MedicalResearch.com Interview with Esther Ooi & Børge G Nordestgaard, MD, DMSc
Professor, University of Copenhagen
Chief Physician, Herlev Hospital, Copenhagen University Hospital
Dept. Clinical Biochemistry Herlev Ringvej 75, DK-2730 Herlev, Denmark
Medical Research: What are the main findings of the study?Answer:Our findings suggest that low 25(OH)D levels observationally is simply a marker for elevated atherogenic lipoproteins, and thus question a role for vitamin D supplementation in the prevention of cardiovascular disease.
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MedicalResearch.com Interview with:Antonis Hatzopoulos, PhD, FAHA
Associate Professor of Medicine- Division of Cardiovascular Medicine
Associate Professor of Cell & Developmental Biology
Vanderbilt Center for Stem Cell Biology
Vanderbilt University
Nashville, TN 37232-6300
Medical Research: What are the main findings of the study?Dr. Hatzopoulos: Using cell tracking in the normal adult mouse heart, we found that endothelial cells can function as cardiac stem cells to generate new heart muscle. Our results show that besides heart muscle, endothelial cells produce quiescent and proliferating cardiac progenitor cells that reside in the media and adventitia layers of the coronary arteries, respectively.
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MedicalResearch.com Interview with Marco Perez, MD
Instructor in Cardiovascular Medicine
Director, Inherited Cardiac Arrhythmia Clinic
Stanford University Medical Center
Cardiac Electrophysiology & Arrhythmia Service
Stanford, CA 94305-5233
Medical Research: What are the main findings of the study?Dr. Perez: It was already known that obesity is an important risk factor for atrial fibrillation. We studied over 80,000 postmenopausal women enrolled in the Women’s Health Initiative who were followed for the onset of atrial fibrillation, an irregular heart rhythm associated with stroke and death. We found that those who exercised more than 9 MET-hours/week (equivalent to a brisk walk of 30 minutes six days a week) were 10% less likely to get atrial fibrillation than those who were sedentary. Importantly, the more obese the women were, the more they benefited from the exercise in terms of atrial fibrillation risk reduction.
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MedicalResearch.com Interview with: Gregg C. Fonarow, MD, FACC, FAHA
Eliot Corday Professor of Cardiovascular Medicine and Science
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Chief of Clinical Cardiology, UCLA Division of Cardiology
Co-Director, UCLA Preventative Cardiology Program
David Geffen School of Medicine at UCLA
Los Angeles, CA, 90095-1679
Medical Research: What are the main findings of the study?Dr. Fonarow: Drawing on data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), 15,177 heart failure patients were followed over two years to measure the benefits of implantable device therapy on survival in community practice settings. The study demonstrated that ICD device therapy reduced the likelihood of death during the two-year period by 36 percent, with no significant differences by race or ethnicity. The study also demonstrated a 45 percent reduction in mortality during the two-year period with CRT therapy, again without any significant differences device benefit by race or ethnicity.
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MedicalResearch.com Interview with: Prof. Michael d’Emden
Endocrine Research Unit
Royal Brisbane Hospital, Brisbane, Australia
Medical Research: What are the main findings of the study?Prof. d’Emden: Our study is the largest trial of women having type 2 diabetes assessing the role of a fibric acid derivative, in this case fenofibrate, ever conducted. There were 3657 female subjects randomized to placebo or fenofibrate. The study demonstrated greater reductions in women of total cholesterol, triglycerides and LDL-cholesterol and greater increases in HDL-cholesterol. In women, fenofibrate decreased total cardiovascular end-points by 30% compared with only 13% in men, although there was no-treatment-by-sex interaction. The majority of end points assessed revealed a consistent trend to increased benefit being seen in women.
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MedicalResearch.com Interview with:Sylvie S.L. Leung Yinko, RD MSc Epidemiology '14
Division of Clinical Epidemiology
Research Institute of McGill University Health Centre (RI MUHC)
Montreal (QC) H3A 1A1
Medical Research: What are the main findings of the study?Answer: Our study indicates that young female patients with premature acute coronary syndrome (ACS) have lower health-related quality of life (HRQL) than their male counterparts. Whereas “sex” refers to whether an individual is biologically male or female, “gender” is a more complex term that refers to social norms, roles, and expectations that are traditionally ascribed to males and females in a society. We found that gender, rather than sex, may larger explain the differences in health-related quality of life between men and women. Particularly, higher femininity score, lower social support and greater housework responsibilities appear to be important gender-related factors linked with poorer HRQL post-ACS.
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MedicalResearch.com Interview with: Ryan T. Borne MD
University of Colorado Anschutz Medical Campus
Division of Cardiology
Aurora, CO 80045
Medical Research: What are the main findings of the study?Dr. Borne: Using the NCDR ICD Registry, we identified Medicare beneficiaries aged 65 years and older with low left ventricular ejection fraction (≤ 35%) who underwent primary prevention implantable cardioverter defibrillator implantation, including those receiving cardiac resynchronization therapy with defibrillator, between 2006 and 2010 who could be matched to Medicare claims. We found that while there were modest changes in the patient characteristics undergoing ICD implantation, there were significant improvements over time in mid-term outcomes including 6-month mortality, re-hospitalization, and device-related complications.
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MedicalResearch.com Interview with:Hurst M. Hall, MD and Sandeep Das, MD, MPH
Division of Cardiology
University of Texas Southwestern Medical Center
Dallas, TX
Medical Research: What are the main findings of the study?Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day. This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns.
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MedicalResearch.com Interview with:Dr. Juhani Airaksinen, MD, PhD
Heart Center, Turku University Hospital
Turku, Finland
Medical Research: What are the main findings of the study?Dr. Airaksinen: The main result of our study is that the risk of thromboembolic complications in general was low (0.7%). However the risk rose to a 3.7-fold level when the delay to cardioversion exceeded 12 hours. The time-dependent increase in the risk of thromboembolic complications was more pronounced in female patients. In addition, as expected, old age, heart failure and diabetes were the other significant predictors of postcardioversion thromboembolic complications.
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MedicalResearch.com Interview with: Susan Cheng MD
Cardiovascular Division, Brigham and Women's Hospital
Boston, MA 02115
Medical Research: What are the main findings of the study?Dr. Cheng: We've known for some time that smoking, high cholesterol, high blood pressure, diabetes, and obesity all contribute to a person’s risk of being at risk for heart disease. The goal of our study was to look back over the last two decades and see how we've been doing in reducing the impact of these major cardiovascular risk factors on the actual risk for developing heart and vascular disease. We found that, not surprisingly, we've been doing generally better over time at lowering the overall impact of some risk factors such as smoking and high cholesterol. On the other hand, the impact of hypertension and diabetes has been high and has remained high over time.
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MedicalResearch.com Interview with: Professeur Philippe Gabriel Steg
Département de Cardiologie
Hôpital Bichat, Assistance Publique - Hôpitaux de Paris
Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
Medical Research: What are the main findings of this study?Prof. Philippe Steg:
Due to increasing use of angiography and revascularization, as well as improved drug therapy, the prevalence of angina and ischemia has diminished.
Most of the events (Cardiovascular death or Myocardial Infarction) occur in patients without angina or ischemia. This is very novel and important and stresses the importance of proper secondary prevention over "testing". We cannot be reassured by having a negative test for angina and ischemia.
Additionally, angina appears associated with a consistently greater risk than ischemia alone (having both is worse), so we need to pay attention to angina as a dire prognostic marker.
Findings should be no different in the US.
Most studies of silent ischemia antedate the advent of modern effective therapies or used very liberal definitions for "silent ischemia". (see our discussion)
MedicalResearch.com Interview with: Sahil Khera, MD and Dhaval Kolte, MD, PhD
Department of Medicine, Division of Cardiology
New York Medical College, NY
Medical Research: What are the main findings of the study?Answer: We used the publicly available Nationwide Inpatient Sample (NIS) databases for our study. We analyzed data on 6.5 million patients with heart attack (all types) from 2002 to 2011 in United States. Out of these 3.98 million were admitted with a diagnosis of non-ST elevation myocardial infarction (NSTEMI). Our objective was to describe how the care for patients with NSTEMI has changed over the past 10 years and whether this has resulted in better patient outcomes. We looked at the proportion of patients with NSTEMI who underwent cardiac catheterization each year. We also studied how many patients died in the hospital, how long was the hospital stay, and what was the total cost of hospitalization for this condition. Lastly, we determined if the changes in treatment and outcomes over the years were similar for different age- groups, men and women, and for different racial/ethnic groups.
In this analysis, we looked at cardiac catheterization trends after NSTEMI for both within 24 hours and within 48 hours. This is the first study of its kind to analyze two different time frames of early catheterization simultaneously. Although there was an increase in the proportion of patients with NSTEMI with increase in utilization of early cardiac catheterization and decrease in in-hospital death and length of stay, age-, sex-, and race/ethnicity-specific differences in the management and outcomes of NSTEMI were observed, and further studies are needed to develop strategies to ensure more equitable care for patients with this type of heart attack. (more…)
MedicalResearch.com Interview with: Rakesh K. Mishra, MD
San Francisco Veterans Affairs Medical Center
San Francisco, CA 94121.
Medical Research: What are the main findings of the study?Dr. Mishra: Increased levels of both BNP and NT-proBNP are associated with elevated risk of adverse cardiovascular events in patients with stable coronary artery disease. However, when added to existing clinical models of risk, NT-proBNP is superior to BNP for risk reclassification.
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MedicalResearch Interview with: Maurizio Gasparini MD
Humanitas Research Hospital
Rozzano, Italy
Medical Research: What are the main findings of the study?Dr. Gasparini: We found that a strategic programming of implantable cardioverter defibrillators which allows the non-sustained arrhythmias to self-terminate is associated with reductions in hospitalizations, length of hospital stay and cost per patient-year and an increase in the time to first hospitalization. These results were mainly driven by reduction in cardiovascular-related events.
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MedicalResearch.com Interview with: S. Mitchell Harman, M.D., Ph.D.
CAPT US Public Health Service, retired
Professor, Clinical Medicine, U of AZ College of Medicine
Interim Chief, Dept. of Internal Medicine
Chair, IRB Subcommitee
Phoenix VA Health Care System
Phoenix, AZ 85012-1892
Medical Research: What are the main findings of the study?Dr. Harman: The major findings are:
1. Neither transdermal nor oral estrogen treatment significantly accelerates or decelerates rate of change of carotid artery intimal medial thickness (CIMT) in healthy recently menopausal women.
2. Both estrogen treatments have some potentially beneficial effects on markers of CVD risk, but these differ depending on the route of estrogen delivery with improvements in LDL and HDL cholesterol seen with oral, and reduced insulin resistance with transdermal.
3. No significant effects were observed on rate of accumulation of coronary artery calcium.
4. Women reported significant relief of vasomotor (hot flush) symptoms with both estrogen treatments
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MedicalResearch.com Interview InvitationProf. Frank B HuDepartment of Nutrition
Department of Epidemiology
Harvard School of Public Health
Medical Research: What are the main findings of the study?Prof. Hu:We found that increasing consumption of fruits and vegetables is associated with reduced risk of mortality, especially cardiovascular mortality. The largest reduction in mortality can be achieved at 5 servings per day of fruits and vegetables.
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MedicalResearch.com: Interview with:Gabriel Arefalk
Department of Medical Sciences
Uppsala University Hospital
Uppsala, Sweden
Medical Research: What are the main findings of the study?Answer: In this prospective cohort study, we investigated mortality risk in 2474 smokeless tobacco users who had been hospitalized for a myocardial infarction between the years of 2005-2009 in Sweden. We used a nationwide quality register and database called SWEDEHEART and found that those who stopped using snus (the Swedish type of snuff) after their MI had half the risk of dying during follow up relative to those who continued to use snus. This association, which was of the same magnitude as for smoking cessation, seemed to be independent of age, gender and smoking habits, as well as of many other relevant covariates.
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MedicalResearch.com Interview with: Dr. Danny Dvir MD
St Paul’s Hospital, Vancouver
British Columbia, Canada
Medical Research: Who were the patients studied?Dr. Dvir: The VIVID registry included high-risk patients with failed aortic bioprostheses treated with valve-in-valve. These patients had many comorbidities and high risk scores for early mortality with conventional redo surgery.
Medical Research: What are the treatment options for these patients?Dr. Dvir: Patients with failed bioprosthetic valves are conventionally treated with redo surgery. Transcatheter valve-in-valve is a less-invasive approach.
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MedicalResearch.com Interview Invitation Dr. Eileen Hsich MD
Director of the Women’s Heart Failure Clinic
Associate Medical Director for the Heart Transplant Program
Cleveland Clinic, Cleveland, Ohio
Medical Research: What are the main findings of the study?Dr. Hsich:Women are dying on the heart transplant waiting list at a faster rate than men for almost a decade (see Figure 1) and few studies have even addressed this problem. The occurrence is largely driven by gender differences in survival at the most urgent status (UNOS Status 1A) but the cause remains unclear. Although data is limited our findings raise concern that women are not successfully bridged to transplantation while they remain at high status and are inactivated due to worsening condition.
Figure 1. Scientific Registry of Transplant Recipients: Mortality on Waiting List For Heart Transplantation
Figure derived from table in Scientific registry of transplant recipients: Heart waiting list by gender 2000-2009. Available at:
Http://srtr.Transplant.Hrsa.Gov/annual_reports/2010/1103_can-gender_hr.Htm
accessed january 9, 2014.(more…)
MedicalResearch.com Interview with:
Reza Robati, MD
Associate Professor of Dermatology
Deputy editor, Iranian Journal of Dermatology
Skin Research Center, Shahid Beheshti University of Medical Sciences
Tehran, Iran
Medical Research: What are the main findings of the study?Dr. Robati: In our study, increased levels of serum leptin and resistin and increased intima-media wall thickness of common carotid artery were observed in 60 psoriasis patients in comparison with 60 healthy controls. Moreover, we found positive correlation between these variables in psoriasis patients.
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MedicalResearch.com Interview with:
Donna Parker, Sc.D., FAHA
Director of Community Health and Research
Center for Primary Care and Prevention
Memorial Hospital of RI
Pawtucket, RI 02860
MedicalResearch: What are the main findings of the study?Answer: The main findings of the study are that women with a history of one or more miscarriages or one or more stillbirths appear to be at increased risk of cardiovascular disease. We found that the multivariable adjusted odds ratio for coronary heart disease for one or more stillbirths was 1.27 (95 percent CI, 1.07-1.51) compared with no stillbirth; for women with a history of one miscarriage, the odds ratio was 1.19 (95 percent CI, 1.08-1.32); and for women with a history of two or more miscarriages, the odds ratio was 1.18 (95 percent CI, 1.04-1.34) compared with no miscarriage. However, we did not find a significant association of ischemic stroke and pregnancy loss. The association between pregnancy loss and CHD appeared to be independent of hypertension, body mass index, waist-to-hip ratio and white blood cell count.
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MedicalResearch.com Interview with:
Aakriti Gupta, MD, MBBS
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital,
New Haven, Connecticut
Medical Research: What were the main findings?
Dr. Gupta: Using a national database, we found that heart attack hospitalization rates for patients under the age of 55 have not declined in the past decade while their Medicare-age counterparts have seen a 20 percent drop.
We also found that among younger patients below 55 years of age, women fare worse because they have longer hospital stays, and are more likely to die in the hospital after a heart attack. Young women were also more likely to have higher prevalence of co-existing medical conditions including diabetes, high blood pressure and higher cholesterol levels. Overall, all patient groups in the study saw increases in these conditions including diabetes and high blood pressure in the past decade.
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MedicalResearch.com Interview with:Kanako K. Kumamaru, MD PhD
Assistant Professor, Departments of Radiology
Brigham and Women’s Hospital & Harvard Medical School
Boston, MA 02115
Medical Research: What are the main findings of the study?Dr. Kumamaru: When a patient does not have diabetes and had no or ≤25% coronary stenosis in his/her previous coronary CT angiography (CCTA) performed within 3 years, the probability of newly developed coronary artery disease (CAD) is very low, suggesting no repeat CCTA necessary, even if the clinical scenario suggested CCTA to be appropriate. Especially, when coronary arteries were completely normal at the prior scan, no patient underwent subsequent revascularization during the study period.
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MedicalResearch.com Interview with:Lisa A. McDonnell
Program Manager, Prevention & Wellness Centre,
Division of Prevention and Rehabilitation,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Medical Research: What are the main findings of the study?
Answer:The analysis focuses on a comparison of women’s perceptions of their heart disease knowledge and heart health risk with their self‐reported knowledge and heart health risk status. In summary, it gives insight into the Perceptions vs Reality when it comes to women and their heart health.
Heart disease knowledge:
For the purposes of measuring knowledge related to heart health, a scoring index was created on which women responding to the survey could score as low as 0 or as high as 40. The overall mean score among women in the survey was 15.0, which is fairly modest given the maximum of 40. In a comparison of actual and perceived heart disease knowledge, 80% of respondents with a low knowledge score perceived that they were moderately or well informed.
The risk factors that Canadian women most commonly associate with heart disease are being overweight/having abdominal obesity (ov/ob), physical inactivity, smoking, and lacking fruits/vegetables. Smoking, diabetes and high blood pressure account for up to 53% of MI’s, followed by Ov/Ob, psychosocial factors, a lack of physical activity, and a lack of fruits/vegetables. The limited awareness of high blood pressure, high cholesterol and diabetes as key risk factors is particularly surprising, given that these are key determinants of heart disease.
Low awareness of symptomology among women in our survey were noted when comparing the occurrence of symptoms versus their recognition of these symptoms as possibly being related to their heart. Only 4 in 10 women could name chest pain as a symptom of heart disease, and a smaller proportion could identify symptoms including dyspnea, radiating pain, or typical prodromal symptoms. Such shortcomings might contribute to the greater number of unrecognized myocardial infarctions in women than in men, not to mention inappropriate treatment of acute events and premature discharge from emergency care.
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MedicalResearch.com Interview with: Cheol Whan Lee andSeung-Jung Park
Division of Cardiology, Asan Medical Center,
University of Ulsan
Seoul, Korea
Medical Research: What are the main findings of the study?Answer: The time window of DES (drug-eluting stent) failure is widely variable from soon after DES implantation to several years after DES implantation. We observed patients with late DES failure are commonly presented with acute coronary syndrome. We hypothesized that temporal patterns of DES failure may be different, and analyzed all patients with first DES failure at our institution. We found that late drug-eluting stent failure is more likely to progress to acute myocardial infarction, aggressive angiographic patterns, and worse outcomes following retreatment.
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MedicalResearch.com Interview with: Dr inz. Joanna Kaluza
Department of Human Nutrition
Warsaw University of Life Sciences - SGGW
Warsaw POLAND
Medical Research: What are the main findings of the study?Response: The most important finding of my study is the fact that processed red meat consumption, but not unprocessed red meat, increases a risk of Heart Failure incidence and Heart Failure mortality.
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MedicalResearch.com Interview with:Professor Jane Armitage
Professor of Clinical Trials and Epidemiology
Clinical Trial Service Unit, Oxford Cardiovascular Science
Oxford, United Kingdom
Medical Research: What are the main findings of the study?Prof. Armitage: The study showed that adding extended release niacin with laropiprant (to reduce the flushing) to standard treatment including statins in people with heart disease or strokes did not improve their outcome or reduce the risk of recurrent heart attacks or strokes.
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MedicalResearch.com Interview with: Dr Alex Dregan
Lecturer in Translational Epidemiology and Public Health,
Division of Primary Care and Public Health Research
King's College London, London
Medical Research: What are the main findings of the study?
Dr. Dregan: Our study showed that chronic inflammation was associated with increased risk of developing cardiovascular disease, specifically type II diabetes and coronary heart disease. The risk of cardiovascular disease increased with the severity of inflammatory disorders. In addition, inflammation also increased the risk of multiple morbidity (two or more cardiovascular diseases).
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MedicalResearch.com Interview with: Jeff Trost, MD
Assistant Professor of Medicine
Johns Hopkins Medicine
Medical Research: What are the main findings of the study?
Dr. Trost: In our study, we reported the use of two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges.
Specifically, we
1) Provided information and education to physicians about proven testing guidelines and
2) Made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, our intervention led to an estimated $1.25 million reduction in laboratory charges.
MedicalResearch.com Interview with: Anthony Bavry, MD MPH
Interventional Cardiology, North Florida/South Georgia Veterans Health System
Associate Professor of Medicine, University of Florida
Gainesville, FL 32610
Medical Research: What are the main findings of the study?Dr. Bavry:
1) Among post-menopausal women, the regular use of NSAIDs was associated with an increased risk of cardiovascular death, myocardial infarction, or stroke.
2) Cardiovascular risk was observed among users of celecoxib, naproxen, but not ibuprofen.
(more…)
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