medical Center- Surgical Services San Francisco, CA What is the background for this study? What are the main findings? Dr. Grenon: In this study, we investigated the impact of PTSD on endothelial function using flow-mediated brachial artery vasodilation. After adjustments for different risk factors and comorbidities, we found that patients with PTSD had worse endothelial function. (more…)
Author Interviews, Heart Disease / 26.03.2016 Interview with: Eric Alexander Secemsky, MD, MSc Fellow in Cardiovascular Medicine Massachusetts General Hospital Harvard Medical School Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center What is the background for this study? Dr. Secemsky: Strategies to reduce bleeding, such as the selective use of procedural anticoagulants, have become an integral component of current percutaneous coronary intervention (PCI) practice to decrease adverse outcomes. For instance, previous randomized clinical trials had demonstrated that use of bivalirudin, a direct thrombin inhibitor, reduces major bleeding events following PCI among patients presenting with acute myocardial infarction (AMI) compared with unfractionated heparin (UFH). These findings resulted in a major increase in bivalirudin use during PCI. However, more recent trials have contradicted these results and created uncertainty as to the relative safety and effectiveness of bivalirudin therapy. In addition, current United States guidelines do not endorse a primary antithrombotic strategy during PCI, leaving the choice of procedural anticoagulant to the discretion of the physician operator. As such, we wanted to determine how bivalirudin was currently being used among United States PCI operators and how usage may have changed in light of these trial findings. (more…)
Author Interviews, End of Life Care, Heart Disease, JAMA / 22.03.2016 Interview with: Colleen K. McIlvennan, DNP, ANP-BC Assistant Professor of Medicine Division of Cardiology Section of Advanced Heart Failure and Transplantation What is the background for this study? What are the main findings? Response: As technology continues to advance, more people are becoming eligible for advanced therapies for end-stage illness. One such therapy, the left ventricular assist device (LVAD) is an option for carefully selected individuals suffering from end-stage heart failure. Use of this innovative technology has expanded from its original indication as a bridge to transplantation to also include destination therapy, in which patients live with the device for the remainder of their lives. Significant focus has been placed on developing and expanding LVAD programs, with less thought about the eventual end-of-life process awaiting patients whose LVAD is indicated for destination therapy. We performed semi-structured interviews about experiences surrounding end of life with 8 caregivers of patients who died with an LVAD. There was a wide range of case histories represented by these patients; however, three main themes emerged that coalesced around feelings of confusion: 1) the process of death with an LVAD, 2) the legal and ethically permissible care of patients approaching death with an LVAD, and 3) the fragmented integration of palliative and hospice care. (more…)
Author Interviews, Gastrointestinal Disease, Heart Disease, Pharmacology / 18.03.2016 Interview with: Giuseppe Gargiulo MD Research fellow in Cardiology Inselspital, University of Bern, Bern, Switzerland What is the background for this study? What are the main findings? Dr. Gargiulo: Every year millions of people with coronary artery disease are treated worldwide with percutaneous coronary intervention (PCI). Consequently, they receive a dual  (DAPT) in order to prevent thrombotic life-threatening complications, such as stent thrombosis. DAPT often consists of aspirin and clopidogrel, but some studies have questioned the efficacy of clopidogrel in case of concomitant therapy with proton-pump inhibitors (PPI) due to pharmacodynamic interactions. Indeed, clopidogrel is a pro-drug needing to be activated, and this could be potentially affected by PPI. This is a relevant topic given that many patients treated with DAPT commonly receive also a PPI to prevent gastrointestinal complications (ulceration and bleeding) or due to pre-existing gastric disease. Some studies demonstrated that the use of a PPI, mainly omeprazole, was associated with an increased risk of cardiovascular adverse events, indeed the Food and Drug Administration (FDA) and the European Medicine Agency (EMA) discouraged the concomitant use of omeprazole and clopidogrel. On the contrary, some other studies did not confirm this finding. We performed a detailed analysis of the impact of PPI therapy on the 2-year clinical outcomes of 1970 patients undergoing PCI with stent implantation enrolled in the PRODIGY trial (a randomized trial comparing 2 DAPT regimens: 6-month versus 24-month DAPT). In our study population, 738 patients (38%) were treated with a PPI (lansoprazole 90%) concomitantly to DAPT. We found that the ischemic and bleeding events at 2 years of follow-up were similar in patients treated with or without a PPI, irrespective of DAPT duration (6-month or 24-month). These findings support the concept that the concomitant use of PPI, when clinically indicated, in patients receiving clopidogrel is not associated with adverse clinical outcomes. (more…)
Author Interviews, Genetic Research, Heart Disease / 18.03.2016 Interview with: Jonathan P. Davis , Ph.D. Associate ProfessorThe Ohio State University Medical Center Department of Physiology & Cell Biology. Columbus, OH 43210 What is the background for this study? What are the main findings? Dr. Davis: Myocardial infarction (MI) is a leading cause of heart failure and death in the US. Since the infarcted heart does not contract as well, therapeutics have been designed (i.e. positive inotropes) to help the heart contract better. While current positive inotropes help the patients in the short-term, they have detrimental long-term effects (“feel better but die sooner”). There is a dire need to be able to increase cardiac contraction without the deleterious side effects. We have achieved this goal by engineering the Ca2+-dependent switch in the heart, troponin C, to be able to better bind Ca2+. Combining gene therapy with our smartly formulated TnC, we demonstrated that our novel strategy not only protected the mouse from the negative consequences of an MI, but was also therapeutic when given after the MI. (more…)
Author Interviews, Heart Disease, JAMA / 18.03.2016 Interview with: Ruut Laitio, MD, PhD Department of Anaesthesiology and Intensive Care Division of Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, Turku, Finland What is the background for this study? Dr. Laitio: Numerous animal studies with different types of brain injury (hypoxic, toxic,stroke, traumatic brain injury) have established the neuroprotective effect of xenon during the last 15 years. We designed a proof-of-concept study to find out whether xenon has neuroprotective effect in humans. An important finding from animal studies was that xenon has at least additive or even synergistic neuroprotective interaction with hypothermia and the results were based on histopathological and functional outcomes. These putative neuroprotective properties had not been reported in humans until now. (more…)
AHA Journals, Author Interviews, Genetic Research, Heart Disease, Lipids / 18.03.2016 Interview with: Dr. Sarah de Ferranti MD MPH Boston Children’s Hospital Director, Preventive Cardiology Program Assistant Professor of Pediatrics Harvard Medical School  What are the main findings? Dr. de Ferranti: Familial hypercholesterolemia, or FH, is a genetic condition that causes severely elevated cholesterol levels from birth and is a leading cause of early heart attack. It is generally slowly progressive without symptoms until there is serious heart disease in the 3rd and 4th decade of life, making it important to look for it at a young age. Prior to this analysis it was thought that FH affected about 1 in 500 adults. The current study used data from 36,949 adults who took part in the 1999-2012 National Health and Nutrition Examination Survey (NHANES) and extrapolated to the 210 million U.S. adults aged 20 years and older. We identified cases of probably or definite Familial hypercholesterolemia in our analysis by using a combination of high levels of low-density-lipoprotein cholesterol (considered “bad” because it contributes to plaque buildup in arteries) and early heart disease in a person or close relative. (more…)
AHA Journals, Author Interviews, Cognitive Issues, Heart Disease / 18.03.2016 Interview with: Hannah Gardener, ScD Department of Neurology, Miller School of Medicine University of Miami Miami, FL What is the background for this study? Response: At the beginning of the study, 1,033 participants in the Northern Manhattan Study (average age 72; 65 percent Hispanic, 19 percent black and 16 percent white), were categorized using the American Heart Association’s “Life’s Simple Seven®” definition of cardiovascular health, which includes tobacco avoidance, ideal levels of weight, physical activity, healthy diet, blood pressure, cholesterol and glucose. The participants were tested for memory, thinking and brain processing speed. Brain processing speed measures how quickly a person is able to perform tasks that require focused attention. Approximately six years later, 722 participants repeated the cognitive testing, which allowed us to measure performance over time. The cardiovascular health factors, which have been shown to predict risk of stroke and myocardial infarction, were then examined in relation to cognitive performance and impairment over time. (more…)
Author Interviews, Heart Disease / 15.03.2016 Interview with: Michael D. Miedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN What is the background for this study? Dr. Miedema: Heart disease is the leading cause of death in the United States. With increasing risk factors like obesity and diabetes more population level prevention efforts are needed. Heart of New Um Project (HONU) was created as a demonstration project to test prevention of cardiovascular disease by reducing modifiable risk factors across the entire community. HONU interventions focus on improving health by reaching individuals in health care, worksites, and the community settings but also creating healthier environment and a social movement around being healthy to enable individuals to make healthier choices. Example interventions in health care, worksite, and the broader community include:
  • Health care: Comprehensive free heart health screening held every few years to identify risks (results shared with providers and follow up was done in clinics to address medication needs). We also used the electronic health record to apply some algorithms to calculate risk of heart disease and were able to offer health coaching to people who did not yet have heart disease or diabetes but who were at high risk.
  • Worksites:  we developed and partnered with over 40 worksites in the community to conduct health screenings of employees, to identify ways companies could improve their wellness policies, and offering onsite behavior change programs.
  • Community: work with restaurants to improve healthy options, increasing farmers market participation by farmers and by consumers, creating run/walk events, community wide health challenges, and creating a social movement through social marketing and community organizing.
Author Interviews, Heart Disease, Stem Cells / 15.03.2016 Interview with: Joost P.G. Sluijter, PhD, FESC Associate Professor Department of Cardiology Experimental Cardiology Laboratory UMC Utrecht What is the background for this study? What are the main findings? Dr. Sluijter: Cell transplantation therapy for ischemic heart disease has entered the arena of clinical trials more than a decade ago. Multiple cell types have been used since these first endeavors, and there is accumulating evidence that different cell types positively influence the damaged heart through paracrine and/or regenerative mechanisms. One of the most promising cell types to be used are the cardiac-located stem cells. Cardiac stem cells (CSCs) have been found to reside in the adult heart and can differentiate towards all cell types that are needed in the normal functional heart. These cells have shown great potential as a regenerative therapeutic upon myocardial infarction (MI) in animal models and are currently being tested in some clinical studies. However, although promising, no systematic overview and subsequent meta-analysis of preclinical data exists to date for this cell type and if they are consistently effective. Our systematic approach, yielded 80 studies and included over 1900 animals, confirms the consistent effect of CSCs and provides us with a first comprehensive overview of pre-clinical MI studies in an unbiased and systematic manner.  Nowadays we are aware of a failure in therapeutic effect size for the translation axis, where we try to bridge fundamental findings from the lab to the bedside. This means that effects we observe in our initial studies on cardiac performance are slowly getting less successful when we are getting closer to a real clinical scenario. Through our meta-analysis, we observed a consistent therapeutic effect of Cardiac stem cells therapy on cardiac function after MI, where 12% of functional improvements is observed in rodents, and only an 8% improvement was still present in large animal models. From previous observations, we know that this leaves a 3-4% of effect in a patient population. In addition to the difference in effect size between small and large animal models, also a difference in study quality and attrition bias was observed. Interestingly, although additional support to the idea that Cardiac stem cells are efficacious in preclinical studies were observed, we did not find any influence of immunosuppression, cell source, comorbidity of CSC donors, culture methods, or model of ischemia on the outcomes. (more…)