Emergency Care, Heart Disease / 23.11.2014

Michael J. Ward, MD, MBA K12 Scholar Assistant Professor Vanderbilt University Department of Emergency Medicine Nashville, TN 37232MedicalResearch.com Interview with: Michael J. Ward, MD, MBA K12 Scholar Assistant Professor Vanderbilt University Department of Emergency Medicine Nashville, TN 37232 Medical Research: What is the background for this study? What are the main findings? Dr. Ward: The number of Americans living with cardiovascular disease is only expected to increase in the coming years.  However, we do not know the national effects of increased medication use and preventive efforts to stop the most serious form of a heart attack, called an ST-elevation myocardial infarction (STEMI). In particular, there are no estimates of how often this serious form of a heart attack shows up in the emergency department. Between 2006 and 2011 we found an average of 258,000 STEMIs annually in the U.S. or 8.7 per 10,000 U.S. adults per year. Interestingly, the number of STEMIs has decreased by more than 70,000 per year over this time, a 24% reduction. We found similar annual decreases across every age group and geographic region in the U.S. The decreases were most pronounced among those 85 years and older and in the Midwest. (more…)
Flu - Influenza, Heart Disease / 21.11.2014

MedicalResearch.com Interview with: Harleen Sandhu, MD MPH Senior Researcher University of Texas Health Science Center at Houston Medical Research: What is the background for this study? What are the main findings? Dr. Sandhu: Previous studies have shown a correlation between seasonal variations and occurrence of acute aortic dissection, however, reasons for such associations are unknown. Seasonal flu activity has been associated with the occurrence of cardiovascular diseases such as acute myocardial infarction in the past. This led us to verify this seasonal correlation in our experience with acute aortic dissection patients and to further investigate if its incidence was associated with flu activity. Our results confirmed the seasonal variation in acute aortic dissection as well as demonstrated a positive correlation with seasonal flu activity. (more…)
Heart Disease / 21.11.2014

Mark Rabbat, MD Assistant Professor of Medicine and Radiology Division of Cardiology at Loyola University Medical CenterMedicalresearch.com Interview with: Mark Rabbat, MD Assistant Professor of Medicine and Radiology Division of Cardiology at Loyola University Medical Center MedicalResearch.com: What are the main findings of this study? Dr. Rabbat : Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and is responsible for significant morbidity and mortality. Epidemiologic data suggest that obesity as measured by one’s BMI is a risk factor for Atrial fibrillation. But there is more to the story. What may be even more important than overall BMI is how much fat you have around the heart. There are many individuals who, as measured by their BMI, are not considered obese, but they have high volumes of fat around their heart, which may have been a major cause for their atrial fibrillation. Therefore, simple measures such as BMI may fail to completely inform us of a patient’s true CV risk. In a previous study we found that epicardial adipose tissue (EAT), or the fat around the heart, has been associated with the presence and severity of AF independent of known risk factors and body mass index (BMI). The inflammatory mediators released from the fat are metabolically active, and may promote fibrosis in adjacent heart muscle. Fibrosis of the left atrium appears to be a hallmark feature of atrial fibrillation and higher amounts of fibrosis are linked to recurrence of atrial fibrillation. New innovations in cardiac magnetic resonance imaging (CMR) allow LA fibrosis and EAT to be precisely quantified. Our current study is the first of its kind to demonstrate the association of EAT volume and extent of LA fibrosis in human AF independent of LA size, BMI, and other AF risk factors. (more…)
Author Interviews, General Medicine, Heart Disease, Lipids / 21.11.2014

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART ProgramMedicalResearch.com Interview with: Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Maddox: With the release of the updated cholesterol guidelines last year and their significant changes in recommendations, we wanted to see what the potential impact would be on U.S. cardiovascular practices.  Specifically, we were interested in present cholesterol treatment and testing patterns, and how they would potentially need to change under the new guidelines. We used the PINNACLE registry to conduct our investigation.  Under the sponsorship of the American College of Cardiology, the registry collects EMR data from 111 cardiovascular practices around the U.S.  We analyzed cholesterol treatment and testing patterns in approximately 1.2 million patients.  We found that most patients qualified for cholesterol treatment with statins, but 32.4% weren't currently prescribed them.  We also found that 22.6% of patients were being treated with non-statin lipid-lowering therapies which, under the new guidelines, aren't currently recommended for cholesterol treatment.  Finally, we found that 20.8% of patients underwent repeated LDL-C testing, which may not be necessary under the new guidelines. (more…)
Emergency Care, Heart Disease / 21.11.2014

Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of ArizoneaMedicalResearch.com Interview with: Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of Arizona Medical Research: What is the background for this study? What are the main findings? Dr. Bobrow: Out-of-Hospital Cardiac Arrest is a leading cause of death worldwide. There are nearly half a million EMS-assessed Out-of-Hospital Cardiac Arrest s in the United States annually. Bystander CPR (B-CPR) before arrival of EMS can double or even triple survival from OHCA. Yet it occurs in only 1/3 of cases. Telephone CPR - the provision of B-CPR with a 9-1-1 telecommunicator's instructions - is independently associated with increased rates of Bystander CPR and patient survival and requires almost no capital investment. For this reason, we believe Telephone CPR may be THE most effective and efficient way to move the needle on OHCA survival. In order to achieve this potential, however, EMS systems must adopt the latest guideline recommendations for T-CPR and continuously measure system performance. Very few systems do this. The aim of our project was to do just this at multiple 9-1-1 centers in Arizona. We implemented the guidelines and measured the impact on process metrics and patient outcomes. Our findings confirmed what we expected: a significant increase in the proportion of cases where T-CPR was performed, a significant reduction in time from call-receipt to first bystander chest compression, and, most importantly, significant increases in patient survival and survival with positive neurologic outcome. (more…)
Author Interviews, CDC, Heart Disease / 19.11.2014

MedicalResearch.com Interview with: Dr. Quanhe Yang PhD CDC’s Division for Heart Disease and Stroke Prevention What is the background for this study? What are the main findings? Dr. Yang: Our study reveals that an individual’s predicted risk of developing cardiovascular disease (CVD), coronary heart disease (CHD) and stroke over the next decade varies significantly from state-to-state, as well as by demographic factors including age, gender, race-ethnicity and household income. Among the key findings: the 10-year risk is higher in the Southeast and lower in northwestern states – and higher among men than women. For men, the 10-year risk of developing CVD was 14.6 percent for the nation as a whole, ranging from a low of 13.2 percent in Utah to a high of 16.2 percent in Louisiana. CHD risk among men ranged from 9.5 percent in Utah to 11.7 percent in Louisiana, while stroke risk was 2.1 percent in Utah and 2.6 percent in Louisiana. Among women, CVD risk was 7.5 percent, ranging from 6.3 percent in Minnesota to as high as 8.7 percent in Mississippi. CHD risk for women ranged from 3.8 percent in Minnesota to 5.3 percent in Mississippi, while stroke risk was as low as 1.5 percent in Minnesota and as high as 2.1 percent in Mississippi. Nationally, we found the risk increased significantly with age and was highest among non-Hispanic blacks, those with less than a high school education and those with household incomes below $35,000 . As part of this study, CDC researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2010, as well as the 2009 Behavioral Risk Factor Surveillance System, the world’s largest ongoing telephone health surveillance system. The state-based, random-digit-dialed phone survey included information from almost 300,000 U.S. residents between the ages of 30 and 74. (more…)
Author Interviews, BMJ, Heart Disease, Occupational Health / 19.11.2014

MedicalResearch.com Interview with: Vasileia Varvarigou MD, Visiting Scientist at Harvard School of Public Health and Senior Medical Resident, St Elizabeth’s Medical Center, Tufts Medical School and Stefanos N Kales MD, MPH, Associate Professor, Harvard School of Public Health, Division Chief of Occupational Medicine, Cambridge Health Alliance/ Harvard Medical School Medical Research: What is the background for this study? Response: Previous epidemiologic studies of firefighters have documented markedly increased risks of acute death from heart disease during strenuous activities such as fire suppression as compared to non-emergency duties. We hypothesized that certain law enforcement tasks could serve as an occupational trigger in susceptible police officers, leading to an increased frequency of sudden cardiac death during stressful duties. Our main objective therefore, was to assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. (more…)
Author Interviews, Heart Disease / 19.11.2014

MedicalResearch.com Interview with: Thanh Huyen T Vu MD, PhD Research Assistant Professor Preventive Medicine-Epidemiology Northwestern University Feinberg School of Medicine Medical Research: What is the background for this study? Response: Ideal levels of all major cardiovascular disease (CVD) risk factors (RF), i.e., low risk (LR), in younger age are associated with lower subsequent CVD morbidity and mortality in older age. However, data are limited on the long-term relationships of LR profile in younger age with functional disability in older age. (more…)
Author Interviews, Heart Disease, JAMA / 19.11.2014

Dr. Lars H. Lund Department of Medicine, Karolinska Institutet Department of Cardiology, Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with: Dr. Lars H. Lund Department of Medicine, Karolinska Institutet Department of Cardiology, Karolinska University Hospital Stockholm, Sweden Medical Research: What is the background for this study? Dr. Lund: Heart Failure and Preserved Ejection Fraction is common and associated with poor prognosis and there is no therapy. Beta-blockers reduce mortality in Heart Failure and Preserved Ejection Fraction and we hypothesized that they may be associated with reduced mortality also in Heart Failure and Preserved Ejection Fraction. (more…)
Author Interviews, Cost of Health Care, Heart Disease, UCLA / 18.11.2014

Boback Ziaeian MD Cardiology Fellow, UCLA Division of Cardiology PhD Candidate, UCLA Fielding School of Public HealthMedicalResearch.com Interview with: Boback Ziaeian MD Cardiology Fellow, UCLA Division of Cardiology PhD Candidate, UCLA Fielding School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to an aging population improved medical therapies that prolong heart failure survival. Spending for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in 2030.  Despite the magnitude of the impact of heart failure on the US population and economy, our understanding of the factors associated with the highest cost heart failure hospitalizations is limited. Our study provides a descriptive analysis of how certain patient and hospital factors are associated with increased medical costs nationally. The top 20% of heart failure hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%. Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral vascular disease) have much higher costs associated with hospital care. As expected, sicker patients receiving more invasive procedures such mechanical ventilation or blood transfusions incurred higher costs. Certain hospital characteristics were also associated with higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals. Hospitals in the Northeast and West Coast of the US were higher in cost compared to the Midwest and South. The reasons for this disparity in medical costs requires further research to better understand. (more…)
Author Interviews, Heart Disease / 18.11.2014

Prof Simon Stewart PhD Mary MacKillop Institute for Health Research, Australian Catholic University, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, AustraliaMedicalResearch.com Interview with: Prof Simon Stewart PhD Mary MacKillop Institute for Health Research, Australian Catholic University, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia Medical Research: What is the background for this study? What are the main findings? Prof. Stewart: Atrial fibrillation (AF) is the most common irregular heart beat and a major cause of deadly and disabling stroke and chronic heart failure. Atrial fibrillation has become a major public health issue that is putting increasing pressure on health care systems worldwide. In an attempt to reduce re-hospitalisations and death due to Atrial fibrillation, we designed the randomised controlled trial the Standard versus Atrial Fibrillation-spEcific managemenT strategY (SAFETY); a home-based, nurse-led, AF-specific management programme delivered to patients who have been hospitalised with Atrial fibrillation and involved individualised AF management. Half of participants (n=168) were given this intervention and the other half (n=167) underwent standard post-hospital management. All participants were followed-up over 24 months with specific clinic visits scheduled at 12 months and 24 months. We found that patients in the intervention group had proportionately more days alive and out of hospital compared to patients who received standard management (reflecting a combination of less hospital stay and prolonged survival). Further, when intervention patients did go to hospital, the length-of-stay of their admission was shorter than for patients under standard management. (more…)
Cognitive Issues, Heart Disease / 17.11.2014

Dr. T. Jared Bunch, M.D Medical Director for Heart Rhythm Services Intermountain Healthcare network.MedicalResearch.com Interview with: Dr. T. Jared Bunch, M.D Medical Director for Heart Rhythm Services Intermountain Healthcare network. Medical Research: What is the background for this study? What are the main findings? Dr. Bunch: Approximately 5 years ago we found that atrial fibrillation was associated with all forms of dementia, including Alzheimer's disease.  At that time we did not know the mechanisms behind the association.  One hypothesis that we had was brain injury in patients with atrial fibrillation is in a spectrum, large injuries result in strokes and repetitive small injuries result in dementia.  In this regard, we anticipated that anticoagulation effectiveness and use may impact dementia risk.  Early this year we published in HeartRhythm Journal that atrial fibrillation patients with no history of dementia that have used warfarin, but had high percent times outside of the therapeutic range were much more likely to develop dementia.  We gained some insight from this trial in that we saw much higher risks of the patients were either over or under anticoagulated. Amongst our atrial fibrillation patients using warfarin nearly one third are also taking aspirin, typically due to the presence of coronary artery disease or a prior myocardial infarction. We hypothesized since these patients were using two agents that increase risk of bleed that over anticoagulation with warfarin may be an even great risk for dementia.  This is was we found.  The patients over anticoagulated greater than 30 percent of the time were nearly 2 and a half times more likely to develop dementia compared to those that were over anticoagulated less that 10 percent to the time. (more…)
Author Interviews, Heart Disease, Lancet / 17.11.2014

Prof Gavin D. Perkins MD Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research; Warwick Medical School and Heart of England NHS Foundation TrustMedicalResearch.com Interview with: Prof Gavin D. Perkins MD Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research; Warwick Medical School and Heart of England NHS Foundation Trust Medical Research: What is the background for this study? Prof. Perkins: Each year around 30,000 people in the United Kingdom suffer out of hospital cardiac arrests and less than one in twelve of those returns home alive. Early high quality Cardio- Pulmonary Resuscitation (CPR – ventilation and chest compressions) is critical to survival. However maintaining high quality chest compressions during resuscitation is difficult for crews of emergency vehicles, especially if they are on their own, because of fatigue and the need to perform other actions. Chest compression is particularly difficult in moving vehicles. A number of mechanical devices, suitable for out of hospital use, have been developed over the years to improve the quality of chest compressions and therefore attempt to improve patient outcomes. Some NHS organisations decided to purchase devices to use although there is limited evidence of their effectiveness. To equip all emergency vehicles in the NHS would cost tens of millions of pounds plus costs for on-going training and maintenance. This prompted the UK Joint Royal College Ambulance Liaison Committee to advise against the purchase of further mechanical chest compression devices until further research had been carried out. The aim of this trial was to compare the effects of the mechanical chest compressions (LUCAS-2) device versus standard manual chest compressions (crew using their hands) on survival. (more…)
Author Interviews, Heart Disease / 17.11.2014

Dr. Yacov Shacham MD Department of Cardiology Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.MedicalResearch.com Interview with: Dr. Yacov Shacham MD Department of Cardiology Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel. Medical Research: What is the background for this study? What are the main findings? Dr. Shacham: Acute kidney injury (AKI) is a common complication among ST elevation (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and it is associated with poor long-term clinical outcomes. No studies have yet evaluated the association between cardiac function and the risk of AKI in this patient population. We conducted a retrospective study of consecutive STEMI patients who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission. We evaluated the relation between systolic and diastolic parameters and AKI. We demonstrated that the occurrence of AKI following primary PCI was associated with worse left ventricular systolic and diastolic function, however only left ventricular EF emerged as an independent predictor of AKI. For every 1% reduction in EF, the risk of AKI increased (OR 1.1, 95% CI 0.86-0.96; p=0.001) (more…)
Heart Disease / 17.11.2014

Dr Guillaume Geri, MD Medical Intensive Care Unit Cochin Hospital Paris, FranceMedicalResearch.com Interview with: Dr Guillaume Geri, MD Medical Intensive Care Unit Cochin Hospital Paris, France   Medical Research: What is the background of the study? What are the main findings? Dr. Geri: Culprit coronary artery occlusion is the main cause of out-of-hospital cardiac arrest. This has been well demonstrated since pioneer study of Spaulding et al in the New England Journal of Medicine in 1997. Several studies highlighted the favorable prognostic impact of an immediate successful PCI in cardiac arrest patients but inclusion biases or the lack of data on in-hospital management limit the generalization of such findings. In this large French cohort of out-of-hospital cardiac arrest patients who were admitted after successful return of spontaneous circulation from 2000 to 2012, those who received immediate PCI had better short- and long-term survival than those who did not undergo the procedure, new data presented here concluded. The researchers examined the association between immediate PCI and survival at 30 days, 2 years and 10 years, and evaluated other potential predicting factors. Furthermore, they used a propensity score method to analyze the impact of PCI on 30-day and long-term survival in matched patients. Overall, 1,722 patients (71.5% male; median age, 59.9 years) were analyzed during a median 2 year follow-up. OHCA  (out-of-hospital cardiac arrest ) was witnessed in 86.7% of patients, and occurred in a public space in 32.2% of patients and with an initial shockable rhythm (eg, ventricular fibrillation/ventricular tachycardia) in 54.6% of cases. (more…)
Cannabis, Heart Disease / 17.11.2014

Matthew L. Springer, Ph.D.  Associate Professor of Medicine Division of Cardiology Cardiovascular Research Institute Broad Center of Regeneration Medicine and Stem Cell Research Center for Tobacco Control Research & Education Helen Diller Family Comprehensive Cancer Center University of California, San Francisco   MedicalResearch.com Interview with: Matthew L. Springer, Ph.D. Associate Professor of Medicine Division of Cardiology Cardiovascular Research Institute Broad Center of Regeneration Medicine and Stem Cell Research Center for Tobacco Control Research & Education Helen Diller Family Comprehensive Cancer Center University of California, San Francisco     Medical Research: What is the background for this study? What are the main findings? Dr. Springer: The general public is aware that cigarette secondhand smoke is harmful. However, many people who actively avoid tobacco secondhand smoke don't feel the need to avoid marijuana secondhand smoke; they don't consider it harmful because there's no nicotine and because we who tell them to avoid tobacco smoke don't tell them to avoid marijuana smoke.  However, secondhand smoke from tobacco and marijuana is very similar in chemical composition (4000-7000 chemicals depending on whom you ask), aside from the nicotine and the THC (the psychoactive drug in marijuana). We and others have shown that brief exposure to tobacco secondhand smoke, such as 30 minutes, at real-world levels impairs vascular function in humans.  We developed a way to study vascular function (measured as arterial flow-mediated dilation; FMD) in living rats, and recently published that even one minute of sidestream smoke from the burning tips of tobacco cigarettes, a well-accepted model for secondhand smoke, is enough to start detecting impairment of FMD.  The main findings of the current study are that in laboratory rats, FMD was substantially impaired by a 30 minute exposure to marijuana secondhand smoke, when measured 10 minutes after the end of exposure.  Impairment was comparable to that resulting from exposure to tobacco sidestream smoke, although whereas impairment from tobacco smoke was temporary and had normalized by 40 minutes later, FMD was still impaired 40 minutes after the end of exposure to marijuana smoke.  Smoke from marijuana lacking THC still impaired FMD, showing that  (more…)
Author Interviews, General Medicine, Heart Disease, JAMA / 16.11.2014

Manesh Patel, MD Associate Professor of Medicine Director Interventional Cardiology and Catheterization Labs Duke University Health System Duke Clinical Research InstituteMedicalResearch.com Interview with: Manesh Patel, MD Associate Professor of Medicine Director Interventional Cardiology and Catheterization Labs Duke University Health System Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Patel: In clinical practice, patients with acute myocardial infarction are found to have non-IRA disease of varying significant and location.  The current recommendations are to have patients recover from the acute myocardial infarction and get non-invasive testing to determine revascualrization after 4-6 six weeks in uncomplicated patients.  These data demonstrate that non-IRA disease is common (>50% of STEMI patients) and that these patients have an elevated 30-day mortality. (more…)
Author Interviews, Emergency Care, Heart Disease / 16.11.2014

Dr. Marc-Alexander Ohlow, MD, adjunct Professor of Medicine Cardiology Department Zentralklinik Bad Berka, GermanyMedicalResearch.com Interview with: Dr. Marc-Alexander Ohlow, MD, Adjunct Professor of Medicine Cardiology Department Zentralklinik Bad Berka, Germany MedicalResearch.com: What are the main findings of the study? Dr. Ohlow: This paper reports the finding of a retrospective study including 4.311 consecutive patients with suspected acute coronary syndrome (ACS). Out of them 272 patients with acute onset of chest pain and elevated levels of cardiac necrosis markers did not have significant (≥50% diameter stenosis) coronary artery stenosis on coronary angiography. Aim of this study was to provide further information and understanding of the clinical characteristics and outcome of patients with acute coronary syndrome without critical stenosis, and comparing those with a consecutive series of patients with ACS requiring percutaneous coronary intervention (non-ST-elevation myocardial infarction patients). Patients presenting without significant coronary stenosis, but with chest pain and elevated troponin level were younger, had less severe angina symptoms, were more likely to be women, had lower level of myocardial necrosis markers (troponin and creatine kinase), and had higher left ventricular ejection fraction compared to patients undergoing angioplasty due to significant coronary obstruction. (more…)
Author Interviews, BMJ, Erasmus, Heart Disease / 16.11.2014

Marco Valgimigli, MD, PhD Associate Professor of Medicine Erasmus MC, Thoraxcenter, Rotterdam The NetherlandsMedicalResearch.com Interview with: Marco Valgimigli, MD, PhD Associate Professor of Medicine Erasmus MC, Thoraxcenter, Rotterdam The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Valgimigli: Drug-Eluting Stents are regarded as more thrombogenic devices as compared to Bare Metal Stents. We have pooled all available datasets comparing a specific second generation Drug-Eluting Stent, namely cobalt chromium everolimus eluting stent (co-Cr EES) versus Bare Metal Stents and found that cardiac mortality along with all other non-fatal endpoints investigated, including myocardial infarction or stent thrombosis were reduced after co-Cr EES. (more…)
AHA Journals, Author Interviews, Diabetes, Heart Disease, Metabolic Syndrome, Weight Research / 12.11.2014

Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director, Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health, LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, LouisianaMedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana Medical Research: What is the background for this study? What are the main findings? Dr. Hu: Many previous studies had small samples, and thus lacked adequate statistical power when the analysis was focused on those who are extremely obese (BMI ≥40 kg/m2). In addition, most epidemiological studies only use a single measurement of BMI at baseline to predict risk of all-cause mortality, which may produce potential bias. The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2. (more…)
Author Interviews, Heart Disease / 11.11.2014

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016. Medical Research: What is the background for this study? What are the main findings? Dr. Bangalore: The evidence to support beta blocker use for patients with myocardial infarction stems from outdated studies performed in the era prior to modern reperfusion and modern medical therapy. It is not know if the mortality benefit of beta blockers for MI are seen in the modern era. Our data from randomized trials suggest a significant interaction between reperfusion era status and beta blocker benefit such that in the modern era beta blockers provide no mortality benefit when compared with controls. However, they are associated with short term (30-days) benefit for reduction in recurrent MI and angina but at the expense of increase in the risk of heart failure, cardiogenic shock and drug withdraw due to adverse events. The benefits were only short term (30-days). (more…)
Author Interviews, Heart Disease, Kidney Disease / 06.11.2014

MedicalResearch.com Interview with: Ning Tan, MD, PHD Senior Consultant Cardiologist. Department of Cardiology Guangdong Cardiovascular Institute Guangdong General Hospital Guangdong Academy of Medical Sciences Guangzhou, Guangdong, China Medical Research: What are the main findings of the study? Dr. Tan: In this study, we evaluated whether Low density lipoprotein cholesterol (LDL-C) is an independent risk factor of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 3236 consecutive patients undergoing PCI in our hospital and demonstrated that LDL-C is significantly and independently associated with CI-AKI in patients undergoing PCI. (more…)
AHA Journals, Author Interviews, Heart Disease / 05.11.2014

MedicalResearch.com Interview with: Dr. Bilal Iqbal MD Royal Brompton and Harefield NHS Foundation Trust Harefield Hospital Middlesex United Kingdom. Medical Research: What is the background for this study? What are the main findings? Dr. Iqbal: The optimal strategy for revascularization of bystander coronary disease at the time of PPCI is unknown. Certainly, this has been the focus of recent debate and randomized controlled trials. We evaluated a strategy of culprit vessel versus multivessel intervention at the time PPCI in the real world setting. We conducted an observational analysis of 3984 consecutive patients with STEMI undergoing Primary percutaneous coronary intervention (PPCI) who had multivessel disease. We excluded patients with cardiogenic shock and patients with bystander LMS disease, which may potentially dictate staged surgical intervention. When analysing all-cause mortality at 1 year, we found that a strategy of culprit vessel intervention only at the time of PPCI was associated with increased survival at 1 year. (more…)
Author Interviews, Heart Disease, JAMA / 05.11.2014

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART ProgramMedicalResearch.com Interview with: Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Maddox: Nonobstructive coronary artery disease (CAD) is atherosclerotic plaque that would not be expected to obstruct blood flow or result in anginal symptoms (such as chest pain). Although such lesions are relatively common, occurring in 10 percent to 25 percent of patients undergoing coronary angiography, their presence has been characterized as “insignificant” or “no significant CAD" in the medical literature.  However, this perception of nonobstructive coronary artery disease may be incorrect, because prior studies have noted that the majority of plaque ruptures and resultant myocardial infarctions (MIs; heart attacks) arise from nonobstructive plaques. Despite the prevalence of nonobstructive CAD identified by coronary angiography, little is known about its risk of adverse outcomes, according to background information in the article. During the study period, 37,674 patients underwent elective coronary angiography for indications related to CAD; of those, 22.3 percent had nonobstructive CAD and 55.4 percent had obstructive CAD.  Within 1 year, 845 patients died and 385 were rehospitalized for myocardial infarction. The researchers found that the 1-year myocardial infarction risk progressively increased by the extent of coronary artery disease, rather than abruptly increasing between nonobstructive and obstructive CAD.  Patients with nonobstructive CAD had an associated risk of MI that was 2-to 4.5-fold greater than among those with no apparent coronary artery disease. Similar observations were seen with 1-year mortality and the combined outcome of 1-year myocardial infarction and death. (more…)
Author Interviews, Heart Disease, JAMA, University of Pittsburgh / 04.11.2014

Yuting Zhang, Ph.D. Associate Professor and Director Pharmaceutical Economics Research Group University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management.MedicalResearch.com Interview with: Yuting Zhang, Ph.D. Associate Professor and Director Pharmaceutical Economics Research Group University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management. Medical Research: What are the main findings of the study? Dr. Zhang: Patients with atrial fibrillation who take the blood thinner dabigatran are at greater risk for major bleeding and gastrointestinal bleeding than those who take warfarin, indicating that greater caution is needed when prescribing dabigatran to certain high-risk patients. High-risk groups include those who are 75 and older; African Americans; those with chronic kidney disease; and those with seven or more co-existing medical problems. (more…)
Author Interviews, Diabetes, General Medicine, Heart Disease / 03.11.2014

MedicalResearch.com Interview with: Dr. Arnold Ng, MBBS, PhD Department of Cardiology Princess Alexandra Hospital University of Queensland, Australia Medical Research: What is the background for this study? What are the main findings? Dr. Arnold: The WHO and American Diabetes Association currently recommends the use of HbA1c >=6.5% as a diagnostic criterion for diabetes. HbA1c is advantageous over fasting plasma glucose and glucose tolerance testing by avoiding the need for patient fasting and inconvenient patient preparation. In addition, patients who are acutely unwell (e.g. STEMI) may develop stress hyperglycemia, complicating the diagnosis of diabetes. It is currently unclear if HbA1c (indicative of overall glycemic control) or fasting plasma glucose predicts worse left ventricular function after acute STEMI. The present study demonstrated that HbA1c identified approximately another 20% of previously undiagnosed patients as diabetic. Furthermore, the present study was first to demonstrate that HbA1c, not fasting plasma glucose, was independently associated with more impaired LV diastolic function and elevated filling pressures after STEMI. (more…)
Author Interviews, Heart Disease, Yale / 03.11.2014

MedicalResearch.com Interview with Dr. Sunny Jhamnani MD Clinical Fellow in Cardiology at Yale School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Jhamnani:  Lifestyle modifications are the crux of atherosclerotic disease management. However adherence to them is not adequate. Additionally, randomized controlled trials (RCTs) looking effects of diet and exercise on atherosclerotic disease progression have not been convincing. We did a systematic review and a meta-analysis of all RCTs looking at the effects of diet and exercise on coronary and carotid atherosclerotic disease progression. We found that , lifestyle modifications were associated with a decrease in coronary atherosclerotic burden in percent stenosis by -0.34 (95% CI: -0.48 to -0.21) standardized mean difference (SMD), with no significant publication bias and heterogeneity (p:0.21, I2:28.25). Similarly, in the carotids, there was a decrease in the carotid intimal medial thickness in mm by -0.21 (95% CI: -0.36 to -0.05) SMD and by -0.13 (95% CI: -0.25 to -0.02) SMD, before and after accounting for publication bias and heterogeneity (p:0.13, I2:39.91 and p:0.54, I2:0), respectively. (more…)
Author Interviews, Heart Disease, JACC, Lipids / 31.10.2014

Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public HealthMedicalResearch.com Interview with Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public Health Professor of Medicine Harvard Medical School Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Hu: There has been much confusion and sensational headlines about the role of different types of fat in coronary heart disease.  A recent meta-analysis suggested that higher saturated fat intake was not associated with coronary heart disease (CHD), but people don't consume saturated fat in isolation from other components of diet. Typically people swap for one type of fat for another. Therefore it is important to look at replacement nutrient when we talk about health effects of saturated fat. Randomized clinical trials have shown that replacing saturated fat with polyunsaturated fat reduces total and LDL cholesterol. Thus it is important to examine whether such replacement confers long-term beneficial effects on heart disease prevention. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the link between dietary intake of linoleic acid (the predominant type of polyunsaturated fat) and heart disease risk in generally healthy people. We identified 13 published and unpublished cohort studies with a total of 310,602 individuals and 12,479 total  coronary heart disease events including 5,882 CHD deaths. We found that dietary linoleic acid intake is inversely associated with  coronary heart disease risk in a dose-response manner—meaning, higher intake of linoleic acid resulted in a lower risk of CHD. Comparing the highest to the lowest level of consumption, dietary linoleic acid was associated with a 15% lower risk of  coronary heart disease events and a 21% lower risk of CHD deaths. These results were independent of common coronary heart disease risk factors such as smoking and other dietary factors such as fiber consumption. (more…)
Author Interviews, BMJ, General Medicine, Heart Disease / 30.10.2014

MedicalResearch.com Interview with: Anne Bellemain-Appaix Service de Cardiologie-La Fontonne Hospital, Antibes, France and Gilles Montalescot Professor of  Cardiology Institut de CardiologiePitié-Salpêtrière Hospital Université Paris 6, France ACTION Study Group, Paris, France Medical Research: What is the background for this study? Response: Pretreatment with P2Y12 inhibitors for Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) patients, although advised in current guidelines, has been recently questioned in term of benefit/risk ratio (no ischemic benefit and increase in major bleeding). We wanted to answer this question by giving enough power to results in a complete meta-analysis of studies comparing P2Y12 inhibitors pretreatment (defined as its administration before the coronary angiogram) to no pretreatment in NSTE-ACS. (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC / 29.10.2014

Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195MedicalResearch.com Interview with: W. H. Wilson Tang, MD FACC FAHA Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195 Medical Research: What are the main findings of the study? Dr. Tang: A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk. (more…)