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…)
AHA Journals, Author Interviews, Heart Disease, McGill / 14.03.2016 Interview with: Dr George Thanassoulis MD MSc FRCPC McGill University Health Center and Research Institute Montreal, Quebec, Canada What is the background for this study? What are the main findings? Dr. Thanassoulis: Currently statins are recommended in most countries worldwide based on 10-yr risk of heart disease but because age is the best predictor of future heart disease this leads to many more older patients being eligible for statins at the expense of younger people.  This means that even young patients with higher levels of low-density cholesterol, a known cause of heart disease, are not eligible for statins until they are much older.  However, waiting for these individuals to become "old enough for treatment" permits their higher LDL  to continue to damage their arteries leading, in some cases, to advanced coronary disease at the time when statins are finally stated.  So we are missing an opportunity to effectively prevent heart disease. What our analysis shows is that we need to consider not just someone's risk of having a heart attack but also whether they would be expected to benefit from statins.  By integrating information from randomized trials we were able to show that there were over 9.5 million Americans who were at low risk (and not eligible for statin therapy) that would have the same absolute benefit as higher risk people who we currently treat.  These patients, as expected, were younger but had higher levels of LDL cholesterol.  We also showed that statin therapy in these individuals would avoid more than 250,000 cardiac events over 10 years.  (more…)
Author Interviews, Heart Disease / 14.03.2016 Interview with: Prof. Dr. Thomas Pilgrim Inselspital Berne Switzerland  Medical Research: What is the background for this study? Dr. Pilgrim: Long-term prognostic implications of different clinical manifestations of coronary artery disease are insufficiently understood at this time. A time variable pattern of recurrent events following PCI for STEMI, Non-STE-ACS or stable ischemic heart disease may have important implications for medical management and secondary prevention. Medical Research:? What are the main findings? Dr. Pilgrim: In our analysis, we found a differential in timing of ischemic events after PCI according to presentation with STEMI, NSTE-ACS, or stable ischemic heart disease, respectively. While patients with NSTE-ACS were at increased risk of death at any time after PCI as compared to patients with stable ischemic heart disease, patients with STEMI had an increased risk during the first 30 days after PCI but not thereafter compared to patients with stable ischemic heart disease. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, OBGYNE / 14.03.2016 Interview with: Ida Behrens, MD and Heather Boyd PhD Department of Epidemiology Research Statens Serum Institut Copenhagen, Denmark What is the background for this study? Response: Over the past decade, we have begun to realize that a woman’s pregnancy experiences can be a predictor of her future health. Miscarriages, stillbirths and preterm deliveries have all been linked with an increased risk of later cardiovascular disease, as have hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). Women with preeclampsia also have an increased risk of peripartum cardiomyopathy, a rare but serious condition that severely compromises heart function at the end of pregnancy or shortly after delivery. We were interested to find out whether women with preeclampsia or gestational hypertension during one or more pregnancies also had an increased risk of cardiomyopathy later in life. What are the main findings? Response: Using Danish national registers, we followed more than 1 million women with pregnancies between 1978 and 2011 – with an average follow-up of almost 18 years per woman – to see whether women with hypertensive disorders of pregnancy had increased rates of cardiomyopathy later in life, compared with women who only had normotensive pregnancies. We found that the women with hypertensive disorders of pregnancy had a two-fold increased risk of cardiomyopathy later in life. Interestingly, only half of this increase in risk could be linked to chronic hypertension, which is common among women who have previously had a hypertensive disorder of pregnancy. The remaining 50% was not associated with hypertension and could potentially be directly attributable to the woman’s pregnancy experience (or to an underlying cause common to both hypertensive disorders of pregnancy and cardiomyopathy).  (more…)
AHA Journals, Author Interviews, Exercise - Fitness, Heart Disease / 14.03.2016 Interview with: Pei-JieChen, Ph.D. Professor of Exercise Science, President of Shanghai University of Sport MedicalResearch: What is the background for this study? Dr. Pei-JieChen: Traditional Chinese exercises (such as Tai Chi, Qigong, Baduanjin) have been used for 2000 years with great contributions to human health, which are increasingly popular around the world. And traditional Chinese exercise is a low-risk, promising intervention that could be helpful for improving quality of life and depression in patients with cardiovascular diseases (CVDs).However, there appears to be no consensus agreement that traditional Chinese exercises (TCEs) could be effective for CVDs. Therefore, we performed a systematic review and meta-analysis to estimate the effectiveness of Traditional Chinese exercise for patients with CVDs. MedicalResearch: What are the main findings? Dr. Pei-JieChen: The pooling revealed that TCEs could decrease systolic blood pressure by 9.12 mmHg and diastolic blood pressure by 5.12 mmHg. Patients performing traditional Chinese exercises were also found superior compared with those in the control group in terms of triglyceride, six-minute walk test, Minnesota Living with Heart Failure Questionnaire results, SF-36 physical function, and Profile of Mood States depression. (more…)
Author Interviews, Heart Disease / 11.03.2016 Interview with: Malin Inghammar, MD, PhD Department of Infectious Diseases Skåne University Hospital, Lund Sweden What is the background for this study? Dr. Inghammar: Fluoroquinolones are a class of antibiotics with a widespread use in the treatment of common infections. Agents of this drug are generally well tolerated and have few side effects but in some people fluoroquinolones can prolong the QT-interval. QT-prolongation is a sort of electrical disturbance in the heart that can, in rare instances, lead to potentially life-threatening arrhythmia. Some drugs are well known to cause QT-prolongation and to be able to trigger arrhythmia. Fluoroquinolones however, have only weak effect on the QT-time. There have been a few previous studies published reporting an increased risk. Some of these, compared fluoroquinolone treated patients with people who were not treated with antibiotics at all. In these studies, it can’t be ruled out that the infection itself, rather than the antibiotic treatment could have influenced the risk of arrhythmia. In some other previous studies, there have been indications that the patients receiving fluoroquinolones were of poorer general health than the comparison group, which could also have affected the results. Therefore it is not clear if oral fluoroquinolone treatment leads to an increased risk of serious cardiac arrhythmia in an everyday clinical situation. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Radiology / 10.03.2016 Interview with: Guillermo J. Tearney, MD PhD Mike and Sue Hazard Family MGH Research Scholar Professor of Pathology, Harvard Medical School Wellman Center for Photomedicine Massachusetts General Hospital What is the background for this study? Dr. Tearney: In this study, we investigated a new, advanced catheter-based imaging technology for identifying the coronary plaques that may potentially precipitate heart attack. The new technique combines intracoronary OCT, that provides images of tissue emicrostructure with near-infrared autofluorescence (NIRAF) that informs on the molecular/biological characteristics of plaque. What are the main findings? Dr. Tearney: Our main findings were that: 1) Intracoronary OCT-NIRAF is safe and feasible in patients 2) NIRAF was elevated focally in portions of the coronary artery that contained high risk OCT features, and 3) The findings are suggestive that NIRAF may be a new imaging feature that is indicative of inflammation in human coronary lesions in vivo. (more…)
Author Interviews, Heart Disease, JACC / 10.03.2016 Interview with: Cathy Handy, MD MPH  Fellow, Department of Oncology Johns Hopkins Hospital What is the background for this study? What are the main findings? Dr. Handy: We explored the relationship between coronary artery calcium and age related diseases.  Coronary artery calcium refers to calcium deposits in the blood vessels of the heart.  It can be seen with a non invasive imaging test and is thought to be a biologic measure of aging.  Previous research has shown coronary artery calcium to be highly correlated with cardiovascular disease and mortality. We found that it is also associated with an increased risk of cancer, pneumonia, chronic kidney disease, chronic obstructive pulmonary disease and hip fractures. (more…)
Author Interviews, Heart Disease / 09.03.2016 Interview with: Anna Gundlund, MB Gentofte Hospital, Kildegårdsvej Hellerup, Denmark What is the background for this study? Response: Atrial fibrillation seems to accumulate in families and several studies have indicated that a family history of atrial fibrillation may be an important risk factor for developing atrial fibrillation. In addition, three genomic regions associated with atrial fibrillation have been identified in Genome Wide Association Studies. In this study we compared atrial fibrillation patients with or without a family history of atrial fibrillation. What are the main findings? Response: We found that patients with a family history are diagnosed with atrial fibrillation at a younger age and with more disabling symptoms than those without a family history of atrial fibrillation. When looking at the longitudinal course of the disease, we found no differences in risk of progression of atrial fibrillation (e.g. from paroxysmal to persistent), risk of thromboembolic complications, all-cause hospitalization, or all-cause death when comparing those with a family history of atrial fibrillation with those without a family history. (more…)
Author Interviews, Heart Disease, JACC, Surgical Research / 06.03.2016 Interview with: Seung-Whan Lee, MD, PHD Associate professor, Asan Medical Center University of Ulsan College of Medicine on behalf of our investigators.  Medical Research: What is the background for this study? Response: Survival benefit of successful coronary Chronic Total Occlusion  (CTO) recanalization has been a rationale behind PCI for CTOs. However, this knowledge is based on many observational studies that predate the widespread use of dedicated devices or techniques, drug-eluting stents (DESs), and current standards of medical management, making them low-quality evidence from the current perspective. Medical Research: What are the main findings? Response: Our study showed that successful PCI using DES was not associated with a lower risk for mortality compared with failed CTO-PCI. The revascularization strategy for non-CTO vessels, high frequency of subsequent CABG in patients with failed PCI, and high procedural success with low life-threatening complication rate may all have contributed to our study finding. (more…)
Author Interviews, Global Health, Heart Disease, Infections, JAMA / 04.03.2016 Interview with: Thomas Pilgrim, Prof. Dr. med. Oberarzt, Invasive Kardiologie Universitätsspital Bern Bern Switzerland What is the background for this study? Dr. Pilgrim: Three quarters of all children worldwide grow up in regions endemic for rheumatic heart disease. Clinically manifest rheumatic heart disease represents only the tip of the iceberg: only one in in 5 to 8 children with valvular lesions consistent with rheumatic heart disease have a heart murmur or clinical symptoms; the remaining children have clinically silent disease that goes undetected unless echocardiography is performed. An understanding of incidence, prevalence, and progression of disease is an important prerequisite to guide active surveillance and secondary prevention. We therefore performed a school-based cross-sectional study among more than 5000 children from 26 schools in Nepal. The objective of the study was to assess prevalence of clinically silent and manifest rheumatic heart disease as a function of age, gender and socioeconomic status and to estimate the age-specific incidence from available prevalence data. What are the main findings? Dr. Pilgrim: In our population-based observational cross-sectional study, the prevalence of borderline or definite rheumatic heart disease among schoolchildren in Eastern Nepal amounted to 10.2 (95% CI 7.5-13.0) per 1000 children between the ages of 5 and 15 years, and was more common in girls as compared to boys. The prevalence increased across age categories in a nearly linear fashion from 5.5 (95% CI 3.5-7.5) per 1000 in children 5 years of age to 16.0 (95% CI 14.9-17.0) in children 15 years of age, while the average incidence remained stable at 1.1 per 1000 children per year. The prevalence of clinically silent rheumatic heart disease was 5 times higher compared to manifest disease and the ratio of manifest to subclinical disease increased with increasing age. (more…)
Author Interviews, Genetic Research, Heart Disease, JACC / 04.03.2016 Interview with: Silvia G Priori ,MD, PhD and Andrea Mazzanti, MD Medical Research: What is the background for this study? What are the main findings? Response: The study investigates a novel therapeutic approach for Long QT Syndrome type 3: a malignant varian of long QT Syndrome a disease in which the risk of arrhythmias is proportional to the prolongation of QT interval. LAQT3 is caused by gain of function mutations in the gene SCN5A that encode for the alpha subunit of the cardiac sodium channel. These mutations increase the late sodium current (INa late) that prolongs the QT interval and predisposes the heart to develop life-threatening ventricular arrhythmias. In 1996 we demonstrated in an animal model of Long QT Syndrome type 3 that administration of mexiletine was able to shorten QT interval and the same results were obtained in LQT3 patients treated with mexiletine : these data provided rational for the adoption in clinical practice guidelines to recommend the use of mexiletine to shorten QT interval in LQT3 patients with the expectation that shortening QT interval would reduce the risk of arrhythmic death. In this setting, our study is the first to provide data in support of the view that mexiletine shortens QT interval and reduces the probability to experience arrhythmic events. (more…)
Author Interviews, Heart Disease, Lipids, Pharmacology, University of Pennsylvania / 03.03.2016 Interview with: Dr. Richard L. Dunbar MD MS Assistant Professor of Medicine, Attending Physician, Preventive Cardiovascular Medicine Clinic, Member, Institute for Translational Medicine and Therapeutics, University of Pennsylvania School of MedicineMember, Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania School of Medicine and Dr. Harsh Goel WellSpan Academic Hospitalists Department of Medicine, York Hospital, PA What is the background for this analysis? Response: Niacin is the first cholesterol lowering treatment to prevent heart attacks and lower long term mortality. It thus provided the first proof that lowering cholesterol reduces cardiovascular risk. However, it is generally poorly tolerated due to almost universal flushing, limiting use. The better-tolerated statin drugs overshadowed niacin, rightly dominating hyperlipidemia therapy. Despite their advantages, statins are far from perfect, leaving important gaps. Firstly, at least 10% of patients simply don’t tolerate statins. Secondly, about 40% of patients have insufficient cholesterol lowering, leaving them far from their target LDL-cholesterol levels. Finally, even though statins lower cardiovascular risk, they by no means eliminate it and significant residual risk remains even in patients who respond to them. The relatively poor tolerance of niacin motivated development of an extended-release alternative which was dosed very differently from the established cardioprotective regimen used in the Coronary Drug Project (CDP) and the Stockholm Ischemic Heart Disease Study (SIHDS), the two landmark trials that proved niacin's benefits. These trailblazing trials used 3 grams of niacin divided throughout the fed portion of the day as 1 gram thrice daily with meals. In sharp contrast, the alternative regimen was severely handicapped by a profoundly lower dose of only 2 grams per day. Perhaps worse, the alternative regimen dosed all of the niacin at one sitting, at bedtime before the overnight fast, rather than three times a day before meals. We believe these were critical departures from the established cardioprotective niacin regimen, insofar as they severely undermined the alternative regimen’s efficacy. Accordingly, when added to statins, the alternative regimen failed to recapitulate the benefits seen with the established cardioprotective regimen in two recent large clinical trials, the AIM-HIGH trial and the HPS2-THRIVE trial. Besides the inherent flaws of the alternative regimen, there were also major issues with the trial designs which likely contributed to null results. From a practice standpoint, this is worrisome, because clinicians may draw erroneous conclusions from the trials of the alternative regimen, and thereby deny a significant population of hyperlipidemic patients the benefits of a well-proven cardioprotective therapy, i.e. the population which does not tolerate or does not respond adequately to statins (almost 50% of at risk patients). Hence, we embarked on a critical analysis and review of the alternative regimen with a special focus on the AIM-HIGH and HPS2-THRIVE trials to bring to light the pitfalls of comparing radically different regimens of what is nominally the same drug. (more…)
Aging, Author Interviews, Exercise - Fitness, Heart Disease / 02.03.2016 Interview with: Dafna Merom, PhD School of Science and Health University of Western Sydney Penrith New South Wales Australia Medical Research: What is the background for this study? What are the main findings? Dr. Merom: It is well established that moderate-intensity physical activity can reduced the risk of having cardiovascular disease (CVD), yet we know very little about the CVD benefits  that is associated with specific activity type. Considering that different types of physical activity challenge muscular-skeletal, neurological and cardio-respiratory systems differently, and that they involves different levels of psychosocial or cognitive demands, one may expect that different types of PA/sport may have differential relationships with health. Previous research found that frequent dancing protected against dementia, to a larger extent than walking. Since  cardiovascular disease and dementia share similar risk factors we hypothesised that dancing will also protect against CVD, even more than walking given the multi-dimensional nature of dance; Dance integrate physical, cognitive, emotional and social elements in its execution. We found that light-intensity dancing as well as light-intensity walking were not protective against  cardiovascular disease mortality. However, dancers who were at least slightly out of breath or sweaty had 46% lower risk of Cardiovascular death. Compared to fast walkers, dancing further reduced the risk of dying from cardiovascular disease by 21%.” (more…)
AHA Journals, Author Interviews, Heart Disease, PAD, Surgical Research, University of Pennsylvania / 26.02.2016 Interview with: Dr. Grace Wang MD FACS Assistant Professor of Surgery Division of Vascular and Endovascular Surgery Hospital of the University of Pennsylvania Medical Research: What is the background for this study? Dr. Wang: PAD is a major source of morbidity and mortality resulting in functional impairment, limb loss, as well as death. Despite epidemiologic studies which have contributed to our understanding of PAD prevalence and its association with traditional atherosclerotic risk factors, there have been conflicting studies published on the incidence of PAD and differences in treatment outcomes in women versus men. Patients with chronic kidney disease (CKD) are at particularly high risk for PAD. We set out to to define how the incidence of peripheral arterial disease (PAD) in chronic kidney disease (CKD) differs according to sex and age. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Race/Ethnic Diversity, Women's Heart Health / 26.02.2016 Interview with: Karin H Humphries, MBA, DSc | Scientific Director BC Centre for Improved Cardiovascular Health UBC-HSF Professor in Women's Cardiovascular Health Vancouver, BC Medical Research: What is the background for this study? Response: Prior studies have shown that among patients with obstructive coronary artery disease (CAD), women have higher short- and long-term mortality rates as compared to men. Furthermore, a few studies have highlighted the existence of ethnic differences in the incidence of acute myocardial infarction (AMI) and outcomes following an AMI event. However, the joint contribution of sex and ethnicity on outcomes of patients with obstructive  coronary artery disease remains unknown. Our primary objective was to extend these findings by examining the joint impact of sex and ethnicity on long-term adverse outcomes of all patients with angiographic evidence of obstructive CAD presenting with myocardial ischemia. Our study included a population-based cohort of patients ≥ 20 years of age who underwent coronary angiography for acute coronary syndromes (ACS) or stable angina in British Columbia, Canada with angiographic evidence of ≥ 50% stenosis in any epicardial artery. (more…)
AHA Journals, Author Interviews, Heart Disease, Mental Health Research, Women's Heart Health / 26.02.2016 Interview with: Dr. Kim Lavoie, Ph.D. CIHR New Investigator, FRQS Chercheur-Boursier Co-Director, Montreal Behavioural Medicine Centre Professor, Dept. of Psychology University of Quebec at Montreal Director, Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal Adjunct Professor, Faculty of Medicine, University of Montreal Associate Researcher, Montreal Heart Institute Chair, Health Psychology and Behavioral Medicine Section Canadian Psychological Association Medical Research: What is the background for this study? Dr. Lavoie: We were interested in looking at whether rates of ischemia in men and women were different as a function of whether or not you had pre-existing heart disease (we would expect those with existing heart disease to have more ischemia because it’s a major marker of disease) or a comorbid anxiety or mood disorder (we expected anx/mood disorders would be associated with higher rates of ischemia because they reflect clinical levels of chronic stress, which has been linked to higher rates of ischemia in previous studies). Medical Research: What are the main findings? Dr. Lavoie: Overall, we found that men have higher rates of ischemia than women, and that anxiety or mood disorders overall aren't associated with higher or lower risk of ischemia (in those with or without previously diagnosed heart disease). HOWEVER, what we did find that was interesting and perhaps new, was that if you looked within women, those without previously diagnosed heart disease AND anxiety disorders (which including things like panic disorder and generalized anxiety - panickers and worriers) had higher rates of ischemia compared to those without anxiety disorders. This suggests higher rates of ischemia among women without heart disease, which seems counter-intuitive because you would expect those WITH disease to have more ischemia. The fact that anxiety disorders were present in those without previously diagnosed heart disease - and they were the ones with more ischemia, suggests that these women likely HAD heart disease that just hadn't been diagnosed up yet, and that the reason might have been because of their anxiety disorder, which can mask many symptoms of heart disease because many of them overlap (e.g., fatigue, decreased energy, heart palpitations, sweating, chest discomfort, hyperventilation, and fear/worry). This could lead physicians to misinterpret symptoms of real heart disease as those of anxiety - but this only appears to be the case in women according to our study, suggesting a possible sex/gender bias here. (more…)
Author Interviews, JACC, Metabolic Syndrome, OBGYNE, Race/Ethnic Diversity, Women's Heart Health / 26.02.2016 Interview with: Catherine J. Vladutiu, PhD, MPH Research Assistant Professor, Department of Obstetrics & Gynecology Adjunct Assistant Professor, Department of Epidemiology Chapel Hill, NC Medical Research: What is the background for this study? Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life.  Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women.  Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts. (more…)
AHA Journals, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Women's Heart Health / 26.02.2016 Interview with: Mercedes Sotos Prieto, PhD Research Associate, Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA, 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Sotos-Prieto: Given that CVD remains the leading cause of death in the US, the prevention of risk factor development through healthy lifestyle factors, or primordial prevention, is of paramount importance to minimize the long-term risk of CVD. However, the prevalence of these healthy behaviors among US adults remains low. The Healthy Heart Score is a 20-year CVD risk prediction model based on modifiable lifestyle factors and we have shown previously that this score effectively predicted the 20-year risk of CVD in mid-adulthood. Whether this risk score is associated with clinically-relevant CVD risk factors is unknown. Therefore, in this study we analyzed the association between the Healthy Heart Score and incidence of clinical CVD risk factors, including diabetes, hypertension, and hypercholesterolemia among 69,505 U.S women in the Nurses’ Health Study II during 20 years of follow-up. The Healthy Heart Score is based on the 9 most critical lifestyle factors that best estimate CVD risk including: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits, vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats. The Healthy Heart Score estimates the 20 –year CVD risk, thus a higher score reflected a higher predictive CVD risk. Over 20 years, we documented 3,275 incident cases of diabetes, 17,420 of hypertension, and 24,385 of hypercholesterolemia. Our main findings showed that women with higher predicted CVD risk based on the Healthy Heart Score (highest quintile vs. lowest) had significantly greater risk of developing each clinical risk factor individually. Specifically, women with a higher predictive CVD risk had an 18-fold higher risk of type 2 diabetes, 5-fold higher risk of hypertension, and 3-fold higher risk of hypercholesterolemia over 20-years. Further, a higher predictive CVD risk was associated with a 53-fold greater risk of developing a high CVD risk profile (defined as the diagnosis of all 3 clinical risk factors) and this association was most pronounced among women who were younger, did not smoke, and had optimal weight (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Pennsylvania, Women's Heart Health / 26.02.2016 Interview with: Dr. Robert L. Wilensky MD Director, Interventional Cardiology Research Director, Interventional Cardiology Training Program Professor of Medicine Hospital of the University of Pennsylvania Medical Research: What is the background for this study? Dr. Wilensky: We wanted to evaluate whether young women, under the age of 50 years, had an increased risk for recurrent ischemic events after percutaneous coronary intervention (PCI) compared to young men or older women. Medical Research: What are the main findings?  Dr. Wilensky: Despite having less severe coronary artery disease,  had an increased risk of repeated events, generally need for repeat PCI in either the exact location of the original procedure or within the artery that underwent the procedure. This despite the finding that young women were treated with the same medications as young men. (more…)
Author Interviews, Heart Disease, NEJM, Pharmacology / 25.02.2016 Interview with: Professor Paul Myles MBBS, MPH, MD, FCARCSI, FANZCA, FRCA Director, Dept of Anaesthesia and Perioperative Medicine Alfred Hospital and Monash University, Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Dr. Myles: When we set up this study 10 years ago there was marked variation in practice for  people taking aspirin waiting for coronary artery bypass surgery.  About half were being told that they must stop their aspirin 5-7 days before surgery, and the other half were told that they should stay on their aspirin. This variation existed across different countries, different cities, and even within a single hospital. Doctors had varied opinions because reliable medical research was sparse; the evidence was contradictory. We thus designed a definitive clinical trial in which half the patients were randomly assigned to receive aspirin and the other half received a placebo. Our study has shown that aspirin is safe (i.e. it does not increase the bleeding risk). We also found that there does not appear to be a benefit during and after surgery, but in view of the clear benefits that exist in daily life, including the preoperative waiting period, we recommend that people should stay on their aspirin if they are having coronary artery surgery. (more…)
Author Interviews, Heart Disease, JAMA, Kidney Disease, Pharmacology / 24.02.2016 Interview with: Frederic T. Billings IV, MD, MSc Assistant Professor of Anesthesiology and Medicine Additional Specialty: Cardiothoracic Anesthesiology Vanderbilt University Medical Research: What is the background for this study? What are the main findings? Dr. Billings: Acute kidney injury (AKI) affects up to 30% of patients following cardiac surgery and is associated with long-term kidney function decline as well as a 5-fold increase in death during hospitalization following surgery. Statins affect several mechanisms of AKI following cardiac surgery including improvement of endothelial function and attenuation of oxidative stress, so we performed a clinical trial to test the hypothesis that high-dose atorvastatin (brand name Lipitor) use prior to and following surgery reduces AKI following cardiac surgery. In 615 patients who completed the study high-dose atorvastatin treatment, compared to placebo administration, did not reduce the risk of AKI overall, among patients naïve to statins, or patients already using a statin. In fact, among patients naïve to statins with baseline chronic kidney disease we found some evidence that atorvastatin may increase risk for kidney injury, although the number of patients was small in this subgroup. (more…)
Author Interviews, Clots - Coagulation, Genetic Research, Heart Disease, JACC / 23.02.2016 Interview with: Professor Keith AA Fox Duke of Edinburgh Professor of Cardiology University of Edinburgh Medical Research: What is the background for this study? Prof. Fox: From previous reports, certain alleles of CYP2C19 are associated with reduced enzymatic function and reduced conversion of clopidogrel to the active metabolite. Patients carrying these reduced function alleles (reduced metabolizers) exhibit higher platelet reactivity when treated with clopidogrel, compared with patients without reduced-function alleles (extensive metabolizers). However, the relationship of CYP2C19 genotype and outcomes in medically managed patients with acute coronary syndromes (ACS) is not known. Medical Research: What are the main findings? Prof. Fox: There was no association between CYP2C19 metabolizer status (EM vs. RM) and the primary composite endpoint of cardiovascular death, myocardial infarction (MI), or stroke (hazard ratio [HR]: 0.86). EM and RM patients had similar rates of the primary endpoint whether treated with prasugrel (HR: 0.82) or clopidogrel (HR: 0.91; p for interaction non significant). (more…)
Author Interviews, Gender Differences, Health Care Systems, Women's Heart Health / 22.02.2016 Interview with: Professor Robyn Norton Principal Director of The George Institute for Global Health Board Member, The George Institute for Global Health Professor of Public Health at the University of Sydney Professor of Global Health at the University of OxfordProfessor Robyn Norton Principal Director of The George Institute for Global Health Board Member, The George Institute for Global Health Professor of Public Health at the University of Sydney Professor of Global Health at the University of Oxford Medical Research: What is the background for this study? What are the main findings? Prof. Norton: The impetus to focus on women’s health, stems from the knowledge that, while noncommunicable diseases (NCDs) are the leading cause of death and disability for women worldwide, this is not sufficiently recognized nor sufficiently resourced. Equally, while there is increasing evidence that we can learn so much more about how to address the burden of disease for women, by collecting and analyzing data on women, separately to that for men, this is not happening. We are calling for a refocus of the women’s health agenda on NCDs – given that globally and in many countries the focus of women’s health almost exclusively is still on women’s sexual and reproductive health. The fact is that in all but the poorest countries, the greatest health burden, for women, is  noncommunicable diseases and so that if we are to make significant gains in improving women’s health then we must focus on addressing NCDs. The current global burden of disease for women reflects both the significant gains that have been made as a result of addressing maternal mortality and changes that have affected both women and men equally – namely, that populations are living longer, as a consequence of reductions in both infant mortality and communicable diseases, as well as the fact that populations are becoming wealthier and, as a result, are engaging in behaviors that increase the risk of noncommunicable diseases. (more…)
Author Interviews, Heart Disease, Stroke / 22.02.2016 Interview with: Dr. Rolf Wachter Head Senior physician University of Goettingen Göttingen, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Wachter: Atrial Fibrillation is a known risk factor for stroke, and in stroke patients, it is a strong predictor of adverse outcome, if it is not adequately treated (e.g. by anticoagulation). However, in its paroxysmal form, Atrial Fibrillation (AF) may escape routine diagnostics. We aimed to show that we can increase the number of patients with detected AF if we do more monitoring for atrial fibrillation. As a unique feature of our study, we did not focus on a certain stroke subtype (i.e. cryptogenic stroke), but we aimed to consider all patients >= 60 years in whom the detection of  Atrial Fibrillation has a clinical relevance. The main finding of our study was that enhanced and prolonged Holter ECG monitoring (3x10 days of monitoring, analysed in a dedicated core lab) tripled the number of detected AF cases (from 4.5 to 13.5 %). 11 patients had to undergo enhanced and prolonged monitoring to find one additional case of Atrial Fibrillation. (more…)
Author Interviews, Biomarkers, Heart Disease, Lipids / 19.02.2016 Interview with: Lorenz Räber, MD, PhD Director Division CAD and MI INSELSPITAL, Bern University Hospital Bern, Switzerland Medical Research: What is the background for this study? Response: Inflammation is a key player in the pathobiology of atheorsclerosis. Inflammatory markers and specifically C-reactive protein (CRP) associate with statin-mediated clinical event reduction and plaque burden reduction in patients with stable CAD. Whether CRP correlates with changes in plaque composition, ie. an important presumed substrate of plaque vulnerability, remains unknown. We thought to assess compositional atheroma changes by means of virtual histology IVUS in relation to levels of hs-CRP in STEMI patients. For this purpose, we performed intracoronary imaging using virtual histology IVUS in the proximal part of the two non-infarct related coronary arteries of STEMI patients at baseline and 13 months follow-up (IBIS-4 study). A total of 44 patients with 80 vessels had serial imaging and hsCRP measurements available. Medical Research: What are the main findings? Response: This is the first study to show that serial changes and on-treatment levels of hs-CRP correlate with virtual histology IVUS-defined necrotic core content in patients with STEMI receiving high-intensity statin therapy. Patients with a low inflammatory activity are more likely to achieve a reduction in necrotic core, which represents a presumed substrate of plaque vulnerability. These findings may provide the basis for assessing inflammation at follow-up to monitor disease activity in STEMI patients. (more…)
Author Interviews, Heart Disease, Hospital Readmissions / 16.02.2016 Interview with: Rashmee U. Shah, MD MS Cardiovascular Medicine University of Utah School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Shah: The purpose of this study was to evaluate long term outcomes of acute myocardial infarction (AMI) survivors who have cardiogenic shock. We used the ACTION Registry-GWTG (from the NCDR), which is the largest database of AMI, or heart attack, patients in the United States. Some heart attack patients develop cardiogenic shock which is a condition in which the heart muscle becomes so weak that it cannot effectively pump blood to the rest of the body. These patients are critically ill, but with advances in our treatment for heart attacks, many will survive to hospital discharge. We wanted to know, after all the intense treatment and sometimes long hospitalization, how do these patients fare when they leave the hospital? From a total of 112,668 heart attack patients who survived hospitalization, we identified 5,555 who had cardiogenic shock. Over half of all patients were either hospitalized or died within one year of discharge, and this poor outcome was more common among patients who had cardiogenic shock. In fact, the risk of death or hospitalization seems to be clustered in the early post-discharge time period, within 60 days, for patients with cardiogenic shock. After 60 days, shock and non-shock patients experience similar risk. In other words, we found that heart attack patients who had cardiogenic shock are particularly vulnerable during the first 60 days after hospital discharge. (more…)