Author Interviews, BMJ, Heart Disease, Mediterranean Diet, Microbiome, Nutrition, Vegetarians / 29.09.2015

Prof. Danilo Ercolini, PhD Department of Agricultural Sciences University of Naples Federico II Portici - ItalyMedicalResearch.com Interview with: Prof. Danilo Ercolini, PhD Department of Agricultural Sciences University of Naples Federico II Portici - Italy Medical Research: What is the background for this study? What are the main findings? Prof. Ercolini: There is a thick body of literature showing that diet can significantly impact the gut microbiota and metabolome. In a recent study, negligible differences in gut microbiota and feca lshort-chain fatty acids (SCFA) were reported between habitual omnivores and vegans in the USA. In addition, Mediterranean diet is a recognized healthy dietary pattern but has not previously been related to the composition of the gut microbiota and related metabolome. That’s the background in short. Here we show how habitual vegetarian and vegan diets promote enrichment of fibre-degrading bacteria in the gut. Subjects who consume a Mediterranean diet rich in fruit, legumes and vegetables have higher levels of fecal short chain fatty acids, regardless of the diet type. Low adherence to the Mediterranean diet corresponds to an increase in urinary trimethylamine oxide levels, a potential risk factor for cardiovascular disease. (more…)
Author Interviews, Depression, Heart Disease, JAMA / 28.09.2015

MedicalResearch.com Interview with:Dr-Ken-Freedland Kenneth E. Freedland, PhD Professor of Psychiatry and Psychology Washington University School of Medicine St. Louis, Missouri Medical Research: What is the background for this study? What are the main findings? Dr. Freedland: Major depression is a common problem in patients with heart failure, and it makes heart failure self-care tasks such as daily weight checks and compliance with dietary restrictions more difficult for these them.  Unfortunately, recent clinical trials have shown that both depression and inadequate self-care can be hard to treat in patients with heart failure. Cognitive behavior therapy (CBT) is often used to treat depression in otherwise healthy individuals, but it hasn’t been tested in patients with heart failure. We added a self-care component to the standard CBT treatment protocol and conducted a clinical trial to determine whether it is effective both for depression and for self-care.  We randomized 158 heart failure patients to  cognitive behavior therapy or to usual care, and both groups received heart failure education.  About 1/3 of the patients in both groups were also taking antidepressant medications. The intervention was effective for depression, with remission rates of 51% in the cognitive behavior therapy group compared to only 20% in the usual care group.  However, it was not effective for heart failure self-care. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Prostate Cancer, Testosterone / 27.09.2015

Anthony V. D'Amico, MD, PhD Chief, Division of Genitourinary Radiation Oncology Professor of Radiation Oncology, Harvard Medical SchoolMedicalResearch.com Interview with: Anthony V. D'Amico, MD, PhD Chief, Division of Genitourinary Radiation Oncology Professor of Radiation Oncology, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. D'Amico: Controversy exists as to whether androgen deprivation therapy (ADT) used to treat prostate cancer can cause fatal cardiac events. We found that in men with moderate to severe comorbidity based most often on a history of a heart attack that the use of 6 months of androgen deprivation therapy to treat non metastatic but clinically significant prostate cancer was associated with both an increased risk of a fatal heart attack and shortened survival. (more…)
Author Interviews, Heart Disease, Karolinski Institute, Nutrition, Stroke / 27.09.2015

Susanna C. Larsson | PhD, Associate Professor Associate professor, Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm, SwedenMedicalResearch.com Interview with: Susanna C. Larsson  PhD, Associate Professor Associate professor, Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm, Sweden Medical Research: What are the main findings? Dr. Larsson: A high dietary cholesterol intake has been postulated to increase the risk of cardiovascular disease. Egg is a rich source of dietary cholesterol and has been positively associated with risk of heart failure in previous prospective studies. High consumption of eggs has also been associated with a higher risk of myocardial infarction in diabetic patients. Medical Research: What is the background for this study? Dr. Larsson:  We investigated the association between egg consumption and risk of cardiovascular diseases in two population-based prospective cohort studies of approximately 38,000 Swedish men and 33,000 Swedish women. Findings from our study indicate that egg consumption does not increase the risk of myocardial infarction, ischemic stroke, or hemorrhagic stroke. High egg consumption (one or more times per day) was associated with an elevated risk of heart failure in men but not in women. Egg consumption was not associated with an increased risk of heart failure, myocardial infarction, or stroke in individuals with diabetes. (more…)
Author Interviews, Heart Disease, Lipids / 25.09.2015

MedicalResearch.com Interview with: Dr Marcus Kleber PhD Post-doctoral researcher at the Vth Department of Medicine of the Medical Faculty Mannheim Heidelberg University Medical Research: What is the background for this study? What are the main findings? Dr. Kleber: Most trans fatty acids in our diet are industrially produced.  High concentrations of trans fatty acids are hazardous to human health but whether low concentrations are also harmful has not been studied in detail. We measured trans fatty acids in the erythrocyte membranes of our study participants  and found relatively low levels that were not associated with increased mortality. To the contrary, we found an association with a reduced risk for sudden cardiac death for higher concentrations of the naturally occurring trans fatty acid trans-palmitoleic acid that is ingested with milk and milk products. (more…)
Author Interviews, End of Life Care, Heart Disease, JAMA / 22.09.2015

MedicalResearch.com Interview with: Dr. Timothy J. FendlerMedicalResearch.com Interview with: Dr. Timothy J. Fendler MD MS Department of Cardiology, Saint Luke’s Mid America Heart Institute Kansas City, Missouri Medical Research: What is the background for this study? What are the main findings? Dr. Fendler: In-hospital cardiac arrest occurs commonly in the United States and is associated with low rates of meaningful survival. This poor prognosis should prompt patient-clinician discussions about goals of care and preferences for future resuscitative efforts. Little is known about how prognosis is aligned with code status decisions among survivors of in-hospital cardiac arrest (in other words, as prognosis worsens, are patients more likely to adopt Do-Not-Resuscitate orders, a sign of less aggressive treatment preferences, should recurrent cardiac arrest occur). We found that, among patients who survive an in-hospital cardiac arrest, there is generally good alignment between prognosis and code status decisions. That is, as prognosis worsens among survivors of in-hospital cardiac arrest, the rate of DNR status adoption increases, on average. However, among patients with very low levels of neurologic functioning and very poor prognosis, nearly two-thirds did not adopt DNR status, despite the fact that only about 4% of these patients with poor prognosis experienced actual favorable neurological survival. These results imply that there could be better alignment between prognosis and goals of care decisions that places the patient's wishes, safety, and quality of life at the forefront of decision-making and decreases the likelihood of undue suffering when the outcome may not be improved by it. Second, survival rates were much lower in patients with DNR orders, compared to those who did not adopt DNR status, after survival from in-hospital cardiac arrest. This was observed regardless of prognosis, implying that patients who adopt DNR status, and thus only request they be treated differently in the setting of recurrent cardiac arrest, may be receiving less aggressive treatment than they prefer, in areas of their care outside of resuscitation from cardiac arrest. (more…)
AHA Journals, Author Interviews, Heart Disease, OBGYNE, Women's Heart Health / 22.09.2015

Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, CaliforniaMedicalResearch.com Interview with: Barbara A. Cohn, PhD Director of the Child Health and Development Studies at the Public Health Institute. Berkeley, California Medical Research: What is the background for this study? Dr. Cohn: I guessed that pregnancy complications would be an early warning sign of cardiovascular problems because of the extraordinary demands that pregnancy places on a woman’s cardiovascular system. Medical Research: What data were used for this study? Dr. Cohn: The Child Health and Development Studies is a large pregnancy cohort that enrolled more than 20,000 pregnancies in the 1960’s. Women and their families have been followed now for more than 50 years. Information on pregnancy complications was captured from medical records as they occurred, long before cardiovascular disease developed. These data are the basis for the current study. Medical Research: Why hasn’t this study already been done? Dr. Cohn: Long-term, large studies of pregnancy are rare. I first tried to do this study forty years ago when I was in graduate school.   At that time, Dr. Bea van den Berg, the late, second director of the Child Health and Development Studies advised that the study mothers were still too young to observe their cardiovascular disease experience. Now 40 years later, my colleague Piera Cirillo and I have been able to test the idea that combinations of pregnancy complications are linked to cardiovascular disease death for women. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC / 21.09.2015

MedicalResearch.com Interview with: Renato Valenti, MD David Antoniucci, MD Cardiology Department; Careggi Hospital Florence; Italy Medical Research: What is the background for this study? Response: Previous data have shown that high residual platelet reactivity in patients receiving clopidogrel is associated with high risk of ischemic events and cardiac death after PCI at short-  and long-term follow-up. Clopidogrel nonresponders patients of  the  REsponsiveness to CLOpidogrel and StEnt thrombosis (RECLOSE-2) ACS study received an increased dose of clopidogrel or switched to ticlopidine under light transmittance aggregometry (LTA) adenosine diphosphate  (ADP) test guidance. Despite some decrease of ADP test after treatment adjustment, there was no improvement on clinical outcome. Currently no evidence exists that the achievement of an optimal platelet aggregation inhibition in clopidogrel nonresponders  modifies  the risk profile of  these patients. The RECLOSE-3  study invesigated if a new antiplatet therapy with prasugrel in clopidogrel nonresponders can modify the risk profile of these patients and improve the outcome in term of cardiac mortality. From the RECLOSE-3 registry we identified  302 consecutive  patients who were clopidogrel nonresponders.  Nonresponders  switched to prasugrel therapy.  Due to the nonrandomized study design the clinical outcome of clopidogrel nonresponders switched to prasugrel (from RECLOSE-3 study) was compared with the historical cohort of clopidogrel nonresponders of the RECLOSE-2 ACS (248 patients)  study. The primary endpoint of the study was cardiac mortality. The 2-year cardiac mortality rate was  4.0% in the RECLOSE-3 group and 9.7% in the RECLOSE-2 group (p=0.007). The difference in 2-year cardiac mortality remained also considering exclusively patients  with ACS on admission: 3.2% and 9.7%, respectively, p=0.023.At the final model of multivariable analysis, prasugrel treatment was inversely related to the risk of  2-year cardiac death (HR 0.32; p=0.036)  after adjusting for ACS and other well known covariates related to the outcome. Medical Research: What are the main findings? Response: The main finding of the RECLOSE-3 study is that nonresponsiveness to clopidogrel may be a “modifiable risk factor” for cardiac death after PCI. Prasugrel treatment overcomes nonresponsiveness to clopidogrel and results in thrombotic risk similar to the one of clopidogrel responders. (more…)
Author Interviews, Dental Research, Heart Disease / 21.09.2015

Boxi Zhang  PhD Student  School of Health and Medical Sciences Örebro University  MedicalResearch.com Interview with: Boxi Zhang  PhD Student  School of Health and Medical Sciences Örebro University   Medical Research: What is the background for this study? What are the main findings? Response: In the past decade, many studies raise concerns about the increased prevalence of cardiovascular disease and mortality among patients with periodontitis. Porphyromonas gingivalis is the major pathogen causing periodontal disease. This bacterium also plays a significant role in the pathogenesis of atherosclerosis. In this study, we infect human aortic smooth cells with P. gingivalis and show that this periodontal pathogen affects gene and protein expression in human aortic smooth muscle cells associated with increased inflammation and atherosclerosis. (more…)
Author Interviews, BMJ, Hearing Loss, Heart Disease, Occupational Health / 20.09.2015

Wenqi Gan, MD, PhD Assistant Professor Department of Preventive Medicine and Environmental Health University of Kentucky College of Public Health Lexington, KY 40536MedicalResearch.com Interview with: Wenqi Gan, MD, PhD Assistant Professor Department of Preventive Medicine and Environmental Health University of Kentucky College of Public Health Lexington, KY 40536 Medical Research: What is the background for this study? Dr. Wenqi Gan: In epidemiologic studies on health effects of noise exposure, community noise is typically assessed using noise prediction models, occupational noise is assessed using self-reports or historical records. These methods are able to estimate community noise exposure in residential areas and occupational noise exposure in the workplace; however, these methods are not able to accurately reflect actual personal noise exposure in the home and workplace. The lack of personal noise exposure information is a major limitation of previous studies, which could cause underestimations of the true health effects of noise exposure. Bilateral high-frequency hearing loss, an objective indicator for long-term exposure to loud noise, may be used to investigate health effects of noise exposure. Medical Research: What are the main findings? Dr. Wenqi Gan: This study includes 5223 people aged 20-69 years who participated in the US National Health and Nutrition Examination Survey 1999-2004. Compared with people with normal high-frequency hearing, people with bilateral high-frequency hearing loss were approximately two times more likely to have coronary heart disease. This association was particularly striking for people who were chronically exposed to loud noise in the workplace or leisure time. For example, for currently employed workers with occupational noise exposure history, the possibility of having coronary heart disease increased more than four times. This study confirms that chronic exposure to loud noise is associated with increased risk of coronary heart disease. (more…)
Author Interviews, Heart Disease, Sleep Disorders / 18.09.2015

Dr Manolis Kallistratos MD,PhD FESC,EHS Cardiologist at Asklepieion Voula General Hospital Athens, Greece MedicalResearch.com Interview with: Dr Manolis Kallistratos MD,PhD FESC,EHS Cardiologist at Asklepieion Voula General Hospital Athens, Greece  Medical Research: What is the background for this study? What are the main findings? Dr Kallistratos: We all know that lifestyle changes represent the cornerstone of treatment of arterial hypertension. Lifestyle changes include restriction of salt and alcohol, physical activity, smoking cessation and weight loss. On the other hand, we know that many individuals especially the elders are sleeping at noon. Unfortunately there are few studies assessing mid-day sleep. A study in healthy individuals affirmed that sleeping at noon resulted in a decrease of 12% of the relative risk of coronary mortality in healthy subjects.  So the question regarding this habit is: Is it only a custom, a behavioral adaptation or is it also beneficial? Should mid-day sleep be included in the life style changes suggested by the doctors in patients with arterial hypertension? because we all know that nowadays is almost a privilege for a few due to the “nine to five” working culture, and the intense daily routine. For this purpose we prospectively studied 386 middle-aged patients (200 males and 186 females) from our outpatient hypertensive clinic. We observed that hypertensive patients that slept at noon presented lower pulse wave velocity levels (less stiff arteries), lower daytime and nighttime as well as average systolic blood pressure levels (24-hours SBP) . In general mid-day sleep decreased systolic blood pressure levels (during 24 hours) for approximately 6 mm of Hg. 60 minutes of mid-day sleep, decreased average SBP in our patients for about 4 mmHg. In addition, there was a trend, patients who slept at noon to be under fewer medications. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Lifestyle & Health, McGill / 18.09.2015

MedicalResearch.com Interview with: Sylvie S.L. Leung Yinko, MSc, RD Division of Clinical Epidemiology Research Institute of McGill University Health Centre (RI MUHC) Montreal (QC) and Louise Pilote, MD, MPH, PhD Professor of Medicine McGill University and Director of the Division of General Internal Medicine McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Response: Patients with premature acute coronary syndrome (ACS) are a vulnerable population of young or middle-aged adults at risk for future cardiovascular events. However, while health behaviors such as diet, physical activity, smoking, alcohol consumption and recreational drug use are important lifestyle factors that can influence cardiovascular risk, there is limited information about health behaviors in this population group. Additionally, there is indication in the literature regarding sex and age differences in health behaviors, but whether such differences exist in patients with premature acute coronary syndrome remained to be explored. Using data from GENESIS-PRAXY (GENdEr and Sex determInantS of Cardiovascular Disease from bench to beyond in PRemature Acute Coronary Syndrome), a large-scale prospective cohort study across Canada, US and Switzerland, we explored the health behavior profile of patients with premature ACS. As well, we examined whether there is a change in health behaviors 1 year post-ACS and assessed sex differences. Our results showed that the health behavior profile of men and women with premature Acute Coronary Syndrome are worse than that of the general population. We found a high prevalence of poor health behaviors in a young population with only modest changes after Acute Coronary Syndrome. Health behaviors remained suboptimal and worse than the general population, especially with regards to diet, smoking and recreational drug use. Sex differences existed in the prevalence of these behaviors at baseline and 1 year post-ACS but not in the magnitude of change after the ACS event. (more…)
Alcohol, Author Interviews, Cancer Research, Heart Disease / 17.09.2015

MedicalResearch.com Interview with: Dr Andrew Smyth PhD Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr Smyth: Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms and previous studies were mostly done in high income countries. In this study we explored the associations between alcohol consumption and clinical outcomes in a prospective cohort study of 12 countries from different economic levels. Over an average of four years of follow-up of almost 115,000 participants, we found that although current drinking was associated with a 24% reduction in risk of heart attack, there was no reduction in the risk of death or stroke, and there was a 51% increase in risk of alcohol-related cancers (mouth, oesophagus, stomach, colorectum, liver, breast, ovary and head and neck) and a 29% increase in risk of injury. For a combination of all outcomes, we found no overall benefit from current alcohol use. We also found differences between countries of different income levels: for higher income countries current drinking was associated with a 16% reduction in risk of the combined outcome, but in lower income countries there was a 38% increase in risk. (more…)
Author Interviews, Cleveland Clinic, Cost of Health Care, Heart Disease, JAMA, Radiology / 16.09.2015

Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland, OH MedicalResearch.com Interview with: Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic  Cleveland, OH Medical Research: What is the background for this study? What are the main findings? Prof. Jaber: Risk stratification of patients presenting with atrial fibrillation often includes a non-invasive evaluation for coronary artery disease. However, the yield of such testing in patients without angina or anginal-equivalent symptoms is uncertain. That is, how often do we find silent myocardial ischemia? In our cohort of 1700 consecutive patients with atrial fibrillation, less than 5% had ischemia on nuclear stress testing, even though comorbidities were prevalent. Moreover, in patients with ischemia that had invasive coronary angiography, less than half had obstructive coronary artery disease. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Race/Ethnic Diversity, Women's Heart Health / 16.09.2015

MedicalResearch.com Interview with: Carmen De Miguel, PhD | Postdoctoral Scholar Section of Cardio-Renal Physiology and Medicine Department of Medicine | Division of Nephrology UAB | The University of Alabama at Birmingham Medical Research: What is the background for this study? Dr. De Miguel: It is known that obesity is a major risk for cardiovascular disease and that cardiovascular disease is more prevalent in the African American population. Specifically, female African Americans have an exceptionally high risk of developing cardiovascular disease. Obesity is known to contribute to the development of diabetes, hypertension, heart disease, etc. All these diseases have in common persistent low-grade inflammation, and we also know that signs of inflammation can be observed in patients with cardiovascular disease years before the disease is diagnosed. A better understanding of the differences within ethnicities regarding the development of cardiovascular disease is needed and will lead to the development of better therapies targeted to each population. Based on all of this knowledge, we hypothesized that obesity would lead to different changes in the immune system of male and female, Caucasian and African American teenagers (14-20 year old). Medical Research: What are the main findings? Dr. De Miguel: We found differences in the immune cell profile in white and black teenagers, and within gender in the African American subjects. We believe that monitoring these differences could be used to recognize at an earlier stage those individuals that are at-risk of developing cardiovascular disease in the future, and this could allow for preventive therapies that would reduce such risk. Specifically, we found that obese white teenagers decrease the numbers of T cells (a kind of immune cell) in the circulation (blood) compared to African American teenagers, which indicates that they have less systemic inflammation than the African Americans subjects in response to obesity. Within the African American subjects, we found that obese males had smaller numbers of T cytotoxic cells (CD8+ cells, a specific kind of T cell) and smaller numbers of activated T cytotoxic cells than lean males, what tells us that obese males are trying to decrease their inflammation levels. However, obese African American females do not decrease those levels, so their inflammation remains elevated. We think that the fact that they do not decrease the activation of T cytotoxic cells (CD8+ cells) could be important in explaining the high risk that black females have of developing cardiovascular disease later in life. (more…)
AHA Journals, Author Interviews, Gastrointestinal Disease, Heart Disease, Microbiome / 16.09.2015

Jingyuan Fu, Ph.D. Associate professor of genetics University Medical Center Groningen NetherlandsMedicalResearch.com Interview with: Jingyuan Fu, Ph.D. Associate professor of genetics University Medical Center Groningen Netherlands  Medical Research: What is the background for this study? What are the main findings? Dr. Jingyuan Fu: Abnormal blood lipid levels are important risk factors for cardiovascular diseases. Because of that, a common advice is to have a healthy lifestyle or take lipid-lowering drugs like statin to control the blood lipid level. However, the problem is only partially solved. Cardiovascular disease remains the No 1 cause of death globally, representing 31% of all global deaths.  The primary purpose of the study is to look for a new solution in humans’ gut. Over millions of years, microbes and humans have formed a truly symbiotic relationship. Human body contains 10 trillion bacteria, 10x more than human cells. They help digest food and train our immune systems. As less than 30% of bacteria in human gut can be cultured, we know very little how they are and what they do in our gut. With the state-of-art deep sequencing technology, we are now able to see who are there. The research questions would be how much effect these bacteria could affect the blood lipids levels and which bacteria play important role. No such an analysis was done in large-scale human population. Our study was the first to provide solid evidence for the associations between gut bacteria and blood lipids. Although we cannot conclude cause-effect relationship yet, it serves an important step in narrowing possible therapeutic targets. (more…)
Author Interviews, Chocolate, Heart Disease / 15.09.2015

PD Dr. med. Christian Heiß Sektion Angiologie Oberarzt, Facharzt für Innere Medizin und Angiologie Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf MedicalResearch.com Interview with: PD Dr. med. Christian Heiß Sektion Angiologie Oberarzt, Facharzt für Innere Medizin und Angiologie Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf Medical Research: What is the background for this study? What are the main findings? Response:  There is an extensive body of research which has shown that cocoa flavanols can improve healthy blood vessel function. However, for the most part, these investigations have focused on high-risk individuals like smokers and people that have already been diagnosed with conditions like hypertension and coronary heart disease. The purpose of the FLAVIOLA HEALTH study, published in BJN, was to find out whether the beneficial cardiovascular effects of cocoa flavanols would hold true for the general population. The studies demonstrated that consumption of cocoa flavanols significantly improves several of the hallmarks of cardiovascular health, including increased flow-mediated vasodilation. Flow-mediated vasodilation is a sign of improved endothelial function and has been shown by some studies to be associated with decreased risk of developing cardiovascular disease. In addition, consuming flavanols decreased both systolic and diastolic blood pressure, and improved the blood cholesterol profile by decreasing total cholesterol, decreasing LDL cholesterol, and increasing HDL cholesterol. The results demonstrate that flavanols are effective at mitigating age-related changes in blood vessels, and could thereby reduce the risk of cardiovascular disease in healthy individuals. (more…)
Author Interviews, Gout, Heart Disease, Kidney Disease, Mayo Clinic / 14.09.2015

Wisit Cheungpasitporn, MD Nephrology Fellow Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MMedicalResearch.com Interview with: Wisit Cheungpasitporn, MD Nephrology Fellow Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN Program director: Suzanne Norby, MD Co-authors: Charat Thongprayoon, MD, Andrew M. Harrison, BS and Stephen B. Erickson, MD Project mentors: Stephen B. Erickson, MD Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN   Medical Research: What is the background for this study? Dr. Cheungpasitporn: Uric acid has been linked to acute kidney injury (AKI) through crystal-dependent pathways and crystal-independent mechanisms, including reduced renal blood flow and glomerular filtration rate. Serum uric acid measurement has recently been examined as a marker for early AKI detection, especially in the setting of postoperative AKI following cardiovascular surgery. The effect of admission serum uric acid levels on the risk of in-hospital AKI in the general hospitalized patients, however, was unclear. Thus, we conducted a study to assess the risk of AKI in all hospitalized patients across different serum uric acid levels. The findings of our study data were recently published in Clinical Kidney Journal. (more…)
Author Interviews, Cannabis, Diabetes, Diabetologia, Heart Disease / 14.09.2015

Mike Bancks, MPH NHLBI Cardiovascular Disease Epidemiology & Prevention Pre-doctoral Fellow University of Minnesota School of Public HealthMedicalResearch.com Interview with: Mike Bancks, MPH NHLBI Cardiovascular Disease Epidemiology & Prevention Pre-doctoral Fellow University of Minnesota School of Public Health [email protected] Medical Research: What is the background for this study? What are the main findings? Response: We chose to research this topic because marijuana is the most commonly used illicit drug in the United States and use can be expected to increase as the effort to legalize marijuana for recreational and medicinal use grows. We found that individuals who reported using marijuana in excess of 100 times during young adulthood had 40% greater risk for developing prediabetes by middle adulthood. However, we did not find an association between marijuana use and overt diabetes during this same period in adulthood, suggesting that marijuana use may be a risk factor for the early stage of diabetes. (more…)
AHA Journals, Author Interviews, Heart Disease, Sleep Disorders / 12.09.2015

Chan-Won Kim, M.D. Clinical Associate Professor Center for Cohort Studies Kangbuk Samsun Hospital Sungkyunkwan University School of Medicine Seoul, South KoreaMedicalResearch.com Interview with: Chan-Won Kim, M.D. Clinical Associate Professor Center for Cohort Studies Kangbuk Samsun Hospital Sungkyunkwan University School of Medicine Seoul, South Korea Medical Research: What is the background for this study? Dr. Chan-Won Kim: In modern society, inadequate sleep either in quantity or in quality is a common problem and widely recognized as a potential determinant of adverse health outcomes including cardiovascular health. Very long or very short duration of sleep are associated with an increased risk for clinical cardiovascular events such as coronary heart disease and strokes. In these previous studies, however, it was possible that extreme sleep duration or poor sleep quality was a consequence of previous co-morbidities such as depression and obesity, and it was still unclear if these co-morbidities were really responsible for the effects of sleep disturbances. Therefore, we evaluated the association of sleep duration and quality with early markers of subclinical arterial disease in asymptomatic apparently healthy men and women. Medical Research: What are the main findings? Dr. Chan-Won Kim:  In our study, we found that sleep duration had a U-shaped association with two early markers of vascular disease. Both short and long sleep duration were associated with a greater amount of calcification in the coronary arteries, a very good measure of subclinical atherosclerosis that predicts the risk of a heart attack. We also found a similar pattern of association with arterial stiffness, a marker of vascular aging. For both markers, we found the lowers risk in study participants who reported 7 hours of sleep. In addition, poor subjective sleep quality was also associated with these markers of vascular disease. Few studies had explored these associations before, and they were inconsistent partly because of small sample sizes. Our research also indicates that these associations were present irrespective of traditional risk factors such as hypertension, hypercholesterolemia, or diabetes. (more…)
Author Interviews, Diabetes, Heart Disease, Karolinski Institute, Kidney Disease / 12.09.2015

MedicalResearch.com Interview with: Dr. Daniel Hertzberg M.D., Ph.D. Student Department of Medicine, Solna Karolinska University Hospital Medical Research: What is the background for this study? Dr. Hertzberg: Acute Kidney Injury (AKI) is a common complication in patients undergoing cardiac surgery. It is associated with increased short and long-term mortality, myocardial infarction, heart failure and chronic kidney disease. Diabetes is often considered as a risk factor for AKI. However, when we searched the literature we did not find any studies which specifically studied diabetes as a risk factor for AKI. In addition, in observational studies, it is uncommon that diabetes is subtyped into type 1 or type 2 even though they have different etiologies and thus may have different impact on risk of adverse outcomes. Thus, we designed this study in order to study the association between the two subtypes of diabetes and risk of AKI. (more…)
Author Interviews, CDC, Heart Disease / 10.09.2015

Dr. Quanhe Yang PHD Epidemiologist CDC’s Division for Heart Disease and Stroke PreventionMedicalResearch.com Interview with: Dr. Quanhe Yang PHD Epidemiologist CDC’s Division for Heart Disease and Stroke Prevention Medical Research: What is the background for this study? What are the main findings? Dr. Yang:  One in every three Americans dies of cardiovascular disease. For both men and women, it is the number one cause of death. Heart age is the predicted age of a person’s vascular system based on his or her cardiovascular risk factor profile. The concept was created as a way to more effectively illustrate an individual’s future risk of developing or dying from a heart attack or stroke. Using information from the Framingham Heart Study and data collected from every U.S. state, this study is the first to provide population-level estimates of heart age and to highlight disparities in heart age nationwide. Our research found one in two U.S. men and two in five U.S. women have a heart age that is five or more years older than their chronological age, a sign they are at higher risk for heart attacks and stroke. In all, we found nearly 69 million adults between the ages of 30 and 74 have a heart age five or more years older than their actual age. That’s about the number of people living in the 130 largest U.S. cities combined. In addition, there are variations in heart age based on gender, race/ethnicity, region and other demographics. The good news is, heart age can be lowered through lifestyle changes or appropriate medication. U.S. adults both young and old can use this information to take charge of their own heart health and take immediate steps to prevent future heart attacks or strokes. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 09.09.2015

Carl "Chip" Lavie MD, FACC FACP, FCCP Medical Director, Cardiac Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular DiseasesMedicalResearch.com Interview with: Carl "Chip"  Lavie MD, FACC FACP, FCCP Medical  Director, Cardiac  Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical  School-UQ School of Medicine Jefferson, LA Editor-in-Chief, Progress in Cardiovascular Diseases  Medical Research: What is the background for this study? What are the main findings? Dr. Lavie: My co-authors and I reviewed the published literature on the impact of running on chronic diseases and cardiovascular disease and all-cause mortality. Although we reviewed substantial running literature, the major 4 studies were from Dr. Paul Williams and 18 of his papers from the National Runners' and Walkers' Study, The National Aging Runners Study, 2 papers from the Copenhagen City Heart Study, and 2 reports from DC Lee and Steven Blair and one from the Aerobics Center Longitudinal Study. Medical Research: What should clinicians and patients take away from your report? Dr. Lavie: This data showed tremendous impact of running to  lower weight and prevent obesity, dyslipidemia,  hypertension, and type 2 diabetes mellitus. Runners also had less osteoarthritis, need for hip replacement, lower disability with aging, less benign prostatic hypertrophy, lower mortality from several cancers and lower stroke, but the most impressive impact was the large reductions in cardiovascular disease and all-cause mortality, particularly the dramatic impacts of quite low running doses. (more…)
Author Interviews, Heart Disease, JACC, NYU / 08.09.2015

MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.Dr.Sripal Bangalore MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016, Principal Investigator ISCHEMIA-CKD trial  Medical Research: What is the background for this study? What are the main findings? Dr. Bangalore: Patients with chronic kidney disease are at high risk of coronary artery disease. However, they are also at risk for worsening kidney function from revascularization procedures and have been routinely excluded from clinical trials of stenting vs bypass surgery. In this registry study of over 5900 patients with multivessel coronary artery disease who underwent bypass surgery or stenting using the latest generation drug eluting stent (everolimus eluting stent), we showed that there are trade off between both procedures. With bypass surgery there was increase in the risk of death, myocardial infarction and stroke in the short term (in-hospital/30-days). For PCI, there was long term risk of repeat revascularization and also increase in myocardial infarction in those who achieved incomplete revascularization. (more…)
Annals Thoracic Surgery, Author Interviews, Heart Disease, Outcomes & Safety / 02.09.2015

Dr. Ansar Hassan MD PhD Department of Cardiac Surgery New Brunswick Heart Centre Saint John Regional Hospital Saint John, New BrunswicMedicalResearch.com Interview with: Dr. Ansar Hassan MD PhD Department of Cardiac Surgery New Brunswick Heart Centre Saint John Regional Hospital Saint John, New Brunswick Medical Research: What is the background for this study? What are the main findings? Dr. Hassan: For years, geographic place of residence and one’s proximity to a tertiary care center has been identified as a predictor for access to care.   Little is known regarding the effect of geography on patient outcomes.   The purpose of this study was to explore the relationship between geography and in-hospital / 30-day outcomes among patients undergoing cardiac surgery.  What we found was that despite there being no relationship between geography and in-hospital outcomes, those who lived further away from hospital clearly had worse 30-day outcomes. Medical Research: What should clinicians and patients take away from your report? Dr. Hassan: While patients from a differing geographic places of residence appear to have similar in-hospital outcomes following cardiac surgery, their clinical courses following discharge from hospital differ considerably.   Clinicians and patients need to realize that where one lives is tremendously important as it relates to his or her health and that particular attention needs to be paid to cardiac surgery patients who live further away from their tertiary care center, especially within the first 30 days following surgery. (more…)
Author Interviews, Heart Disease, Johns Hopkins, Outcomes & Safety, Surgical Research / 01.09.2015

MedicalResearch.com Interview with: Jill A. Marsteller, PhD, MPP Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland and Juan A. Sanchez, MD, MPA, FACS, FACC Associate Professor of Surgery Associate Faculty, Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine Medical Research: What is the background for this study? What are the main findings? Response: The culture of healthcare organizations with regards to safety has an impact on patient outcomes.  A strong culture serves as a platform for preventing medical errors. This study examines the culture of safety along several dimensions in cardiac surgical teams and compares this data to surgery of all types using a large database. In our study, cardiac surgery teams scored highest in teamwork and lowest in non-punitive responses to error.  In addition, there was substantial variation on safety climate perception across team roles. For example, surgeons and support staff had higher perceptions of a safety climate than other team members. Compared to all types of surgery teams, cardiac surgery teams scored higher in overall perceptions of safety except for anesthesiologists who reported lower scores on communication about errors and communication openness. (more…)
Author Interviews, Heart Disease, JAMA, Thromboembolism / 01.09.2015

Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg DenmarkMedicalResearch.com Interview with: Line Melgaard MSc. Industrial Medicine, PhD student AALBORG Univerity Hospital Thrombosis Research Center Aalborg Aalborg Hospital Science and Innovation Center Aalborg Denmark Medical Research: What is the background for this study? What are the main findings? Response: In recent years, use of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death has extended beyond the original disease state (atrial fibrillation) for which it was proposed. In addition, it is recognized that the cluster of multiple stroke risk factors included within the CHA2DS2-VASc score increases the risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation is present. Thus, there is a need to study the extent to which concomitant atrial fibrillation modifies the pattern of the association between CHA2DS2-VASc score and the risk of ischemic stroke, thromboembolism, and death in patients with heart failure.
  • Our principal findings were that patients with heart failure had a high risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation was present.
  • Second, the CHA2DS2-VASc score was able to modestly predict these endpoints, and had a moderately high negative predictive value at 1-year follow-up.
  • Third, at high CHA2DS2-VASc scores (≥4), patients with heart failure without atrial fibrillation had high absolute risk of ischemic stroke, thromboembolism, and death, and the absolute risk increased in a comparable manner in patients with heart failure with and without atrial fibrillation, exhibiting a clear dose-response relationship. Indeed, the absolute risk of thromboembolic complications was higher among patients without atrial fibrillation compared to patients with concomitant atrial fibrillation at high CHA2DS2-VASc score (≥4).
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Author Interviews, Education, Heart Disease / 31.08.2015

Jaclyn Portanova, Ph.D School of Gerontology University of Southern California DavisMedicalResearch.com Interview with: Jaclyn Portanova, Ph.D student School of Gerontology University of Southern California Davis Medical Research: What is the background for this study? Response: Over the past two decades, we have made a lot of progress in educating the public about the need to engage in advance care planning and make health care decisions, such as whether or not to receive CPR in a medical crisis. The media plays a major role in shaping the way people think about life-saving measures such as cardiopulmonary resuscitation (CPR). In fact, a study published in 1996 showed that popular medical shows portrayed CPR as having a much higher rate of success than actual rates. We sought to determine if popular media has improved in the accuracy of their depiction of CPR survival rates. Medical Research: What are the main findings? Response: Nearly 70% of TV show patients who received CPR survived the initial incident. This success rate is twice as high as actual rates. Even more striking, survival rate to hospital discharge following receipt of CPR was four times higher in popular medical television shows than actual rates. Advance care planning discussions between physicians and patients were rarely portrayed, but when they did occur patient preferences were honored. (more…)
Author Interviews, Heart Disease, JAMA / 27.08.2015

Jay R. Desai, PhD, MPH HealthPartners Institute for Education and Research Minneapolis, MN 55425MedicalResearch.com Interview with: Jay R. Desai, PhD, MPH HealthPartners Institute for Education and Research Minneapolis, MN 55425 Medical Research: What is the background for this study? What are the main findings? Dr. Desai: SUPREME-DM is a consortium of 11 integrated health systems throughout the United States that serve a culturally and economically diverse population of 16 million members. This study monitors changes in cardiovascular outcomes from 2005 through 2011 among the 1.2 million members identified with diabetes and a matched sample of 1.2 million members without diabetes. We found very encouraging and sustained declines in the rates of myocardial infarction/acute coronary syndrome (MI), stroke, heart failure (HF), and all-cause mortality among adults with and without diabetes.   Declines were greatest among the 15% adults who were already at high risk for cardiovascular events (such as people with diabetes or a prior history of heart disease). There was less improvement in cardiovascular event rates and mortality among the other 85% of members with low to moderate cardiovascular risk. (more…)