AHA Journals, Author Interviews, Heart Disease, Outcomes & Safety / 10.08.2015

Helle Søholm, MD, PhDDepartment of Cardiology Copenhagen University Hospital Rigshospitalet Denmark MedicalResearch.com Interview with: Helle Søholm, MD, PhD Department of Cardiology Copenhagen University Hospital Rigshospitalet Denmark Medical Research: What is the background for this study? Dr. Søholm: The background of the current study is that previous studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centres for post-resuscitaton care compared with nontertiary hospitals, however the reasons for this difference has only been speculative. The aim of the study was to examine the level-of post-resuscitation care at tertiary heart centers compared with nontertiary hospitals and to associate this with outcome. Only patients without ST-segment elevation myocardial infarction was examined to avoid referral bias. Medical Research: What are the main findings? Dr. Søholm: The main findings of the study of 1.078 patients was that the survival in patients admitted to tertiary heart centers was significantly higher compared with survival in patients admitted to nontertiary hospitals even after adjustment for known risk markers including pre-arrest co-morbidity. We found that the adjusted odds of predefined markers of level-of-care differed in both the acute phase after admission, during the intensive care admission and in the workup prior to hospital discharge. The odds of admission to an intensive care unit was 1.8 for patients admitted to a tertiary heart centre. During the intensive care admission the odds of a temporay pacemaker was 6.4, use of vasoactive agents 1.5, acute and late coronary angiography was 10 and 3.8 respectively, neurophysiological examination 1.8, brain computed tomography 1.9, whereas no difference in the odds of therapeutic hypothermia was found. Prior to hospital discharge the odds of a consultation by a cardiologist was 8.6, having an echocardiography was 2.9, and survivors more often had an implantable cardioverter defibrillator implanted (odds 2.1) as compared with patients admitted to nontertiary hospitals.
Author Interviews, Heart Disease, Lancet / 09.08.2015

Henning Kelbæk, MD Department of Cardiology Roskilde Hospital Roskilde, DenmarkMedicalResearch.com Interview with: Henning Kelbæk, MD Department of Cardiology Roskilde Hospital Roskilde, Denmark Medical Research: What is the background for this study? What are the main findings? Dr. Kelbæk: The background to conduct the DANAMI 3-Primulti trial is the uncertainty of which strategy is most favourable to the patient with ST-segment elevation myocardial infarction: to treat the culprit (resposible for the acute infarction) lesion only or to treat all visible lesions (complete revascularisation) The main findings of the PRIMULTI trial are that patients with ST-segment elevation myocardial infarction and multivessel disease, benefit from supplementary complete revascularisation of lesions in non-infarct related arteries when the second procedure is done during the index admission guided by measurement of the fractional flow reserve. This strategy results in a significant reduction in the combination of all-cause mortality, nonfatal reinfarction, and ischaemia-driven revascularisation.
Author Interviews, Clots - Coagulation, Duke, Heart Disease, JACC / 09.08.2015

Connie N. Hess, MD, MHS Duke Clinical Research Institute Duke University Durham, North CarolinaMedicalResearch.com Interview with: Connie N. Hess, MD, MHS Duke Clinical Research Institute Duke University Durham, North Carolina Medical Research: What is the background for this study? What are the main findings? Dr. Hess: Guidelines recommend the use of anticoagulation for thromboembolic prophylaxis in atrial fibrillation and also recommend use of dual antiplatelet therapy to reduce cardiovascular events after myocardial infarction and percutaneous coronary intervention.  The use of triple therapy in patients with indications for DAPT and anticoagulation is challenging due to the increased bleeding risk associated with this regimen.  The optimal antithrombotic regimen in this population has not yet been defined. This study specifically focused on older patients, a population that is at greater risk for Atrial Fibrillation-related stroke and recurrent events after MI but also higher risk for bleeding. Despite a growing population of older patients with indications for triple therapy, these patients have been underrepresented in clinical trials and are therefore understudied. We found that relative to DAPT, patients on triple therapy had a similar risk of 2-year major adverse cardiac events but a significantly increased risk of bleeding requiring hospitalization, including greater risk of intracranial hemorrhage.
Author Interviews, Heart Disease, Medicare, Outcomes & Safety / 05.08.2015

MedicalResearch.com Interview with: Philip G. Cotterill PhD Centers for Medicare & Medicaid Services Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Dr. Cotterill: Chest pain is one of those elusive complaints where patients can seem initially low-risk based on symptoms or risk factors, and subsequently have an acute myocardial infarction (AMI) or die in a short period of time. Using combinations of history and physical examination findings to discriminate patients with serious causes of chest pain is often not possible. In our study, we demonstrated wide variation in the decision to hospitalize Medicare beneficiaries with chest pain – nearly two fold between the lowest (38%) and highest (81%) quintile of hospitals – and that patients treated in hospitals with higher admission rates for chest pain are less likely to have an acute myocardial infarction within 30-days of the index event and less likely to die. While the findings were statistically significant – differences in outcomes were small: 4 fewer AMIs and 3 fewer deaths per 1,000 patients comparing the highest and lowest admission quintiles. Stated differently, these numbers suggest that if low admitting hospitals were to behave more like high admitting hospitals, 250 patients would need to be admitted to prevent one AMI and 333 cases to prevent one death.
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 02.08.2015

MedicalResearch.com Interview with: Prof. Sante D. Pierdomenico Associate Professor of Internal Medicine University "Gabriele d'Annunzio" Chieti-Pescara - Italy Medical Research: What is the background for this study? What are the main findings? Dr. Pierdomenico: Though a peak incidence of cardiovascular events in the morning has been observed, the independent prognostic value of morning surge (MS) of blood pressure (BP) is not yet clear. We investigated the association between morning surge of systolic blood pressure and risk of coronary events in elderly treated hypertensive patients. Subjects were divided according to tertiles of MS of systolic blood pressure of the population as a whole, by dipping status (nondippers are at increased risk than dippers) and by group-specific tertiles of morning surge of systolic blood pressure in dippers and nondippers because these groups have different MS of blood pressure. In elderly treated hypertensive patients, high MS of systolic BP predicts coronary events in dippers but not in nondippers. Nondippers, however, show higher risk of coronary events independently of morning surge in systolic blood pressure. Medical Research: What should clinicians and patients take away from your report? Dr. Pierdomenico: Blood pressure should be better controlled after awakening in dippers with high morning surge and during the night in nondippers in order to better prevent cardiovascular events.
Author Interviews, Heart Disease, JACC, Johns Hopkins / 31.07.2015

Alan Cheng, MD, FACC, FAHA, FHRS Associate Professor of Medicine Associate Professor of Pediatrics Director, Arrhythmia Device Service Johns Hopkins University School of Medicine Baltimore, MD 21287MedicalResearch.com Interview with: Alan Cheng, MD, FACC, FAHA, FHRS Associate Professor of Medicine and Pediatrics Director, Arrhythmia Device Service Johns Hopkins University School of Medicine Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Dr. Cheng: Sudden cardiac death (SCD) has been the most common way in which people in the United States die. While it's hard to accurately identify who is a higher risk for SCD, we have learned from a number of studies over the past 30-40 years that people with significant reductions in their heart function (measured as the ejection fraction (EF)) is one group of individuals at high risk for Sudden cardiac death. In fact, the current American College of Cardiology and American Heart Association guidelines state that people with an EF below 35% are at high enough risk for Sudden cardiac death that these patients should undergo implantation of an implantable cardioverter defibrillator (or ICD for short), a device capable of monitoring the heart 24/7 and shocking the heart out of any arrhythmias that could lead to Sudden cardiac death. The data they cite for this recommendation are so compelling that they currently recommend implanting ICDs in patients not only among those who already experienced an Sudden cardiac death event, but also those who have not. Implanting an ICD to prevent Sudden cardiac death before they have had Sudden cardiac death is known as primary prevention and this accounts for about 70-80% of all ICD implants in the United States. While the EF is the best metric out there to determine if a patient should get an ICD, it has its limitations. Because of these limitations, we have been interested for a long time in better understanding how the EF and other metrics affect a patient's risk for Sudden cardiac death. In this study, we followed 538 patients who were recipients of a primary prevention ICD who underwent repeat assessment of their EF during followup in order to determine if changes in their EF over time altered their risk for ICD shocks for ventricular arrhythmias or death. Over a median of almost 5 years of followup, we found that 40% of the cohort had improvements in their EF. And when the EF does improve, the risk goes down for ICD shocks for ventricular arrhythmias as well as for death.
Author Interviews, Geriatrics, Heart Disease, Surgical Research / 27.07.2015

Yigal Abramowitz, MD Cedars-Sinai Heart InstituteMedicalResearch.com Interview with: Yigal Abramowitz, MD Cedars-Sinai Heart Institute Medical Research: What is the background for this study? Dr. Abramowitz: The number of elderly patients with severe symptomatic aortic stenosis (AS) that require aortic valve replacement has been significantly increasing in recent years. However, a decade ago, third of the patients were not referred to surgery, in particular because of advanced age, and /or multiple comorbidities. TAVR has emerged as a treatment option for elderly inoperable or high-risk surgical patients with severe aortic stenosis. There is scarce evidence on the feasibility and safety of TAVR in very old patients. Medical Research: What are the main findings? Dr. Abramowitz: We compared 136 patients that were at least 90 years old at the time of TAVR (mean age: 92.4years) to 598 younger patients (mean age: 79.7years). Device success was excellent in both groups (96% for both). All-cause mortality at 30-days and 1-year was 2.9% and 12.5% vs. 2.8% and 12.3%  in patients aged ≥ 90 and ˂ 90, respectively. All major complication rates were similar between groups.
Author Interviews, Genetic Research, Heart Disease, PNAS, Rheumatology / 27.07.2015

MedicalResearch.com Interview with: Philippe Bouillet, PhD Walter and Eliza Hall Institute Parkville, Vic Australia Medical Research: What is the background for this study? What are the main findings? Dr. Bouillet: This study was initiated when we discovered mice that developed rheumatoid arthritis as a result of what was obviously a spontaneous dominant genetic mutation. Using several approaches, we identified the mutation as the insertion of a mobile genetic element called retrotransposon into the regulatory sequences of the gene encoding tumor necrosis factor (TNF). The mutation caused excessive amounts of TNF to be produced, a known cause of rheumatoid arthritis. The surprise came when some mice with the mutation died prematurely and suddenly with from heart disease. We showed that excess TNF also led to inflammation of the aortic and mitral valves, causing aortic regurgitation. Depending on the genetic background of the mice, the disease could also culminate in aortic aneurysm and death. We also investigated the regulatory region of the TNF gene and identified novel regulators and a new genetic element that normally make sure that levels of serum TNF are kept within reasonable limits, high enough to ensure its numerous physiological functions, low enough to prevent its harmful effects such as those described here.
Author Interviews, Genetic Research, Heart Disease / 24.07.2015

MedicalResearch.com Interview with: Dr. Paraskevi Christofidou Department of Cardiovascular Sciences, University of Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Leicester UK MedicalResearch: What is the background for this study? Dr. Christofidou: Homozygosity arises when identical alleles are present on both chromosomes. Runs of homozygosity (ROHs) are very long segments of uninterrupted sequences of homozygous variants across the human genome. Runs of homozygosity represent "re-union" of pieces from DNA from parents in their children. The two DNA copies are identical because have been inherited from a common ancestor somewhere in the distant past. Runs of homozygosity are recognized signature of recessive inheritance, because they allow unmasking of recessive variants. Recessive variants only show their effect when present on both chromosomes of an individual's genome. Some of these ROHs may potentially harbor variants that exert their pathological effects in the homozygous recessive state. This is important because it helps us better understand the consequences of the recessive model of inheritance in relation to complex diseases. Coronary artery disease (CAD) is a terminal clinical manifestation of cardiovascular disease and is the leading cause of death worldwide and is the UK's single biggest killer. Nearly one in six men and one in ten women die from CAD. Coronary artery disease is a complex, multifactorial disorder originating from a complicated interplay of multiple genetic and environmental factors. Contributions of ROHs to the genetic architecture of CAD are not known. The primary goal of this project was a comprehensive analysis of association between genome-wide homozygosity measures and CAD in individuals of white European ancestry. A secondary aim was to explore the association of ROHs and gene expression in human monocytes and macrophages. MedicalResearch: What are the main findings? Dr. Christofidou: Our analysis of 24,320 individuals from 11 populations of white European ethnicity revealed statistically significant differences in homozygosity levels between individuals with Coronary artery disease and control subjects. On average, individuals with CAD had 0.63 ROHs more than control subjects. The average total length of ROHs was approximately 1046.92 kb greater in individuals with CAD than control subjects. We were able to qualify a measure of genome-wide homozygosity levels in relation to CAD - an estimated 13% increase in CAD per 1 standard deviation increase in the proportion of the autosomal genome covered by ROHs. Individual ROHs showed significant associations with monocyte and macrophage expression of genes located nearby. These associations suggest that many ROHs might be signatures of biologically active recessive variants with a potential to regulate transcription.
Author Interviews, Heart Disease, JCEM, University of Pittsburgh, Women's Heart Health / 24.07.2015

Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Graduate School of Public Health Department of Epidemiology University of Pittsburgh MedicalResearch.com Interview with: Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Graduate School of Public Health Department of Epidemiology University of Pittsburgh Medical Research: What is the background for this study? Dr. El Khoudary: Cardiovascular disease is the leading cause of death in women, and it increases after age 50 - the average age when a woman is going through menopause. Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations. No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events. My team and I investigated whether there may be a link between menopause and cardiovascular fat using data from 456 women from Pittsburgh and Chicago enrolled in the Study of Women's Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy. Medical Research: What are the main findings? Dr. El Khoudary: Our study is the first to find that  late- and post-menopausal women have significantly greater volumes of fat around their hearts than their pre-menopausal counterparts. As concentrations of the sex hormone estradiol - the most potent estrogen - declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after my colleagues and I took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases.
Author Interviews, CDC, Heart Disease, Stroke / 23.07.2015

Dr. Jing Fang Ph.D. Epidemiologist Center For Disease ControlMedicalResearch.com Interview with: Dr. Jing Fang Ph.D. Epidemiologist Center For Disease Control MedicalResearch: What is the background for this study? What are the main findings? Dr. Fang: Although the effectiveness of aspirin for secondary prevention (e.g. people who already have coronary heart disease or have had an ischemic stroke) of cardiovascular disease has been determined, its prevalence as a preventive measure has varied widely across settings, data collection methods and U.S. states. As a result, we wanted to more closely examine aspirin use among U.S. adults with a history of coronary heart disease or stroke. To determine these findings, we analyzed data from the 2013 Behavioral Risk Factor Surveillance System. Nearly 18,000 people from 20 states and the District of Columbia with a self-reported history of coronary heart disease or stroke were included in the annual telephone survey. Overall, we found about 70 percent of U.S. adults with heart disease or stroke reported regularly taking aspirin – meaning every day or every other day. Out of that group, nearly 94 percent said they take aspirin for heart attack prevention, about 80 percent linked it to stroke prevention efforts, and approximately 76 percent said they use it for both heart attack and stroke prevention. However, four percent of respondents with pre-existing cardiovascular problems said they take aspirin for pain relief without awareness of its benefits for cardiovascular disease. Aspirin use also differed by state and sociodemographic characteristics including gender, race/ethnicity and age. In general, men, non-Hispanic whites, individuals aged 65 and older, and people with at least two of four risk factors (hypertension, smoking, diabetes and high cholesterol) are more likely to use aspirin than other groups. By state, aspirin use ranged from 44 percent in Missouri to more than 71 percent in Mississippi.
Author Interviews, Heart Disease, Race/Ethnic Diversity / 22.07.2015

Dr. Sumeet Chugh MD Pauline and Harold Price Professor of Cardiac Electrophysiology Associate director of the Cedars-Sinai Heart InstituteMedicalResearch.com Interview with: Dr. Sumeet Chugh MD Pauline and Harold Price Professor of Cardiac Electrophysiology Associate director of the Cedars-Sinai Heart Institute Medical Research: What is the background for this study? What are the main findings? Response: Research studies performed in the past 2 decades suggest that there is a higher burden of sudden cardiac arrest in black americans compared to whites. However there are no studies that explore the reasons for this phenomenon. Our study confirmed that these observations hold true in the current era. There are two additional novel findings. Firstly, we uncovered the disturbing fact that blacks are significantly younger than whites at the time of their cardiac arrest. The majority of blacks are under the age of 65 and the majority of whites were over 65. Furthermore, blacks who suffered sudden cardiac arrest were more likely to have diabetes, high blood pressure and chronic kidney disease.
Author Interviews, Heart Disease, JACC / 22.07.2015

Dr. Jagat Narula MD, PhD Associate Dean For Global Affairs Professor Medicine, Cardiology and Radiology Mt. Sinai Hospital, NYMedicalResearch.com Interview with: Dr. Jagat Narula MD, PhD Associate Dean For Global Affairs Professor Medicine, Cardiology and Radiology Mt. Sinai Hospital, NY Medical Research: What is the background for this study? What are the main findings? Dr. Narula: The cardiovascular diseases remain number one cause of mortality in men and women and in high as well as middle and low income countries. It is important that we identify those who are likely to die of preventable causes. Identification of the vulnerable plaques that are likely to result in acute events has been an interesting focus of investigators, and numerous intravascular imaging and noninvasive imaging strategies have been employed. CT angiography has offered fairly attractive accuracy. We were the first to establish the features of high-risk plaques (Motoyama, Narula JACC 2007) and their short-term prognostic implications (Motoyama, Narula JACC 2009). In this new paper in a large population we present intermediate- to long-term follow-up that critically analyzes the role of plaque characterization and puts it in perspective. Should we keep chasing plaques or should we treat the patient? Does the answer lie in high risk plaque busting or prevention be the mainstay? From the previous studies from us and others we have known that computed tomography angiography (CTA)-based plaque characteristics identify high-risk plaque (HRP) that predict short-term risk of acute coronary syndrome (ACS). We in this study wanted to evaluate whether plaque characteristics by CTA would predict intermediate- to long-term likelihood of acute events. The presence of high-risk plaque characteristics were evaluated in more than 3000 patients undergoing CTA and plaque progression (PP) in additional 450 patients who had two CTA one year apart. We recorded fatal and nonfatal acute events and outcomes during follow-up: mean about 4 years and maximum up to 10 years. Acute Coronary Syndrome occurred in about 40 of ~300 (16%) with high risk plaque and 40 (less than 1.5%) of the remaining patients with non high risk plaques. In patients with serial CTA, plaque progression also was an independent predictor of ACS, with HRP (27%) and without HRP (10%) compared with patients without plaque progression (0.3%).
Author Interviews, Duke, Education, Heart Disease, JAMA / 22.07.2015

Carolina Malta Hansen, M.D Duke Clinical Research InstituteMedicalResearch.com Interview with: Carolina Malta Hansen, M.D Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Hansen: Approximately 300,000 persons in the United States suffer an out-of-hospital cardiac arrest every year and under 10% survive. Cardiopulmonary resuscitation (CPR) and defibrillation within the first few minutes of cardiac arrest can increase the chance of survival from under 10% to over 50%. In 2010, the HeartRescue program in North Carolina initiated statewide multifaceted interventions to improve care and outcomes for cardiac arrest patients in North Carolina. The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest. We found that following these four years of initiatives to improve care and outcomes for cardiac arrest patients, the proportion of patients who received bystander CPR and first responder defibrillation increased by more than 25% to approximately 50%, the combination of bystander CPR and first responder defibrillation increased from 14% to 23%. Survival with favorable neurologic outcome increased from 7% to 10% and this increase was only observed among patients who received bystander CPR. Finally, we found that compared to patients who received CPR and defibrillation by emergency medical services (EMS), patients who received bystander and/or first responder CPR, defibrillation, or both, were more likely to survive. The combination of bystander CPR and bystander defibrillation was associated with the best survival rates but remained low during the study period with no increase over time.
Author Interviews, Heart Disease, JACC, Outcomes & Safety, Surgical Research / 22.07.2015

Dr Scot Garg FRCP PhD (Hons) FESC Cardiology Department, Royal Blackburn Hospital United KingdomMedicalResearch.com Interview with: Dr Scot Garg FRCP PhD (Hons) FESC Cardiology Department, Royal Blackburn Hospital United Kingdom Medical Research: What is the background for this study? Dr. Garg: In contrast to other countries, in particular the United States, the UK has seen a vast expansion in the number of PCI centres operating without on-site surgical support. Part of the reason for this is that outcome data from these centres are from modest populations at short-term follow-up; consequently the ACC/AHA have failed to give delivery of PCI in centres without surgical back-up a strong endorsement. The study was ultimately driven therefore to show whether any differences existed in mortality between patients having PCI in centres with- and without surgical support at long-term follow-up in large unselected population cohort. Medical Research: What are the main findings? Dr. Garg: The study included the largest population of patients treated in centres without off-site surgical support (n=119,036) and main findings were that following multi-variate adjustment there were no differences in mortality for patients treated at centres with- or without surgical support at 30-days, 1-year or 5-year follow-up irrespective of whether patients were treated for stable angina, NSTEMI or STEMI. Furthermore, similar results were seen in a sensitivity analysis of a propensity matched cohort of 74,001 patients.
Author Interviews, Genetic Research, Heart Disease, McGill / 20.07.2015

Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec CanadaMedicalResearch.com Interview with: Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec Canada Medical Research: What is the background for this study? What are the main findings? Response: There have been great advances in the field of genetics in recent years. Especially in cardiology, a number of genetic variants have been identified that are associated with cardiovascular disease. But it is not clear how useful these variants are in terms of predicting future evens in patients that have already suffered a myocardial infarction. What we found in our study is that a genetic risk score composed of the 30 most common genetic variants associated with cardiovascular diseases was not useful in predicting recurrent events in the first year after a patient suffered a myocardial infarction.
Author Interviews, Beth Israel Deaconess, Diabetes, Heart Disease, University of Michigan / 18.07.2015

MedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD, FACC, FASNC University of MichiganVenkatesh L. Murthy, MD, PhD, FACC, FASNC University of Michigan Dr. Ravi Shah MD Beth Israel Deaconess Medical Centerand Dr. Ravi Shah MD Beth Israel Deaconess Medical Center   MedicalResearch: What is the background for this study? Response: Recent changes recommend statin therapy for cardiovascular risk reduction in an increasingly large number of Americans. Conversely, a number of studies have identified an increased risk of diabetes with statin treatment. Thus, there is increasing need for tools to target statin therapy to those with a favorable risk-benefit profile. MedicalResearch: What are the main findings? Response: In our study, we analyzed data from 3,153 individuals from the Multi-Ethnic Study of Atherosclerosis who underwent CT scanning at baseline for assessment of calcium score. The CT scans were analyzed to assess liver attenuation as a measure of the amount of liver fat. We demonstrated that high liver fat doubled the risk of diabetes over a median of 9 years of follow-up. Importantly, statin therapy also doubled the risk of diabetes. The two together had an additive effect, even after adjusting for BMI, age, gender, family history of diabetes, waist circumference, lipids, hsCRP and exercise habits. As in prior studies, the risk of cardiovascular disease (CVD) events increased with increasing calcium score, as has previously been shown in MESA and in other studies. We then divided the cohort into six groups based on calcium score (0, 1-100 and >100) and liver fat (low/high). Using published data from meta-analyses of statin trials, we computed the number needed to treat to prevent one hard CVD event for statin therapy. Using data from our study, we computed the number needed to harm to cause one additional case of diabetes from statin therapy. The numbers needed to treat with ranged from 29-40 for calcium score of >100 to 218-252 for calcium score of 0. Conversely, the numbers needed to harm were approximately 63-68 for those with low liver fat versus 22-24 for those with high liver fat. Thus the combination of calcium score and liver fat assessment, from a single standard calcium score scan, allows for physicians to provide better assessment of risk and benefit of statins in discussion with their patients.
Author Interviews, Clots - Coagulation, Heart Disease, JACC / 17.07.2015

Prof. Johan Bosmans Interventional cardiologist University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, BelgiumMedical Research Interview with: Prof. Johan Bosmans Interventional cardiologist University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium MedicalResearch: What is the background for this study? What are the main findings? Prof. Bosmans : Transcatheter aortic valve replacement (TAVR) has become standard of care for patients who cannot undergo surgery. With this, it is important to ensure that the risks associated with TAVR be fully understood, and if possible prevented. Even at this stage of the adoption of TAVR, large trials continue to provide information to the clinician about how to select the right patients to ensure the best possible outcomes. The ADVANCE Study is a prospective, multicenter study that evaluated the use of TAVR in 1015 patients at 44 experienced TAVR centers, which was designed to reflect routine clinical practice. We know that the risk of serious adverse events, such as stroke or transient ischemic attack (TIA), in post-TAVR patients can vary based on the timing before and after the procedure. A patient’s baseline demographics and medical history can affect their risk of procedure-related events as well as long-term outcomes. The manipulations required crossing the aortic valve and appropriately positioning any type of TAV has been thought to be related to procedural stroke events. Therefore, we performed a multivariable analysis looking for predictors of stroke – or stroke and TIA at 3 unique time periods (periprocedural, early and late) following TAVR. The most striking result from our analyses was that we were not able to identify any predictors of periprocedural (either during the procedure or on the day after) stroke, illustrating this very multifactorial etiology. We were able to show that being female, experiencing acute kidney injury or a major vascular complication positively predicted stroke during the early (2-30 days post procedure) time period. When we combined the outcome of stroke or TIA, we found that a history of prior atrial fibrillation (AF) was also a predictor. The only late predictor (day 31-730 post-procedure) of stroke was a history of coronary artery bypass grafting, which could reflect the patients’ risk of vascular disease.
Author Interviews, Heart Disease, Lifestyle & Health / 17.07.2015

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 Editor-in-Chief, Progress in Cardiovascular Diseases Medical Research: What is the background for this study? What are the main findings? Dr. Lavie: This was a review of the literature on this topic.The main findings are that various lifestyle choices, including obesity,  hypertension, metabolic syndrome/diabetes, obstructive sleep apnea , moderate and  high alcohol intakes, and sedentary lifestyle but also very high exercise doses are all associated with increased risk of atrial fibrillation (AF).
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Statins / 14.07.2015

Dr. Ankur Pandya Ph.D. Assistant Professor of Health Decision Science Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston, MA MedicalResearch.com Interview with: Dr. Ankur Pandya Ph.D. Assistant Professor of Health Decision Science Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Pandya: The American College of Cardiology and the American Heart Association (ACC-AHA) cholesterol treatment guidelines were controversial when first released in November 2013, with some concerns that healthy adults would be over-treated with statins. We found that the current 10-year ASCVD risk threshold (≥7.5%) used in the ACC-AHA cholesterol treatment guidelines has an acceptable cost-effectiveness profile (incremental cost-effectiveness ratio of $37,000/QALY), but more lenient ASCVD thresholds would be optimal using cost-effectiveness thresholds of $100,000/QALY (≥4.0%) or $150,000/QALY (≥3.0%).
Author Interviews, Cost of Health Care, Heart Disease / 13.07.2015

MedicalResearch.com Interview with: Azfar B. Sheikh, M.D. Internal Medicine Resident Physician Staten Island University Hospital New York Medical Research: What is the background for this study? Dr. Sheikh: The background of this review article circles around the impact of atrial fibrillation on epidemiology, trends in hospitalizations, costs associated with hospitalization and outpatient care, in the United States. This article also describes the benefits of newer treatment modalities compared to the standard of care with regards to symptomatic improvement and prevention of thromboembolism. These findings are supported by several cost-utility analyses. Medical Research: What are the main findings? Dr. Sheikh:  The main findings of the study are:
  • The cost of hospitalization is three times higher for patients with atrial fibrillation than those without atrial fibrillation.
  • 5 million new cases are being reported annually.
  • The incidence of atrial fibrillation is projected to increase from 1.2 million cases in 2010 to 2.6 million cases by 2030. Due to this increase in incidence, the prevalence of atrial fibrillation is projected to increase from 5.2 million cases to 12.1 million cases by 2030.
  • The most common co-moribidites associated with atrial fibrillation were hypertension, diabetes mellitus, and chronic obstructive lung disease.
  • According to the NIS database, the atrial fibrillation. hospitalization rate has increased from 1552 to 1812 per one million US residents per year from 2000 to 2010 (relative increase 14.4%).
  • According to the NIS database, the mortality associated with atrial fibrillation hospitalizations has decreased significantly from 1.2% in 2000 to 0.9% in 2010 (relative decrease 29.2%).
  • The median length of stay in the hospital is 3 days and increases proportionally with a rise in CHADS2 score.
  • The largest source of direct healthcare costs associated with atrial fibrillation is hospitalization. According to the NIS database, the mean cost of inpatient atrial fibrillation hospitalization increased significantly from $6401 in 2001 to $8439 in 2010 (relative increase 24.0%). The mean cost of atrial fibrillation hospitalization also increases proportionally with a rise in CHADS2 score.
  • In the outpatient setting, the highest costs were associated with physician office visits in comparison to emergency room and urgent care visits.
  • With regards to prevention of thromboembolism, the new oral anticoagulant agents (dabigatran, rivaroxaban, and apixaban) have been found to be more cost-effective compared to warfarin.
  • Left atrial catheter ablation is more effective than rate control and rhythm control. It is more cost-effective in younger patients who are moderate risk for stroke.
Author Interviews, Heart Disease, Psychological Science, Sexual Health, University Texas / 11.07.2015

Amelia Stanton, Graduate Student Department of Psychology The University of Texas at Austin Austin, TXMedicalResearch.com Interview with: Amelia Stanton, Graduate Student Department of Psychology The University of Texas at Austin Austin, TX Medical Research: What is the background for this study? What are the main findings? Response: Heart rate variability (HRV) has emerged as a valuable non-invasive test to assess autonomic nervous system (ANS) activity. Several studies have linked low resting Heart rate variability to mental health conditions including depression, anxiety, and alcohol dependence, indicating these disorders may be related to an imbalance in autonomic activity. As Heart rate variability is an index of the balance of sympathetic nervous system (SNS) and parasympathetic nervous system activity (PNS), it has proven a useful tool for examining the relative role of SNS activity in female sexual arousal. Moderate SNS dominance (relative to PNS activity) has been shown to predict women’s genital arousal in the laboratory, while high levels of SNS activation have been shown to inhibit genital arousal. Based on this background evidence and on a growing clinical literature indicating that low HRV (generally indicative of high SNS) is associated with negative health outcomes, we predicted a positive linear relationship between Heart rate variability and sexual arousal function. That is, we predicted that women with autonomic balance indicating moderate or low resting SNS activity (relative to PNS activity) would be less likely than women with autonomic balance indicating high resting SNS to report clinically relevant sexual arousal dysfunction. We also predicted that this relationship would hold for overall sexual function. To test this hypothesis, sexual arousal function, overall sexual function, and resting HRV were assessed in 72 women, aged 18-39. The main finding of the study is that women with below average Heart rate variability were significantly more likely to report sexual arousal dysfunction (p < .001) and overall sexual dysfunction (p < .001) than both women with average HRV and women with above average HRV. Based on these results, we concluded that low HRV may be a risk factor for female sexual arousal dysfunction and overall sexual dysfunction.
Author Interviews, Heart Disease, JAMA / 09.07.2015

MedicalResearch.com Interview with: Dr Emanuele Di Angelantonio FESC FAHA University Lecturer | University of Cambridge Director | MPhil in Public Health, University of Cambridge Deputy Director | NIHR Biomedical Research Unit in Donor Health and Genomics Honorary Consultant | NHS Blood and Transplant Department of Public Health and Primary Care Strangeways Research Laboratory Cambridge, UK Medical Research: What is the background for this study? What are the main findings? Response: Previous research as mainly focused on individual with one cardiometabolic condition alone and, despite it could be expected that having more than one condition poses a greater risk, this is the first study that is able to precisely quantify how much is worst. Furthermore, given that the conditions we study (diabetes, heart attack, and stroke) share several risk factors, it could be expected that the combination of these will not be  multiplicative. We were somewhat surprised to find that participants who had 1 condition had about twice the rate of death; 2 conditions, about 4 times the rate of death; and all 3 conditions, about 8 times the rate of death. We  estimated that at the age of 60 years, men with any two of the cardiometabolic conditions studied would on average have 12 years of reduced life expectancy, and men with all three conditions would have 14 years of reduced life expectancy. For women at the age of 60 years, the corresponding estimates were 13 years and 16 years. The figures were even more dramatic for patients at a younger age. At the age of 40 years, men with all three cardiometabolic conditions would on average have 23 years of reduced life expectancy; for women at the same age, the corresponding estimate was 20 years.
AHA Journals, Author Interviews, Connective Tissue Disease, Heart Disease, NYU / 08.07.2015

Mohamed Boutjdir, PhD, FAHADirector of the Cardiovascular Research Program VA New York Harbor Healthcare System Professor, Depts of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Medical Center and NYU School of Medicine, New York, NYMedicalResearch.com Interview with: Mohamed Boutjdir, PhD, FAHA Director of the Cardiovascular Research Program VA New York Harbor Healthcare System Professor, Depts of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Medical Center and NYU School of Medicine, New York, NY Medical Research: What is the background for this study? What are the main findings? Dr. Boutjdir: Patients with autoimmune diseases including Sjogren’s syndrome, systemic lupus erythematosus and other connective tissue diseases who are seropositive for anti-SSA/Ro antibodies may present with corrected QTc prolongation on the surface ECG. This QTc prolongation can be arrhythmogenic and lead to Torsades de Pointes fatal arrhythmia. In our study, we established for the first time an animal model for this autoimmune associated QTc prolongation that is reminiscent of the clinical long QT2 syndrome. We also demonstrated the functional and molecular mechanisms by which the presence of the anti-SSA/Ro antibodies causes QTc prolongation by a direct cross-reactivity and then block of the hERG channel (Human ether-a-go-go-related gene). This hERG channel is responsible for cardiac repolarization and its inhibition causes QTc prolongation. We were able to pinpoint to the target epitope at the extracellular pore forming loop between segment 5 and segment 6 of the hERG channel.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Lifestyle & Health / 08.07.2015

Liana C. Del Gobbo, PhDPostdoctoral Research Fellow Friedman School of Nutrition Science & Policy Tufts University Boston MAMedicalResearch.com Interview with: Liana C. Del Gobbo, PhD Postdoctoral Research Fellow Friedman School of Nutrition Science & Policy Tufts University Boston MA Medical Research: What is the background for this study? What are the main findings? Dr. Del Gobbo: Heart failure most commonly develops in adults over 65 years old- the most rapidly growing portion of the US population. The condition greatly reduces the quality of life of older adults. Heart failure is the leading cause of hospitalizations in the US among those on Medicare, and is associated with large  health care costs. Prevention is key for reducing the burden of this disease. A detailed analysis of factors that might help prevent heart failure, such as a person's pattern of eating (as well as individual foods), in addition to other lifestyle factors (eg. smoking, physical activity, etc), had not been previously examined all together, in the same study. To get a fuller picture of how to prevent this condition, this study examined the relative importance of dietary habits and other lifestyle factors for development of heart failure. Our paper shows that older adults can cut their risk in half by adhering to a few healthy lifestyle factors, including moderate physical activity, modest alcohol consumption (eg. more than one drink/week, but not more than 1-2 drinks/day), not smoking, and maintaining a healthy weight.
Author Interviews, Heart Disease, Nature / 07.07.2015

Dr. Gary K OwensRobert M. Berne Cardiovascular Research Center University of Virginia, Charlottesville, VirginiaMedicalResearch.com Interview with: Dr. Gary K Owens Ph.D Robert M. Berne Cardiovascular Research Center University of Virginia, Charlottesville, Virginia Medical Research: What is the background for this study? Dr. Owens: The leading cause of death in the USA and worldwide is cardiovascular disease with many of the clinical consequences including heart attacks (myocardial infarctions) and strokes being secondary consequences of atherosclerosis, commonly referred to as hardening of the arteries. Importantly, a heart attack is not caused by gradual narrowing of a large coronary artery by the atherosclerotic plaque, but rather is caused by acute rupture of a plaque that results in a catastrophic thrombotic event that can completely occlude a major coronary artery shutting off blood supply to a major heart region. Similarly, rupture of a plaque can result in formation of a thrombus that breaks off and circulates to a cerebral vessel where it can occlude blood flow to a brain region leading to a stroke. As such, it is critical to understand the mechanisms that regulate the stability of plaques, and the likelihood of plaque rupture. The general dogma among clinicians and cardiovascular researchers has been that atherosclerotic plaques that have an abundance of macrophages and macrophage-derived foam cells relative to smooth muscle cells (SMC), the cells that normally line all of your blood vessels, are less stable and more prone to rupture with subsequent clinical consequences. However, the evidence for this is based on use of methods that are unreliable in identifying which cells within the plaque are truly derived from macrophages versus SMC, and even more importantly, what mechanisms regulate phenotypic transitions of these cells that are critical in the pathogenesis of this disease. Indeed, results of studies in cultured smooth muscle cells and macrophages have shown that each cell can express markers of the other cell type in response to stimuli likely to be present within advanced atherosclerotic lesions while down-regulating expression of their typical cell selective markers. As such, previous studies in the field have likely mis-identified which cell is which in many cases. The goals of our studies were to clearly identify which cells within advanced atherosclerotic lesions are derived from SMC, to determine the various phenotypes exhibited by these cells and their functional role in lesion pathogenesis,  and to determine what regulates these phenotypic transitions.
Author Interviews, Heart Disease, JAMA, University of Pittsburgh, Weight Research / 02.07.2015

Anita P. Courcoulas M.D., M.P.H., F.A.C.S Professor of Surgery Director, Minimally Invasive Bariatric & General Surgery University of Pittsburgh Medical CenterMedicalResearch.com Interview with: Anita P. Courcoulas M.D., M.P.H., F.A.C.S Professor of Surgery Director, Minimally Invasive Bariatric & General Surgery University of Pittsburgh Medical Center Medical Research: What is the background for this study? Dr. Courcoulas: This study is a randomized clinical trial that was originally funded through the American Recovery and Reinvestment Act of 2009 (ARRA) as a high priority comparative effectiveness topic; the goal of which was to better understand the role of surgical versus non-surgical treatments for Type 2 diabetes mellitus (T2DM) in people with lower Body Mass Index (BMI) between 30 and 40 kg/m2. This report highlights longer-term outcomes at 3 years following random assignment to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) followed by low-level lifestyle intervention in years 2 and 3.
Author Interviews, Heart Disease, Statins / 01.07.2015

dr-duk-woo-park.pngMedicalResearch.com Interview with: Duk-Woo Park, MD, PhD. Professor, Division of Cardiology Asan Medical Center, University of Ulsan College of Medicine Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: The applicability and potential clinical effects of the 2013 ACC/AHA cholesterol guidelines on major cardiovascular outcomes in the “real-world” population remains uncertain and also should also be evaluated in multiple groups of various ethnic backgrounds. We determined the proportions of adult persons eligible for statin therapy by changes of 2013 ACC/AHA cholesterol guidelines using a nationally representative sample from an Asian country (South Korea) and also we evaluated the potential clinical effects of this cholesterol guideline on future cardiovascular outcomes using an external validation cohort from the Korean National Health Examination. Similar to findings from the United States and the European cohort, our study showed that the 2013 ACC/AHA guidelines would substantially increase the number of adults who would be potentially eligible for statin therapy in Korean population. In addition, the 2013 ACC/AHA guidelines would have identified more cases with higher events of cardiovascular disease (CVD) for statin treatment than the ATP-III guidelines.
Author Interviews, Columbia, JACC, PTSD, Women's Heart Health / 30.06.2015

Jennifer A. Sumner, Ph.D.MedicalResearch.com Interview with: Jennifer A. Sumner, Ph.D. Columbia University Mailman School of Public Health New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Sumner: Cardiovascular disease, which includes conditions like heart attack and stroke, is the leading cause of death worldwide. Stress has long been thought to increase risk of cardiovascular disease, and posttraumatic stress disorder (PTSD) is the quintessential stress-related mental disorder. Some individuals who are exposed to traumatic events, such as unwanted sexual contact, the sudden unexpected death of a loved one, and physical assault, develop PTSD, which is characterized by symptoms of re-experiencing the trauma (e.g., nightmares), avoidance of trauma reminders (e.g., avoiding thinking about the trauma), changes in how one thinks and feels (e.g., feeling emotionally numb), and increased physiological arousal and reactivity (e.g., being easily startled). PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men. My colleagues and I wanted to see whether PTSD was associated with the development of cardiovascular disease in a large sample of women from the general public. We looked at associations between PTSD symptoms and new onsets of heart attack and stroke among nearly 50,000 women in the Nurses’ Health Study II over 20 years, beginning in 1989. Women with the highest number of PTSD symptoms (those reporting 4+ symptoms on a 7-item screening questionnaire) had 60% higher rates of developing cardiovascular disease (both heart attack and stroke) compared to women who were not exposed to traumatic events. Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and hormone replacement use, accounted for almost 50% of the association between elevated PTSD symptoms and cardiovascular disease. We also found that trauma exposure alone (reporting no PTSD symptoms on the screening questionnaire) was associated with elevated cardiovascular disease risk compared to no trauma exposure. Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women. These results add to a growing body of evidence suggesting that trauma and PTSD have profound effects on physical health as well as mental health.
Author Interviews, Heart Disease, Technology / 26.06.2015

Dr. Carsten Lennerz Deutsches Herzzentrum München MedicalResearch.com Interview with: Dr. Carsten Lennerz Deutsches Herzzentrum München Medical Research: What is the background for this study? What are the main findings? Response: The number of cardiovascular implantable electronic devices (CIEDs) is increasing. Worldwide more than 4 million people rely on an implanted pacemaker (PM) or implantable cardioverter defibrillator ICD. Sensing intrinsic cardiac electrical activity is the core principle of all CIED devices, however in case of electromagnetic interference (EMI) exogenous electric and magnetic fields can be picked up by the sensing circuit and mistakenly interpreted as a cardiac signal by the CIED. PM can respond to EMI with pacing-inhibition, leading to bradycardia or asystole and resulting in syncope. In ICDs EMI may be detected as a life threatening ventricular arrhythmia with the subsequent delivery of inappropriate shocks. Early studies on EMI, run more than 10 years ago, have identified mobile phones as a source of EMI with pacemakers. Based on these pacemaker studies the CIED manufacturer and the regulatory authorities (e.g. Food and Drug Administration [FDA]) currently recommend a safety distance, i.e. hold the phone to the contra-lateral ear and avoid placing a turned-on phone next to the generator pocket. In the meantime telecommunication and the CIED techniques have dramatically evolved. The classic mobile phone has been replaced by modern smartphones, furthermore the network standards have changed from GSM to UMTS (3G) and LTE (4G). New cardiac devices are now in use including more devices for cardiac resynchronisation therapy (CRT) or for the protection from sudden cardiac death (ICD); some of them are even compatible for MRI diagnostics. With the use of a hemertic titanium shell, new filtering properties of the feed-throughs, sense amplifiers and noise protection algorhythms as well as the predominant use of bipolar leads the CIED may be better shielded against external influences and adverse effects of EMI. In light of the above, the purpose of our study was to evaluate if previous precautions recommended to cardiovascular implantable electronic devices recipients are still up-to-date or if they can be abandoned. By today there are neither studies focusing on EMI between modern smartphones and modern CIEDs nor on newer mobile network standards (UMTS or LTE). In a cross-sectional study we enrolled 308 patients and exposed them to the electromagnetic field of three smartphones (Samsung Galaxy 3, Nokia Lumia, HTC One XL) by placing the handhelds directly over the pulse generator. Installing an own base mobile network station we ensured that each smartphone went through a standardized protocol that included the entire calling process (connecting, ringing, talking), the handovers between all current network standards (GSM, UMTS, LTE where applicable) and operation at maximal transmission power. More than 3.400 tests on electromagnetic interference were performed. One out of 308 patients (0.3%) was repeatedly affected by EMI caused by smartphones. The patient’s MRI compatible CRT-defibrillator malfunctioned with short-term ventricular and atrial oversensing when exposed to Nokia or HTC smartphones operating at GSM and UMTS.