AHA Journals, Author Interviews, CDC, Heart Disease / 28.03.2016

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Leonardo Calo', MD, FESC and Annamaria Martino, MD Policlinico Caslino, Rome, Italy MedicalResearch.com: 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

MedicalResearch.com 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   MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Colleen K. McIlvennan, DNP, ANP-BC Assistant Professor of Medicine Division of Cardiology Section of Advanced Heart Failure and Transplantation MedicalResearch.com: 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

MedicalResearch.com Interview with: Giuseppe Gargiulo MD Research fellow in Cardiology Inselspital, University of Bern, Bern, Switzerland  MedicalResearch.com: 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

MedicalResearch.com Interview with: Jonathan P. Davis , Ph.D. Associate ProfessorThe Ohio State University Medical Center Department of Physiology & Cell Biology. Columbus, OH 43210 MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Dr. Sarah de Ferranti MD MPH Boston Children’s Hospital Director, Preventive Cardiology Program Assistant Professor of Pediatrics Harvard Medical School MedicalResearch.com:  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

MedicalResearch.com Interview with: Hannah Gardener, ScD Department of Neurology, Miller School of Medicine University of Miami Miami, FL MedicalResearch.com: 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

MedicalResearch.com Interview with: Michael D. Miedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN MedicalResearch.com: 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.
(more…)
Author Interviews, Heart Disease, Stem Cells / 15.03.2016

MedicalResearch.com Interview with: Joost P.G. Sluijter, PhD, FESC Associate Professor Department of Cardiology Experimental Cardiology Laboratory UMC Utrecht MedicalResearch.com: 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

MedicalResearch.com Interview with: Dr George Thanassoulis MD MSc FRCPC McGill University Health Center and Research Institute Montreal, Quebec, Canada MedicalResearch.com: 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

MedicalResearch.com 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

MedicalResearch.com Interview with: Ida Behrens, MD and Heather Boyd PhD Department of Epidemiology Research Statens Serum Institut Copenhagen, Denmark MedicalResearch.com: 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. MedicalResearch.com: 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

MedicalResearch.com 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

MedicalResearch.com Interview with: Malin Inghammar, MD, PhD Department of Infectious Diseases Skåne University Hospital, Lund Sweden  MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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. MedicalResearch.com: 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

MedicalResearch.com Interview with: Cathy Handy, MD MPH  Fellow, Department of Oncology Johns Hopkins Hospital MedicalResearch.com: 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

MedicalResearch.com Interview with: Anna Gundlund, MB Gentofte Hospital, Kildegårdsvej Hellerup, Denmark MedicalResearch.com: 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. MedicalResearch.com: 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

MedicalResearch.com 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

MedicalResearch.com Interview with: Thomas Pilgrim, Prof. Dr. med. Oberarzt, Invasive Kardiologie Universitätsspital Bern Bern Switzerland MedicalResearch.com: 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. MedicalResearch.com: 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

MedicalResearch.com 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

MedicalResearch.com 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  MedicalResearch.com: 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

MedicalResearch.com 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

MedicalResearch.com 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

MedicalResearch.com 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…)