30 Dec COVID-19 and Heart Attacks: Role of Neutrophil Extracellular Traps in Coronary Clots
Posted at 01:42h
in Author Interviews, Clots - Coagulation, COVID -19 Coronavirus, Heart Disease, JAMA
MedicalResearch.com Interview with:
Ana Blasco, MD, PhD
Cardiology Department,
Hospital Universitario Puerta de Hierro–Majadahonda
Madrid, Spain
MedicalResearch.com: What is the background for this study?
Response: Our group has been investigating issues related to coronary thrombosis in patients with acute myocardial infarction for years. Recently, we developed a standardized technique for the detection and quantification of extracellular neutrophil networks (NETs) in coronary thrombi. During the first wave of the COVID-19 pandemic in Madrid, Spain, we had some cases of myocardial infarctions with ST elevation and a large thrombotic component among patients with severe SARS-CoV-2 infection.
Given the important participation of NETs in severe COVID-19 disease, causing occlusion of microvessels as shown in pulmonary samples, we decided to analyze their role in coronary thrombi. Thanks to similar previous analyzes in patients without COVID-19, we have been able to compare our results with a historical series.
Dr. Flaherty[/caption]
Michael R. Flaherty, DO
Attending, Pediatric Critical Care Medicine
Co-Director, Trauma and Injury Prevention Outreach Program, MGH
Instructor in Pediatrics,
Harvard Medical School
Boston, MA 02114
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study was a joint collaboration between Massachusetts General Hospital and Boston Children’s Hospital. The Consumer Product Safety Commission (CPSC) found an increasing incidence of rare earth magnet ingestions by children causing serious injury; Injuries are particularly serious when a child ingests two of these small magnets, or a magnet with another metal object – this can lead to bowel walls becoming attached and kinked, leading to catastrophic bowel injury and/or death.
The Consumer Product Safety Commission initiated campaigns to limit sales in 2012 with voluntary recalls and safety standards, as well as public awareness campaigns, legislative advocacy, and lawsuits. In October 2014, the CPSC published their final rule, “Safety Standard for Magnet Sets,” which prohibited the sale of magnets based on a pre-specified size and power scale, essentially eliminating the ability to sell SREMs. This rule was appealed by largest manufacturer of these magnets, Zen Magnets, LLC., and in November 2016 this rule was legally reversed by the U.S. Court of Appeals Tenth Circuit resulting in a resurgence of these magnets on the market. 
Dr. Kubik[/caption]
Martha Kubik, Ph.D., R.N.
Professor and director of the School of Nursing
College of Health and Human Services at George Mason University
USPSTF Task Force Member
MedicalResearch.com: What is the background for this study? What are the main findings? Has the recommendation changed over the last decade?
Response: High blood pressure is becoming more common among children and teens in the United States and can have serious negative health effects in childhood and adulthood, such as kidney and heart disease. However, there is not enough research to know whether treating high blood pressure in young people improves cardiovascular health in adulthood.
The Task Force continued to find that there is not enough evidence to recommend for or against screening for high blood pressure in children and teens who do not have signs or symptoms. 
Dr. Bayes-Genis[/caption]
Antoni Bayes-Genis, MD, PhD, FESC, FHFA
Head, Heart Institute. Hospital Universitari Germans Trias i Pujol
Full Professor, Autonomous University Barcelona
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Omega-3 fatty acids are incorporated into the phospholipids of cellular membranes, including cardiac contractile cells, and have a wide range of demonstrated physiological effects. Several potential mechanisms have been investigated, including antiarrhythmic, anti-inflammatory, and endothelial.
Omega-3 fatty acids lower heart rate and improve heart rate variability, both associated with lower sudden cardiac death risk, one of the complications that may occur after a myocardial infarction.
Increased omega-3 fatty acids also enhance arterial elasticity by increasing endothelium-derived vasodilators, which is associated with blood pressure–lowering effects.
They also have a cardioprotective effect on platelet-monocyte aggregation, and lower triglyceride levels. 
Dr. Mahncke[/caption]
MedicalResearch.com: What is heart failure?
Response: Heart failure – sometimes called congestive heart failure or congestive cardiac failure – is when the heart cannot pump sufficient blood flow to maintain the body’s needs. Common symptoms include excessive tiredness, shortness of breath and swelling particularly in legs. It’s treated with a combination of lifestyle changes, drugs, and devices. An estimated 6.5 million Americans are diagnosed with heart failure, with 960,000 new cases each year, leading some to describe it as reaching epidemic proportions. In older adults, it’s the most common cause of hospital readmissions within 30 days of discharge and among the most costly areas of Medicare expenditures.
Dr. Kriner[/caption]
Douglas L. Kriner, PhD
The Clinton Rossiter Professor in American Institutions
Department of Government
Cornell University
MedicalResearch.com: What is the background for this study?
Response: When a safe and effective vaccine for COVID-19 reaches the market, the world will not change overnight. Rather, government and public health individuals will have to develop a comprehensive plan to distribute the vaccine and to convince potentially wary Americans to take it.
Our study examined the influence of both specific vaccine characteristics and the politics surrounding it on public willingness to vaccinate. Both matter in important ways. For example, efficacy is unsurprisingly a major driver of public opinion; Americans are more willing to take a vaccine that is more efficacious.
Dr. Al Rafai[/caption]
Mahmoud Al Rifai MD MPH
Section of Cardiology, Department of Medicine
Baylor College of Medicine Houston
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Dr. Virani[/caption]
Salim S. Virani, MD, PhD
Section of Cardiology
Michael E. DeBakey Veterans Affairs Medical Center
Section of Cardiology, Department of Medicine
Baylor College of Medicine Houston
MedicalResearch.com: What is the background for this study?
Response: E-cigarettes typically cost more than combustible cigarettes and there is more variability in cost due to a wide variety of flavors, e-cigarette liquid, and vaping device that are available in the market. Therefore, use of e-cigarettes may vary depending on income with potentially higher use among higher income individuals. 
Salim S. Virani, MD, PhD, FACC, FAHA, FASPC
Professor, Section of Cardiovascular Research
Director, Cardiology Fellowship Training Program
Baylor College of Medicine
Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center
Co-Director, VA Advanced Fellowship in Health Services Research & Development at the Michael E. DeBakey VA Medical Center, Houston, TX
Investigator, Health Policy, Quality and Informatics Program
Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation
Houston, TX @virani_md
MedicalResearch.com: What is the background for this study? What are the main findings? What do you think accounts for the gender differences?
Response: We know that women with ischemic heart disease (IHD) have lower prescription rates for statin and high-intensity statin therapy. In this study, we assessed whether the same trends hold true for women with other forms of atherosclerotic cardiovascular disease (ASCVD) i.e. women with peripheral artery disease (PAD) or ischemic cerebrovascular disease (ICVD). Maximally tolerated statin therapy is a Class-I indication in patients with clinical ASCVD which includes PAD and ICVD.
We also assessed statin adherence among men and women with PAD and ICVD.
Lastly, we performed exploratory analyses to assess whether statin therapy, statin intensity, and statin adherence in women with PAD and ICVD were associated with cardiovascular outcomes and/or mortality. 
