MedicalResearch.com Interview with: Anne-Marie Schjerning Olsen, MD, PhD Department of Cardiology Gentofte Hospital, University of Copenhagen Denmark MedicalResearch.com: What is the background for this study? Dr....
MedicalResearch.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.
MedicalResearch.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.
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 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.
MedicalResearch.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...
MedicalResearch.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.
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.
MedicalResearch.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%.
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.
MedicalResearch.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.
MedicalResearch.com Interview with:
Xiao Xu, PhD Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Yale University School of Medicine and
Harlan 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.
MedicalResearch.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. 
MedicalResearch.com Interview with:
Prof. Ran Kornowski, M.D, FACC, FESC on behalf of the coauthors
Chairman - Division of Cardiology,
Rabin Medical Center, Petah-Tikva, Israel
Medical Research: What is the background for this study?
Prof. Kornowski: Over the years, the PCI procedure went-through many progresses. Among those are some angioplasty techniques, generalize use of stents and drug eluting stents, and adjuvant novel antithrombotic therapy. Unmistakably, these were associated with an overall improved PCI outcome. As many of the data on PCIs’ adverse outcomes predictors come from predates studies, we sought to update this matter.
Medical Research: What are the main findings?
Prof. Kornowski: This study confirms the influence of advanced age, diabetes-mellitus and urgent settings (i.e. acute coronary syndromes) on PCI long term outcome. However, we found that their effect extent is modest while supplementary predictors such as anemia (even mild), chronic kidney injury and echocardiographic findings of left ventricular dysfunction have a greater effect on contemporary PCI prognosis.
MedicalResearch.com Interview with:
Ann Marie Navar-Boggan, MD PhD
Fellow, Cardiovascular Disease
Duke University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: In this study of adults from the Framingham Offspring Study, we evaluated the impact of prolonged exposure to elevated cholesterol in early adulthood and future risk of coronary heart disease. In adults aged 55, the duration of time a person has been exposed to a non-HDL of >=160 mg/dL was associated with increased risk of coronary heart disease, and that risk was above and beyond the risk conferred by lipid levels at age 55. Every 10 years spent with a non-HDL of 160 or above was associated with a 39% increased future risk of coronary heart disease. We also looked at the association between prior average blood cholesterol between the age of 35 and 55, and found that every 10 mg/dL increase in prior average cholesterol above 125 mg/dL was associated with a 33% increased risk of coronary heart disease. These findings were particularly notable because the vast majority of adults with prolonged exposure to hyperlipidemia would not have been identified by the guidelines for statin therapy.
MedicalResearch.com Interview with:
W. H .Wilson Tang, M.D., F.A.C.C., F.A.H.A.
Professor in Medicine, Cleveland Clinic Lerner College of Medicine
Cleveland Clinic, Cleveland, OH 44195.
Medical Research: What is the background for this study? What are the main findings?
Dr. Tang: Our group has previously demonstrated that TMAO is linked to future cardiac risks in both humans and in animal models. We now show that long-term exposure to higher levels of TMAO promotes renal functional impairment and fibrosis in animal studies. We also show that in humans, as the kidneys lose function, TMAO isn’t eliminated as easily, and their blood levels further rise, thereby increasing cardiovascular and kidney disease risks further. This newly discovered TMAO link offers further insight into the relationship between cardiovascular disease and chronic kidney disease.
MedicalResearch.com Interview with:
Robert Hutchins, M.D., M.P.H.
Department of Medicine, Division of General Internal Medicine
UCSF
Medical Research: What is the background for this study? What are the main findings?
Dr. Hutchins: "Utility" refers to the effect on quality of life that a certain intervention carries and a utility value generally varies from 0-1.0. The more negative the effect is, the lower the utility value (closer to 0), and the less it affects quality of life, the closer to 1.0 it is. On a theoretical scale, "perfect health" is 1.0 and death is 0. There are a number of studies that -- USE a utility value for taking pills, generally between 0.95 and 1.0. However, many cost-effectiveness analyses ignore the utility value altogether, or arbitrarily choose 1.0 as the utility. We found that a small change in the utility value can have a very large effect on the overall cost-effectiveness of an intervention. We found that the utility value of taking pills, assessed by three different commonly used methods, to be 0.990-0.994, depending on the method.
MedicalResearch.com Interview with:
Dmitry Yaranov, MD
Danbury Hospital
Western Connecticut Health Network
Medical Research: What is the background for this study? What are the main findings?
Dr. Yaranov: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke (CVA) that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation. The aim of this study was to investigate the impact of OSA on CVA rate in patients with atrial fibrillation. We found that Obstructive sleep apnea in patients with atrial fibrillation is an independent predictor of CVA and this association may have important clinical implications in CVA risk stratification. 
MedicalResearch.com Interview with:
Richard J. Holden, PhD Assistant Professor
Department of BioHealth Informatics
Indiana University
School of Informatics and Computing – Indianapolis
Indianapolis, IN 46202
Medical Research: What was your motivation for this study?
Dr. Holden: Many patients arrive in the emergency room with acute heart failure (AHF), a worsening of their chronic heart failure condition. These visits and subsequent hospital admissions and readmissions for acute heart failure represent a sizeable cost in the US healthcare system. Evidence suggests that some of these cases could be prevented if patients were better able to perform self-care activities such as monitoring their symptoms, taking medications, getting exercise, and maintaining a sodium-restricted diet. However, in community-based studies that we and others have done, patients with heart failure face a variety of barriers to optimally performing self-care. We therefore created an instrument to assess barriers to self-care, which we designed to be implemented in the emergency room. We tested the instrument with 31 patients with acute heart failure at Vanderbilt University’s adult Emergency Department.
Medical Research: What are the main findings?
Dr. Holden: Almost everyone who participated reported experiencing barriers to self-care. A median of 15 barriers per patient were reported. Of the 47 barriers that we tested, 34 were reported by at least one quarter of participants. The top ten most prevalent barriers included individual-level factors such as physical disability, disease knowledge, and memory deficits as well as factors related to the organization of home life, including major disruptions such as holidays. Other barriers were related to inadequate health information, low literacy, and lack of resources. Many barriers interacted with one another, for example, lack of transportation yet not wanting to rely on others. We found that the instrument could be feasibly administered within a short period following the patient’s emergency room arrival.
MedicalResearch.com Interview with: Donald M Lloyd-Jones, MD/ScM Senior Associate Dean for Clinical and Translational Research Chair, Department of Preventive Medicine Director, Northwestern University Clinical...
Dong Zhao MD.PhD
Deputy Director & Professor and
Dr. Que Qi, MD.PhD Assistant Professor
Beijing Institute of Heart,Lung & Blood Vessel Diseases
Capital Medical University Beijing Anzhen Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Dong Zhao: Lower serum HDL-C level used to be considered as a key risk factor of atherosclerotic cardiovascular diseases. This knowledge was based on very consistent findings from researcher of basic science and observational studies of epidemiology. HDL-C has been also introduced as "good cholesterol" to the public. However, this well accepted knowledge was challenged when two large RCTs demonstrated that increased serum HDL-C by CETP inhibitor (ILLUMINATE and dal-OUTCOMES) failed to show benefits on reducing the risk of atherosclerotic cardiovascular disease. Therefore, many researchers questioned whether serum HDL-C can fully represent the capacity of cholesterol reverse transport of HDL particle, an underpinning of the anti-atherogenic function of HDL. And HDL particle number was considered to be better than HDL-C as a proper parameter to assess the function of HDL. In fact, RCTs that increased serum HDL-C substantially by CETP inhibitor had little effect on HDL particle number, thus resulting in increased cholesterol-overloaded HDL particle. Previous experimental studies observed that cholesterol-overloaded HDL particle exerted a negative impact on cholesterol reverse transport. However, it remains unclear whether cholesterol-overloaded HDL is involved in the development of atherosclerosis in humans. In our study, we measured HDL particle number using nuclear magnetic resonance spectroscopy, and calculated the ratio of HDL-C to HDL particles number to estimate the cholesterol content per HDL particle (HDL-C/P ratio). We found that cholesterol-overloaded HDL particles, indicated by high HDL-C/P ratio, are independently associated with the progression of carotid atherosclerosis in asymptomatic individuals from a community-based cohort study of the Chinese Multi-provincial Cohort Study-Beijing Project.
MedicalResearch.com Interview with:
Andre Lamy MD MHSc
COMPASS (CABG sub-group PI) CORONARY Principal Investigator
Professor, Dept Surgery, Division Cardiac Surgery
Associate Member, Dept Clinical Epidemiology & Biostatistics
McMaster University Hamilton General Hospital
Hamilton, ON, Canada
Medical Research: What is the background for this study?
Dr. Lamy: The Canadian healthcare system operates in an environment that must constantly find new ways to make healthcare delivery more efficient. In the TIMACS clinical led by Dr. Shamir Mehta, it was found that the primary outcome was similar for an early invasive procedure within 24 hours and a delayed approach of after 36 hours in outcomes. However, because of the inherent shorter length of stay associated with early invasive procedures within 24 hours there will be definite cost-savings from an early invasive strategy. Dr. Andre Lamy et al looked at the cost implications of this shorter length of stay in the TIMACS trial and explored the impact of the use of a catheterization lab on days when they are normally not in use (i.e. weekends), which may negate the savings of early intervention.
Medical Research: What are the main findings?
Dr. Lamy: The main findings of our study were that early invasive strategy was cost-saving for Canadian NTSE-ACS patients due to significant savings from the shorter length of stay. These savings were present even if as many as 50% of TIMACS patients were assumed to be weekend cases. Given many high-risk NSTE-ACS patients receive delayed intervention due to weekend catheterization lab status, these findings support operating catheterization labs on weekends to facilitate the use of early invasive intervention.
MedicalResearch.com Interview with:
Abraham Morgentaler, MD
Director and Founder
Men’s Health Boston
Medical Research: What is the background for this study? What are the main findings?
Response: There has been tremendous media attention over the last 15 months to two retrospective studies that reported increased cardiovascular risks with testosterone. Those reports anchored a variety of stories critical of testosterone therapy for non-scientific reasons, such as alleged dangers of direct-to-consumer advertising. In this review we investigated the two recent studies in depth, as well as the broader literature regarding testosterone and cardiovascular issues. One primary finding was that the studies alleging risk were remarkably weak and flawed- one reported low rates of MI and had no control group, and the other had such large data errors (nearly 10% of the all-male population turned out to be female!) that 29 medical societies have called for its retraction. In contrast, there is substantial literature suggesting that testosterone therapy, or naturally occurring higher levels of testosterone, is protective against atherosclerosis, and mortality. Several small randomized controlled trials in men with known heart disease- angina and congestive heart failure- have even shown benefits for men that received testosterone compared with placebo.
Medical Research Interview
Dr Gomez-Puerta MD, PhD, MPH
Division of Rheumatology, Immunology, and Allergy; Brigham and Women's Hospital, Harvard Medical School, Boston, MA
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Gomez-Puerta: Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology which can cause multiorgan system damage and which disproportionately affects women and non- Caucasian minorities. Up to 60% of SLE patients develop renal disease, lupus nephritis (LN), and of these, approximately one fifth progress to end-stage renal disease (ESRD). The risk of cardiovascular (CV) events and mortality is higher in patients with ESRD and in particular in patients suffering SLE. However, information about CV outcomes and mortality is limited in patients with LN associated ESRD.
We observed important variation in cardiovascular outcomes and mortality by race and ethnicity among lupus nephritis related ESRD patients. After adjusting for multiple demographic and clinical factors and accounting for the competing risk of kidney transplantation and loss to follow-up, our results illustrate for the first time that Asian (vs. White) and Hispanic (vs. non-Hispanic) lupus nephritis related ESRD patients have lower mortality risks.