Author Interviews, Heart Disease / 10.03.2015

MedicalResearch.com Interview with:Elaine W. Yu, MD, MMSc Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital MGH Endocrine Unit Elaine W. Yu, MD, MMSc Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital MGH Endocrine Unit Medical Research: What is the background for this study? What are the main findings? Dr. Yu: It is well known that cardiovascular disease is more common in men than in women.  The exact reasons for this are unknown, but may be related to gender differences in levels of sex hormones such as testosterone and estrogen.  As compared to premenopausal women, men have higher testosterone and lower estrogen levels.  It is currently unclear whether the actions of testosterone and/or estrogen affect cardiovascular risk factors. In this study, we explored the regulation of cardiovascular risk factors by testosterone and estrogen in men. We found that higher levels of testosterone led to lower HDL levels (“good” cholesterol), whereas estrogen did not regulate HDL.  In contrast, low levels of estrogen led to worsening insulin resistance and increased muscle fat, markers for developing diabetes.  Importantly, LDL cholesterol (“bad” cholesterol”) was not affected by either testosterone or estrogen in men.   (more…)
Author Interviews, Depression, Heart Disease, Statins / 07.03.2015

Heidi May, Ph.D., M.S.P.H. Cardiovascular Epidemiologist Intermountain Medical Center Heart Institute Salt Lake CityMedicalResearch.com Interview with: Heidi May, Ph.D., M.S.P.H. Cardiovascular Epidemiologist Intermountain Medical Center Heart Institute Salt Lake City   Medical Research: What is the background for this study? What are the main findings? Dr. Heidi May: Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Statin therapy is known to reduce the risk of cardiovascular disease incidence through the reduction of blood cholesterol levels and through its pleiotropic cardioprotective properties. Depression is a risk factor for cardiovascular disease. It has been recommended that antidepressant medications should be considered first-line treatment for depression of any severity. We hypothesized that taking both statins and antidepressants would reduce cardiovascular risk more than either medication alone. However, we did not find this. Instead we found that the effectiveness of antidepressants and statin therapy to reduce death and incident cardiovascular disease at 3 years varied by the severity of depressive symptoms. Among those with none to mild depressive symptoms, statin use, with or without antidepressant therapy, was associated with a decrease in risk, but among those with moderate to severe depression, antidepressant use was associated with a decrease in risk. The combination of antidepressant and statin use did not result in a greater risk reduction in either depressive symptom category. (more…)
AHA Journals, Author Interviews, Heart Disease, Social Issues / 06.03.2015

Randy Cohen, MD, MS, FACC Division of Cardiology Mt. Sinai St. Luke's Hospital New York, NYMedicalResearch.com Interview with: Randy Cohen, MD, MS, FACC Division of Cardiology Mt. Sinai St. Luke's Hospital New York, NY MedicalResearch: What is the background for this study? Dr. Cohen: Psychosocial conditions such as depression, anxiety, chronic stress and social isolation have strong associations with heart disease and mortality. Recently, however, attention has focused on positive emotions, psychological health and their collective impact on overall health and well-being.   Purpose in life is considered a basic psychological need, and has been defined as a sense of meaning and direction in one’s life which gives the feeling that life is worth living. We performed a meta-analysis of prospective studies evaluating the relationship between having a sense of purpose in life, mortality and cardiovascular disease. MedicalResearch: What are the main findings? Dr. Cohen: We identified 10 prospective studies involving over 137,000 subjects and found that possessing a sense of purpose in life was associated with a 23% reduced risk for all-cause mortality and a 19% reduced risk for cardiovascular disease events. (more…)
Author Interviews, Heart Disease, Menopause, University of Pittsburgh, Women's Heart Health / 06.03.2015

Dr. Rebecca Clark Thurston Ph.D Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science University of PittsburghMedicalResearch.com Interview with: Dr. Rebecca Clark Thurston Ph.D Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science University of Pittsburgh   MedicalResearch: What is the background for these studies? What are the main findings? Dr. Clark Thurston: The understanding of women’s cardiovascular disease and the role that reproductive factors play in women’s cardiovascular health is evolving. There are some studies showing links between menopausal hot flashes and cardiovascular disease risk in women. These studies help further refine this understanding. We showed in two separate studies that women who have hot flashes, particularly frequent hot flashes early in midlife, have poorer vascular health on certain indices. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 05.03.2015

Prof. Scott Montgomery Prof. Montgomery is a clinical epidemiologist, conducting research in life-course influences on chronic disease risk Örebro UniveristyMedicalResearch.com Interview with: Prof. Scott Montgomery Prof. Montgomery is a clinical epidemiologist, conducting research in life-course influences on chronic disease risk Örebro Univeristy Medical Research: What is the background for this study? What are the main findings? Prof. Montgomery: Stress is thought to increase the risk of heart disease. However, an experience that is stressful for one person may not be so for another, as stress resilience varies. As we believe that stress resilience is influenced by childhood experiences, we examined whether teenagers with low stress resilience were more likely to have coronary heart disease in subsequent adulthood (they were followed to a maximum age of 58 years). In this study of 237,980 men, we found that low stress resilience in adolescence was associated with a raised risk of heart disease. A surprising result was that although higher levels of fitness in adolescence were associated with lower heart disease risk, the benefit of such fitness, in terms of heart disease risk, was not present in the men with low stress resilience. (more…)
AHA Journals, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Nutrition / 05.03.2015

Luc Djousse, MD, ScD, FAHA Associate Professor of Medicine, Harvard Medical School Editor-in-Chief, Current Nutrition Reports Director of Research, Division of Aging Brigham and Women's Hospital Boston, MA 02120MedicalResearch.com Interview with: Luc Djousse, MD, ScD, FAHA Associate Professor of Medicine, Harvard Medical School Editor-in-Chief, Current Nutrition Reports Director of Research, Division of Aging Brigham and Women's Hospital Boston, MA 02120 MedicalResearch: What is the background for this study? What are the main findings? Dr. Djousse: While some studies have reported a higher risk of coronary heart disease, diabetes, or high blood pressure with frequent consumption of fried foods, other investigators did not confirm those results. To date, only few studies have evaluated whether frequent consumption of fried foods can raise the risk of developing heart failure. Frying foods not only increases the energy density of foods, but also increase the amount of trans fats. Trans fats can lead to development of heart disease and diabetes and consumption of energy-dense foods in large quantity can lead to weight gain and resulting cardiovascular consequences. We followed about 15000 US male physicians who were free of heart failure for an average of 10 years and found that frequent consumption of fried foods was related to a higher risk of developing heart failure. For example, people that consumed fried foods daily or more were twice more likely to develop heart failure than individuals who consumed fried foods less than once per week. (more…)
AHA Journals, Author Interviews, Heart Disease, Wake Forest / 05.03.2015

Simon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem NC 27157MedicalResearch.com Interview with: Simon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem NC 27157 Medical Research: What is the background for this study? Dr. Mahler: Care patterns for patients with acute chest pain are inefficient. Most patients presenting to US Emergency Departments (ED) with chest pain, including those at low-risk for acute coronary syndrome (ACS), are hospitalized for comprehensive cardiac testing. These evaluations cost the US health system $10-13 billion annually, but have a diagnostic yield for ACS of <10%. American College of Cardiology/ American Heart Association (ACC/AHA) guidelines recommend that low-risk patients with acute chest pain should receive serial cardiac markers followed by objective cardiac testing (stress testing or cardiac imaging). However, guideline adherent care among low-risk patients fails to accurately focus health system resources on those likely to benefit. Among low-risk patients, who have acute coronary syndrome rates less than 2%, objective cardiac testing  is associated with a substantial number of false positive and non-diagnostic tests, which often lead to invasive testing. Consensus is building within the US health care system regarding the need to more efficiently evaluate patients with acute chest pain. Medical Research: What are the main findings? Dr. Mahler: Patients randomized to the HEART Pathway were less likely to receive stress testing or angiography within 30 days than patients in the usual care arm (an absolute reduction of 12%. P=0.048). Early discharge (discharges from the ED without stress testing or angiography) occurred in 39.7% of patients in the HEART Pathway arm compared to 18.4%: an absolute increase of 21.3% (p<0.001). Patients in the HEART Pathway group had a median LOS of 9.9 hours compared to 21.9 hours in the usual care group: a median reduction in LOS of 12 hours (p=0.013). These reductions in utilization outcomes were accomplished without missing adverse cardiac events or increasing cardiac-related ED visits or non-index hospitalizations. The HEART Pathway, which combines the HEART score, with 0- and 3-hour cardiac troponin tests, is an accelerated diagnostic protocol (ADP), which may improve the value of chest pain care by identify patients who can safely be discharged from the ED without stress testing or angiography. Observational studies have demonstrated that the HEART Pathway can classify >20% of patients with acute chest pain for early discharge while maintaining a negative predictive value (NPV) for major adverse cardiac event (MACE) rate of greater than 99% at 30 days. However, prior to this study the real-time use of the HEART Pathway had never been compared with usual care. Therefore, we designed a randomized controlled trial to evaluate the efficacy of the HEART Pathway to guide providers’ testing and disposition decisions for patients with acute chest pain. The hypothesis was that the HEART Pathway would meaningfully reduce objective cardiac testing, increase early discharges, and reduce index hospital length of stay compared to usual care while maintaining high sensitivity and NPV (>99%) for MACE. (more…)
Author Interviews, Heart Disease / 04.03.2015

MedicalResearch.com Interview with: Joo-Yong Hahn, MD, PhD Associate Professor Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Medical Research: What is the background for this study? What are the main findings? Response: In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction (POST) trial, ischemic postconditioning failed to improve myocardial reperfusion (Hahn JY et al. Circulation 2013;128:1889-96) . However, long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, the aim of this study was to investigate the long-term effects of ischemic postconditioning on clinical outcomes. In this prospective, randomized trial, ischemic postconditioning with primary percutaneous coronary intervention  (PCI) did not improve clinical outcomes compared with conventional primary PCI in patients with STEMI. There was no significant difference in a composite of death, myocardial infarction, severe heart failure, or stent thrombosis between the 2 groups. Beneficial effects of ischemic postconditioning were not found in any of various subgroups. (more…)
Author Interviews, BMJ, End of Life Care, Heart Disease / 04.03.2015

MedicalResearch.com Interview with: Prof. Dr. med. Paul Erne AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute University of Zurich Department of Cardiology Clinic St. Anna, Lucerne and University Hospital Zurich Zurich, SwitzerlandProf. Dr. med. Paul Erne AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute University of Zurich Department of Cardiology Clinic St. Anna, Lucerne and University Hospital Zurich Zurich, Switzerland MedicalResearch: What is the background for this study? What are the main findings? Prof. Erne: Very little is known on this important subgroup of patients with Acute Coronary Syndrome (ACS) at admission who for various reasons receive restricted or palliative treatment only. Reasons for withholding comprehensive and/or invasive therapy may be the very limited life expectancy, advanced age or severe comorbidities. These patients are not represented in prospective trials and often not included in outcome statistics and registries. This study provides evidence that the population which received palliative therapy is older and sicker when compared to patients who underwent conservative or reperfusion treatment. However, this study shows that these decisions are very individually addressed. Acute Coronary Syndrome patients treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. Changes of treatment decisions over time and the proportion of patients surviving 1 year suggest in part non homogenous and potentially questionable decision criteria. While refraining from more active therapy may be the most humane and appropriate approach in many patients, in others it represents under treatment. (more…)
Author Interviews, Heart Disease, JAMA, Nutrition / 03.03.2015

Xiao-ou Shu M.D., MPH, Ph.D Associate Director of Global Health Co-Leader, Cancer Epidemiology Research Program Ingram Professor of Cancer Research Professor of Medicine (Epidemiology) Cancer EpidemiologistMedicalResearch.com Interview with: Xiao-ou Shu M.D., MPH, Ph.D Associate Director of Global Health Co-Leader, Cancer Epidemiology Research Program Ingram Professor of Cancer Research Professor of Medicine (Epidemiology) Cancer Epidemiologist MedicalResearch: What is the background for this study? What are the main findings? Dr. Shu: Nuts are rich in nutrients, such as unsaturated fatty acids, fiber, vitamins, phenolic antioxidants, arginine, and other phytochemicals. These are all known to be beneficial to cardiovascular health, probably through their anti-oxidative, anti-inflammatory, and endothelial function maintenance properties.   Previous studies, primarily conducted in white and affluent populations, have shown that nut consumption may be related to cardiovascular health. Much of the nut consumption in those populations would be tree nuts. In our study, we found that peanut consumption was associated with reduced total mortality and CVD mortality in a predominantly low-income black and white population in the US, and among Chinese men and women living in Shanghai. Because peanuts are much less expensive than tree nuts, as well as more widely available to people of all races and all socioeconomic backgrounds, increasing peanut consumption may provide a potentially cost-efficient approach to improving cardiovascular health. (more…)
Author Interviews, Baylor College of Medicine Houston, Cost of Health Care, Erectile Dysfunction, Heart Disease / 03.03.2015

Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Houston, TX MedicalResearch.com Interview with: Alexander W. Pastuszak, MD, PhD Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Houston, TX   Medical Research: What is the background for this study? Dr. Pastuszak: The link between erectile dysfunction (ED) and cardiovascular disease (CVD) has been growing stronger in recent years, and recommendations have recently been made to screen men with ED for CVD risk factors.  The arteries in the penis are much smaller than those in the heart, and if vascular disease contributes to ED, which we know it does, then ED should be detected before CVD in affected men.  We also know that treating men with CVD risk factors results in improvement in their risk of having acute cardiovascular events (i.e. heart attack, stroke, etc.).  Because of these relationships, we wanted to assess the economic impact of screening men with erectile dysfunction for CVD, identifying men with CVD risk factors, and treating these men on the incidence of cardiovascular events and new cases of ED.  Specifically, we wanted to look at the costs associated with screening and treatment of CVD and erectile dysfunction, and the cost savings resulting from screening and treating men with CVD risk factors and ED when preventing acute cardiovascular events. Medical Research: What are the main findings? Dr. Pastuszak: We modeled the reduction in acute cardiovascular events and the associated cost savings over 20 years.  We predicted that approximately 5.8 million men with both CVD and ED would be identified over 20 years if we screened men with ED for CVD risk factors, and the cost of this screening would be $2.7 billion.  We assumed that if we treated these at-risk men, there would be an approximately 20% decrease in cardiovascular events, which would prevent 1.1 million cardiovascular events over 20 years, saving $21.3 billion that would otherwise be put to treatment of these acute events.  Since ED and CVD arise from the same pathology, we predicted that in treating the CVD risk factors, a similar decrease in ED cases would be seen as well, which would save $9.7 billion that would otherwise be put to ED treatment.  In screening these men, a combined $28.5 billion would be saved over 20 years. (more…)
Author Interviews, Gender Differences, Heart Disease, Women's Heart Health / 03.03.2015

Saskia Haitjema MD PhD candidate Division Heart and Lung, Laboratory of Experimental Cardiology University Medical Center UtrechtMedicalResearch.com Interview with: Saskia Haitjema MD PhD candidate Division Heart and Lung, Laboratory of Experimental Cardiology University Medical Center Utrecht Medical Research: What is the background for this study? What are the main findings? Response: Although cardiovascular diseases are often considered a disease of men, more women than men die each year of cardiovascular diseases. Sex-differences are increasingly being researched and acknowledged. For treatment and prognosis of coronary artery disease, however, many discrepancies exist between studies that investigated sex-differences. For example, it remains unclear whether the observed differences in the outcome after coronary artery bypass grafting (CABG) are due to a different risk burden between men and women or whether female sex is an independent risk factor. In a group of 2553 patients followed up during a median of 2.5 years after CABG we found an increased risk for worse outcome in women versus men. We found a strong indication for female sex as an independent risk factor, but lacked power to definitively prove th (more…)
Author Interviews, Heart Disease, Kidney Disease / 28.02.2015

Dr. Simonetta Genovesi MD Department of Health Science University of Milano-Bicocca, Monza Italy Nephrology Unit San Gerardo Hospital, Monza, ItalyMedicalResearch.com Interview with: Dr. Simonetta Genovesi MD Department of Health Science University of Milano-Bicocca, Monza Italy Nephrology Unit San Gerardo Hospital, Monza, Italy MedicalResearch: What is the background for this study?   Dr. Genovesi: The prevalence of atrial fibrillation (AF) in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is high. The presence of atrial fibrillation increases the risk of thrombo-embolic stroke in the general population. The treatment of choice for reducing thrombo-embolic risk in AF patients is oral anticoagulant therapy (OAT) with warfarin. However, the use of warfarin in HD patients is controversial because of the high risk of bleeding and the fact that it is not demonstrated a clear protection against the risk of stroke in this population. The purpose of the study was to prospectively evaluate the effect of OAT on the risk of mortality, stroke and bleeding in HD population. MedicalResearch: What are the main findings?   Dr. Genovesi: In our hemodialysis population oral anticoagulant therapy does not increase the risk of total mortality, while antiplatelet agents are associated with an increased risk of death of about 70%. The continuous use of warfarin tends to be associated with improved survival as compared with individuals who discontinued the medication during the follow-up, but the incidence of thrombo-embolic events is not different in OAT subjects as compared with those who do not take it. Moreover, bleeding events are more frequent in patients taking warfarin, although the maintenance over time of an INR in the therapeutic range wards against the risk of bleeding. (more…)
AHA Journals, Author Interviews, Heart Disease, Mayo Clinic, Women's Heart Health / 28.02.2015

dr-shannon-dunlayMedicalResearch.com Interview with: Shannon M. Dunlay, M.D. M.S. Advanced Heart Failure and Cardiac Transplantation Assistant Professor of Medicine and Health Care Policy and Research Mayo Clinic Rochester MedicalResearch: What is the background for this study? Dr. Dunlay: Loss of mobility and independence can complicate the care of patients with chronic conditions such as heart failure, and can degrade their quality of life.  However, we have a very poor understanding of the burden of disability in patients with heart failure and how it impacts outcomes.  What are the main findings?  In this study, patients with heart failure were asked whether they had difficulty performing activities of daily living (ADLs)—these include normal activities that most people do in daily life such as eating, bathing, dressing, and walking.  Most patients with heart failure reported having difficulty with at least one ADL at the beginning of the study, and over 1/3 had moderate or severe difficulty with activities of daily living.  Patients who were older, female and had other chronic conditions such as diabetes, dementia and obesity had more difficulty with activities of daily living.  Patients that reported more difficulty with ADLs (worse mobility) were more likely to die and be hospitalized over time.  Some patients had a decline in function over time, and this was also predictive of worse outcomes. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Pennsylvania, Women's Heart Health / 26.02.2015

Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of PennsylvaniaMedicalResearch.com Interview with: Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of Pennsylvania MedicalResearch: What is the background for this review? What are the main findings? Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation. (more…)
AHA Journals, Author Interviews, General Medicine, Heart Disease, Women's Heart Health / 26.02.2015

Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC Professor of Cardiovascular Medicine, University of Birmingham, UK; Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark; Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK; Visiting Professor of Cardiology, University of Belgrade, Serbia Centre for Cardiovascular Sciences City Hospital Birmingham England UKMedicalResearch.com Interview with: Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC Professor of Cardiovascular Medicine, Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark; Aston Centre for Cardiovascular Sciences City Hospital Birmingham England UK Medical Research: What is the background for this study? What are the main findings? Prof. Lip: Women with atrial fibrillation are at higher risk of stroke than men with atrial fibrillation. The reasons for this elevated risk remain unclear. The results from our worldwide study suggest that women are treated no differently to men in terms of anticoagulant therapy for stroke prevention. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Women's Heart Health / 26.02.2015

Judith Lichtman, PhD, MPH Associate Professor (with tenure) Chair, Department of Chronic Disease Epidemiology Yale School of Public Health New Haven, CT 06520-803MedicalResearch.com Interview with: Judith Lichtman, PhD, MPH Associate Professor (with tenure) Chair, Department of Chronic Disease Epidemiology Yale School of Public Health New Haven, CT 06520-803 Medical Research: What is the background for this study? What are the main findings? Dr. Lichtman: Heart disease in younger women (18-55 years of age) is relatively rare, and represents less than 5% of all heart disease in women; however, young women who present with a heart attack are twice as likely to die in the hospital as compared with a similarly aged man, and this excess mortality risk continues beyond the index event. Delays in seeking prompt care has been suggested as one potential cause for the excess mortality in young women. We were interested in learning about the recognition of symptoms, perceived risk of heart disease, decision-making process to seek medical care, and interactions with the healthcare system among young women who recently had a heart attack. We found that even though the majority of young women presented with chest pain, they also experienced many other symptoms such as fatigue, nausea, muscle pain, and weakness. They commonly attributed symptoms to non-cardiac conditions because they felt they did not experience the “Hollywood Heart Attack” that is commonly portrayed in the media. Interestingly, despite reporting a strong family history of cardiac disease, and having multiple risk factors, many of the women we spoke with did not perceive they were at risk for heart disease, and many were not working with their physicians to manage their risk factors. They were also concerned about being seen as a hypochondriac if they reported their symptoms. Finally, women reported that the healthcare system was not consistently responsive when they reported their symptoms. (more…)
Annals Internal Medicine, Author Interviews, Heart Disease / 25.02.2015

Andrew Paul DeFilippis, MD, MSc Assistant Professor of Medicine University of Louisville Director, Cardiovascular Disease Prevention Medical Director, Cardiovascular Intensive Care Unit Adjunct Assistant Professor of Medicine Johns Hopkins University of Louisville Jewish Hospital Rudd Heart & Lung Center Louisville, KY MedicalResearch.com Interview with: Andrew Paul DeFilippis, MD, MSc Assistant Professor of Medicine University of Louisville Director, Cardiovascular Disease Prevention Medical Director, Cardiovascular Intensive Care Unit Adjunct Assistant Professor of Medicine Johns Hopkins University of Louisville Jewish Hospital Rudd Heart & Lung Center Louisville, KY Michael Joseph Blaha, MD MPH Director of Clinical Research Ciccarone Center for the Prevention of Heart Disease Assistant Professor of Medicine John HopkinsMichael Joseph Blaha, MD MPH Director of Clinical Research Ciccarone Center for the Prevention of Heart Disease Assistant Professor of Medicine John Hopkins MedicalResearch: What is the background for this study? Response: Atherosclerotic cardiovascular disease is the leading cause of death worldwide. While multiple therapies are available to prevent this common disease, accurate risk assessment is essential to effectively balance the risks and benefits of therapy in primary prevention. For more than a decade, national guidelines have recommended the use of an objective risk assessment tool based on the Framingham Risk Score (FRS) to guide therapy in primary prevention. Recently, the American Heart Association (AHA) and the American College of Cardiology (ACC) developed a new risk score to guide cardiovascular risk-reducing therapy. We had two main objectives in our study: 1) To compare the performance of the new AHA-ACC risk score with four other commonly used risk scores in a MODERN DAY gender balanced multi-ethnic population. 2) To explore how the use of modern day preventive therapy (aspirin, statins, BP meds and revascularization) impact the performance of the AHA-ACC score. MedicalResearch: What are the main findings? Response:  We found that the new AHA-ACC atherosclerotic cardiovascular disease (ASCVD) risk score and three Framingham-based risk scores, all derived from cohorts’ decade’s old, overestimated cardiovascular events by 25 – 115%, while the Reynolds Risk score, derived from more modern cohorts, accurately predicted the overall event rate in a modern, multi-ethnic cohort free of baseline clinical cardiovascular disease. Overestimation was noted throughout the continuum of risk and does not appear to be secondary to missed events or use of preventive therapies. (more…)
Author Interviews, Heart Disease, JAMA / 24.02.2015

Jari Laukkanen Cardiologist, MD, PhD Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio, FinlandMedicalResearch.com Interview with: Jari Laukkanen Cardiologist, MD, PhD Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio, Finland Medical Research: What is the background for this study? What are the main findings? Dr. Laukkanen: We have been studying many risk factors for cardiovascular disease (CVD) in the general population, and especially exploring protective factors of sudden cardiac death. In our qualified and well defined data on the KIHD prospective study, there were also many questionnaires about other health habits such as the use of sauna (how much, how often, temperature and so on). It was very logical to investigate further sauna use and the risk sudden cardiac death/CVDSs, because sauna is a part of our culture here in Finland. In this country, we have tradition to trust, that its healthy habit, although there are not previous studies showing the value of sauna in the prevention of cardiovascular disease. So we have to study this kind of health habit and CVVs in Finland based on our common traditions... (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Women's Heart Health / 24.02.2015

Jennifer L. Cook, MD FAHA Assistant Professor of Medicine | Heart Failure and Transplantation Medical Director Left Ventricular Assist Device Program Medical University of South Carolina Charleston, SC 29425MedicalResearch.com Interview with: Jennifer L. Cook, MD FAHA Assistant Professor of Medicine | Heart Failure and Transplantation Medical Director Left Ventricular Assist Device Program Medical University of South Carolina Charleston, SC 29425 Medical Research: What is the background for this study? What are the main findings? Dr. Cook: Although the incidence of heart failure is similar in men and women, women are more likely to die from it.  Despite this fact a common misperception persists that men are at greater risk.  Although advanced therapies such as mechanical support are as effective in women as in men, women are less likely to receive mechanical support.  In clinical trials investigating mechanical support as a bridge to transplant less than 30% of patients were women.  In trials investigating mechanical support for patients ineligible for heart transplant even fewer were women, less than 20%.  . Medical Research: What should clinicians and patients take away from your report? Dr. Cook: It has been shown that women with heart failure are more likely to remain under the care of a primary physician instead of being referred for specialized cardiovascular care.  The explanation for this pattern is not understood.  It is important to raise awareness and emphasize the high risk of heart failure mortality among women. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Michigan, Women's Heart Health / 24.02.2015

Claire Duvernoy, MD Chief, Cardiology Section VA Ann Arbor Healthcare System Professor of Medicine University of Michigan Health System Ann Arbor, MI MedicalResearch.com Interview with: Claire Duvernoy, MD Chief, Cardiology Section VA Ann Arbor Healthcare System Professor of Medicine University of Michigan Health System Ann Arbor, MI MedicalResearch: What is the background for this study? What are the main findings? Dr. Duvernoy: We wanted to look at the indications and outcomes for women veterans undergoing cardiac catheterization procedures as compared with men veterans, given that we know that there are significant gender differences in the non-veteran population between women and men undergoing cardiac catheterization. (more…)
Author Interviews, Diabetes, Heart Disease, Toxin Research / 20.02.2015

Katherine A James, PhD, MSPH, MSCE Colorado School of Public Health University of Colorado Denver, Aurora, ColoradoMedicalResearch.com Interview with: Katherine A James, PhD, MSPH, MSCE Colorado School of Public Health University of Colorado Denver, Aurora, Colorado Medical Research: What is the background for this study? What are the main findings? Dr. James: Exposure to inorganic arsenic in drinking water has been associated with several chronic diseases including cardiovascular disease and diabetes mellitus in areas with high levels of exposure.  Our study is one of the first to show association with cardiovascular disease and diabetes mellitus in a low-moderately exposed population. Our results show that for every 15 micrograms per liter of inorganic arsenic in drinking water the risk for CHD disease increased 38% and for diabetes it increases 27%. (more…)
Author Interviews, Heart Disease, JAMA, Karolinski Institute / 18.02.2015

Karolina Szummer, MD, PhD Section of Cardiology, Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm, Sweden MedicalResearch.com Interview with: Karolina Szummer, MD, PhD Section of Cardiology, Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Please note: This work is comparing the anticoagulant fondaparinux with low-molecular-weight heparin (not heparin). Medical Research: What is the background for this study? What are the main findings? Dr. Szummer: Since the publication of the OASIS-5 trial in 2006, many hospitals chose to change their medical practice and start using fondaparinux instead of low-molecular-weight heparin in the treatment of myocardial infarctions. In this study from the nation-wide near-complete myocardial infarction registry we were able to follow how the use of fondaparinux instead of low-molecular-weight heparin translated in clinical life was associated to a reduction in bleeding events and death. It is a very satisfying study, that confirms that the randomized clinical trial results are transferred with improvements in outcome to the treated patients. (more…)
Author Interviews, Exercise - Fitness, Gender Differences, Heart Disease / 17.02.2015

Dr. Miranda ArmstrongMedicalResearch.com Interview with: Dr Miranda Armstrong M.Phil. Physical Activity Epidemiologist Cancer Epidemiology Unit University of Oxford Oxford, UK Medical Research: What is the background for this study? What are the main findings? Dr. Armstrong: Physical activity has generally been associated with reduced risk of heart disease. However, there is limited evidence on the associations between the frequency and durations of various activities with stroke and blood clots, especially in middle-aged women. This is a very large study of 1.1 million middle-aged women, which confirms the benefits of moderate activity for reducing the risk of heart disease and stroke. Further to this, it shows that benefits may be more wide ranging than previously thought as the risk of blood clots was also lower in women reporting moderate activity when compared to inactive women. We found little evidence to suggest that activity more frequent than a few times per week provided further benefits in relation to these diseases. (more…)
Author Interviews, Gender Differences, Heart Disease, Psychological Science / 16.02.2015

Xiao Xu, PhD Assistant Professor Department of Obstetrics, Gynecology and Reproductive Sciences Yale University School of Medicine andMedicalResearch.com Interview with: Xiao Xu, PhD Assistant Professor Department of Obstetrics, Gynecology and Reproductive Sciences Yale University School of Medicine and Harold H. Hines, Jr. Professor of Medicine (Cardiology) and Professor of Faculty of Arts and Sciences, of Investigative Medicine and of Public Health (Health Policy); Co-Director, Clinical Scholars Program; Director, Yale-New Haven Hospital Center for Outcomes Research and Evaluation New Haven, CT 06510Harlan M Krumholz MD, SM Harold H. Hines, Jr. Professor of Medicine (Cardiology) and Professor of Faculty of Arts and Sciences, of Investigative Medicine and of Public Health (Health Policy);  Co-Director, Clinical Scholars Program;  Director, Yale-New Haven Hospital Center for Outcomes Research and Evaluation New Haven, CT 06510 Medical Research: What is the background for this study? What are the main findings? Response: Prior research of heart attack has mostly examined older patients, while few studies have focused on younger patients. Although we know that younger women differ from men and older patients in heart attack etiology and mortality, there is limited data on non-mortality outcomes of younger women and factors influencing their recovery. Mental stress is a particularly relevant factor for younger women as prior research showed higher stress in women than in men and an inverse association between age and stress. Therefore, in this study, we compared women and men 18-55 years old with heart attack and examined gender difference in mental stress and its potential role in explaining the worse recovery in women. We addressed these questions using data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) project, which is the largest prospective observational study of young and middle-aged women and men with heart attack and has comprehensive information on patients’ clinical and psychosocial characteristics. Our findings showed significantly higher stress in women than in men. Moreover, mental stress is associated with worse recovery in multiple health outcomes 1 month after heart attack, such as angina-specific and overall quality of life. The greater stress in women may partially contribute to their worse recovery. (more…)
Author Interviews, Heart Disease, JCEM, Pediatrics, Vitamin D / 12.02.2015

MedicalResearch.com Interview with: Markus Juonala, MD, PhD University of Turku Finland Medical Research: What is the background for this study? What are the main findings? Response: Earlier studies suggest that low vitamin D levels may be associated with cardiovascular disease. We wanted to study whether low childhood vitamin levels predict carotid intima-media thickness, a marker of early atherosclerosis, in adulthood. We observed that those children with vitamin D in lowest quartile had increased risk for high carotid intima-media thickness. (more…)
Author Interviews, BMJ, Heart Disease, Nutrition / 11.02.2015

James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart InstituteMedicalResearch.com Interview with: James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute   Medical Research: What is the background for this study? What are the main findings Response: There were 6 randomized controlled dietary trials performed before the government dietary fat recommendations were released.  When we performed a systematic review and meta-analysis of the available trials at this time, there was no significant difference in all-cause mortality or cardiovascular heart disease mortality.  In essence, there was no support from randomized controlled trials at the time to support a reduction in fat and saturated fat (and there still isn't from recent meta-analysis including newer trials). The reductions in mean serum cholesterol levels were significantly higher in the intervention groups but this did not result in significant differences in cardiovascular heart disease or all-cause mortality. (more…)
AHA Journals, Author Interviews, Genetic Research, Heart Disease / 10.02.2015

MedicalResearch.com Interview with: Wolfgang Sadee, Dr.rer.nat. Felts Mercer Professor of Medicine and Chair, Pharmacology Director and Elizabeth S Barrie, PhD Center for Pharmacogenomics The Ohio State University Columbus OH MedicalResearch: What is the background for this study? What are the main findings? Dr. Sadee and Dr. Barrie: We have determined that two frequent genetic variants can interact in a way that lowers the carrier’s risk for a heart attack. These genetic variants are single nucleotide polymorphisms (SNPs) - single base changes in the DNA sequence - of the dopamine-beta hydroxylase gene (DBH), which converts dopamine to norepinephrine. Both act as hormones in the periphery and as neurotransmitters vital to the brain's activity central nervous system. Numerous studies had tested genetic variants in DBH for effects on brain functions. In contrast to expectations, however, our work demonstrates that our two genetic variants lower DBH activity primarily in the periphery, in tissues with sympathetic innervation mediated by norepinephrine, such as the heart, lung, and liver.  As a result, we searched for genetic influence on risk of various diseases of the cardiovascular system and the lung, metabolic disorders, and more.   Each of the two DBH variants alone was associated with a number of disease states; however, when considering both variants in combination, a strong protective effect on the risk for heart attacks was discovered in several clinical trials. Such combined effects arising from interactions between two genetic variants may be more common than currently realized, possibly providing a path towards effective biomarker panels for personalized medicine. (more…)