Author Interviews, Gastrointestinal Disease, Heart Disease / 20.08.2013

MedicalResearch.com Interview with: John P. Cooke MD PhD Chair, Department of Cardiovascular Sciences Director, Center for Cardiovascular Regeneration Houston Methodist Research Institute 6670 Bertner St MS: R6-414, Houston, TX 77030John P. Cooke MD PhD Chair, Department of Cardiovascular Sciences Director, Center for Cardiovascular Regeneration Houston Methodist Research Institute 6670 Bertner St MS:  R6-414, Houston, TX 77030   MedicalResearch.com: What are the main findings of the study? Answer: We discovered that the proton pump inhibitors PPIs), as a class, impair vascular relaxation.  The PPIs have this effect by suppressing the activity of a key enzyme required for cardiovascular health. The enzyme is known as DDAH (for dimethylarginine dimethylaminohydrolase).  This enzyme is critical in clearing ADMA (asymmetric dimethylarginine) from tissues and the circulation.  Because ADMA is an endogenous inhibitor of nitric oxide synthase, accumulation of ADMA impairs vascular relaxation and vascular homeostasis.   Previously, we and others have found that, by inhibiting endothelium-derived nitric oxide, ADMA accelerates vascular disease in preclinical models.  In humans, ADMA is linked to the severity of vascular disease, and is an independent risk factor for major adverse cardiovascular events (MACE).  Thus, the effect of PPIs to inhibit DDAH would be anticipated to impair cardiovascular health, and to increase the risk of MACE. (more…)
Author Interviews, Heart Disease / 18.08.2013

MedicalResearch.com: Orly Vardeny, PharmD, MS Associate Professor of Pharmacy and Medicine University of Wisconsin-Madison MedicalResearch.com What are the main findings of the study? Answer: We performed a post-hoc analysis of the RALES study to assess rates of hyperkalemia and hypokalemia among African American (AA) and non-AA study participants, and examined clinical outcomes by race. We found that AA had less overall increases in potassium compared to non-AA, and exhibited less hyperkalemia with spironolactone. AA subjects were also found to have higher rates of hypokalemia, even among those randomized to spironolactone. Moreover, AA participants appeared to derive less clinical benefit from spironolactone. While non-AA demonstrated reduced risk for death and the combined endpoint of death or heart failure hospitalizations when randomized to spironolactone, African Americans did not derive benefit, and the risk of these outcomes were not different between spironolactone and placebo among AA. (more…)
Author Interviews, General Medicine, Heart Disease, Mayo Clinic, Surgical Research / 16.08.2013

MedicalResearch.com Interview with: Rakesh M. Suri MD, D.Phil. Mayo Clinic College of Medicine, Rochester, Minnesota MedicalResearch.com: What might clinicians “take home” from this study? Answers: a. The contemporary outcomes of surgical correction of mitral regurgitation are excellent based upon results observed in this large multinational, multi-institutional study, Mitral valve surgery now has a low peri-operative risk of death or complications, and a very high likelihood of saving a patient’s own heart valve (>90% - repair); thereby avoiding the need for replacement with an artificial valve substitute. b. All patients with severe degenerative mitral regurgitation are at risk for heart failure and/or death when surgical correction is delayed.  A safe period of “watchful waiting” in those with severe mitral regurgitation due to flail leaflets, even in the absence of traditional Class I triggers for surgery (symptoms or left ventricular dilation/dysfunction) does not exist. c. Prompt mitral valve surgery within months following the diagnosis of severe degenerative mitral regurgitation, even in those without symptoms, is associated with important and sustained long term benefits including a 40% decrease in death and 60% less heart failure risk, sustained many years following surgical intervention (more…)
Author Interviews, Diabetes, Heart Disease, Nature / 13.08.2013

MedicalResearch.com Interview with: Tina Costacou, Ph.D. Assistant Professor of Epidemiology University of Pittsburgh MedicalResearch.com: What are the main findings of the study? Answer: The generation of reactive oxygen species is a natural and essential feature of human physiology, although excess production of free radicals has been related to the development and progression of diabetes complications. Simply put, a “balance” is required between the pro- and the anti-oxidant forces to maintain good health. Our aim in this study of people with type 1 diabetes was to evaluate whether an individual’s antioxidant vitamin levels in blood can modify the heart disease risk conferred by increased oxidative stress. Indeed, we observed that higher concentrations of α-tocopherol (a form of vitamin E) in blood overtime were related to lower risk of developing coronary heart disease, whereas greater oxidative stress (as measured by urinary 15-isoprostane F2t) was related to greater risk of disease. Interestingly, the ratio of α-tocopherol to urinary 15-isoprostane F2t, which we used as a measure of an individual’s ability to respond to / counteract oxidative stress, also was a strong predictor of subsequent coronary heart disease development. Our findings thus point to a different way of assessing a person’s risk for developing disease. Currently in clinical practice, physicians assess an individual’s risk factors (e.g. oxidative stress) for a pathologic condition (e.g. heart disease) to make inferences about the person’s risk to develop this condition and take preventive measures if needed (e.g. assign a treatment regimen). Our findings, however, suggest that an individual’s risk for disease may be better evaluated by simultaneously assessing factors representing the risk and those representing protection from or resistance to the risk. Thus, though two individuals may have similarly high levels of oxidative stress, there may be differences in the concentration of antioxidant vitamins between the two (and vice versa), which may put them at different risk categories, with one person potentially requiring vitamin supplementation while the second not needing to use supplements. (more…)
Author Interviews, Biomarkers, Diabetes, Heart Disease, Vitamin K / 12.08.2013

MedicalResearch.com Interview with: Gerdien Dalmeijer Postdoc | Julius Centrum | Universitair Medisch Centrum Utrecht Kamernummer STR. 6.119 | Huispostnummer STR. 6.131 | Postbus 85500| 3508GA UTRECHT MedicalResearch.com: What are the main findings of the study? Answer: The main findings of our prospective study among type 2 diabetes patients show that high circulating desphospho-uncarboxylated matrix Gla protein (dp-ucMGP) concentrations, reflecting a poor vitamin K status, are associated with increased cardiovascular disease risk, especially with peripheral arterial disease and heart failure. These results suggest that a poor vitamin K status is associated with increased cardiovascular disease risk. MedicalResearch.com: Were any of the findings unexpected? Answer: To our knowledge, this is the first study investigating the association of circulating MGP species with the risk of cardiovascular events; thus far only the association between dp-ucMGP and calcification has been investigated. Several studies but not all have shown that high dp-ucMGP concentrations are associated with increased calcification. We now extend these findings by showing the high circulating dp-ucMGP concentration is also associated with increased CVD risk, especially with peripheral arterial disease and heart failure. (more…)
Annals Thoracic Surgery, Author Interviews, Heart Disease, Transplantation, Vanderbilt / 12.08.2013

Simon Maltais MD PhD Vanderbilt University Medical Center Division of Cardiovascular Surgery 1215 21st Ave S, MCE 5th Flr Nashville, TN 37232-8808.MedicalResearch.com Interview with: Simon Maltais MD PhD Vanderbilt University Medical Center Division of Cardiovascular Surgery 1215 21st Ave S, MCE 5th Flr Nashville, TN 37232-8808. MedicalResearch.com: What did your study evaluate and why is this important? Answer: We performed a rigorous, retrospective review of the Scientific Registry of Transplant Recipients (SRTR) data base to evaluate donor, recipient, and technical characteristics associated with graft survival in patients undergoing mechanical circulatory support (MCS) device explantation at the time of heart transplantation surgery. Donor and recipient characteristics has been well described in the medical literature for routine heart transplantation, however these characteristics in patients who were supported with a long term MCS device at the time of heart transplant was not known.  Additionally, due to chronic donor heart shortages, an increasing number of patients with advanced heart failure are being bridged with MSC devices until a suitable donor heart can be obtained. (more…)
Annals Thoracic Surgery, Author Interviews, Heart Disease, Pulmonary Disease / 07.08.2013

MedicalResearch.com Interview with: Hossein Almassi, MD Professor, Cardiothoracic Surgery Medical College of Wisconsin and Zablocki VA Medical Center Milwaukee, Wi, 53226 MedicalResearch.com: What are the main findings of the study? Answer: The main findings of this study were that off-pump coronary bypass grafting did not have a positive differential impact on outcome of patients with COPD as compared to the standard operation performed on cardiopulmonary bypass. (more…)
Author Interviews, Heart Disease, Long Term Care / 06.08.2013

MedicalResearch.com Interview with: Dr. James R. Edgerton, MD Cardiopulmonary Research Science and Technology Institute, Dallas, Texas MedicalResearch.com: What are the main findings of the study?   Dr. Edgerton: We can use certain patient factors to determine if a patient will be discharged to extended care facility and to predict if he/she will be successfully discharged from that facility to home. (more…)
Author Interviews, Erasmus, Heart Disease, Tobacco Research / 03.08.2013

MedicalResearch.com Interview with: Dr. R.T. van Domburg Clinical epidemiologist, Associate Professor Erasmus Medical Center Department of Cardiology Ba561 ‘s-Gravendijkwal 230 3015 CE Rotterdam MedicalResearch.com: What are the main findings of your study? Answer: We collected data from the first patients who underwent coronary angioplasty in the early 1980s and followed them for 25 to 30 years. We found that patients who were able to quit smoking in the year following their PCI lived on average more than two years longer than those who continued to smoke. (more…)
Author Interviews, Heart Disease, Radiology / 31.07.2013

Hybrid PET/MR Imaging of the Heart: Feasibility and Initial Results Felix Nensa, MD Department of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany; MedicalResearch.com: What are the main findings of the study? Dr. Nensa: Cardiac positron emission tomography (PET)/magnetic resonance imaging (MRI) with fluorine 18 fluorodeoxyglucose (FDG) turned out to be feasible with an integrated whole-body 3-Tesla PET/MRI system. Despite the presence of a PET detector in the magnetic field of the MR imaging unit, high-quality cardiac MR images were acquired. PET images originating from a PET/CT and the PET/MR scanner showed very good visual agreement and no statistical significant difference of the mean was found in standardized uptake values, however, variance was considerable. In patients with myocardial infarction, PET and MR images were in good concordance regarding both, cine imaging and late gadolinium-enhanced imaging. (more…)
Author Interviews, Heart Disease, JAMA, Kidney Stones / 27.07.2013

Dr. Pietro Manuel Ferraro Division of Nephrology–Renal Program, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli Hospital, Rome, ItalyMedicalResearch.com Interview with Dr. Pietro Manuel Ferraro Division of Nephrology–Renal Program, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli Hospital, Rome, Italy MedicalResearch.com: What are the main findings of the study? Dr. Ferraro: We analyzed three large cohorts over time to see if those with prevalent or incident kidney stones might have a higher risk of developing coronary heart disease (fatal or non fatal myocardial infarction or the need for coronary revascularization). The cohorts consisted of over 200,000 participants without any prior history of coronary heart disease. After a median follow-up of over 8 years, we observed that women affected with stones seem to have a greater risk of developing coronary heart disease independent of a number of other known cardiovascular risk factors such as diabetes or high blood pressure. We did not observe a significant association among men. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Radiology, UT Southwestern / 24.07.2013

Susan Matulevicius, MD, MSCS Department of Medicine, The University of Texas Southwestern Medical Center, DallasMedicalResearch.com Interview with: Susan Matulevicius, MD, MSCS Department of Medicine, The University of Texas Southwestern Medical Center, Dallas MedicalResearch.com: What are the main findings of the study? Dr. Matulevicius: In our cohort of 535 transthoracic echocardiograms performed at a single academic medical center, we found that the majority (92%) of echocardiograms were appropriate by the 2011 Appropriate Use Criteria; however, only 1 in 3 echocardiograms lead to an active change in patient care while 1 in 5 resulted in no appreciable change in patient care. (more…)
Author Interviews, Heart Disease, OBGYNE / 18.07.2013

MedicalResearch.com Interview with Prof. Eyal Sheiner MD PhD Senior Obstetrician

Soroka Medical Center, Israel

MedicalResearch.com: What are the main findings of the study? Dr. Sheiner: The study was aimed to investigate whether a history of preterm delivery (PTD) poses a risk for subsequent maternal long-term cardiovascular morbidity. During the study period 47,908 women met the inclusion criteria; 12.5% (n=5992) patients delivered preterm. During a follow-up period of more than ten years, patients with PTD had higher rates of simple as well as complex cardiovascular events and higher rate of total cardiovascular related hospitalizations. A linear association was found between the number of previous PTD and future risk for cardiovascular hospitalizations (5.5% for two or more PTD, 5.0% for one PTD vs. 3.5% in the comparison group; P<0.001). The association remained significant for spontaneous vs. induced PTD and for early (<34 weeks) as well as late (34-36+6 weeks) PTD. In a Cox proportional hazards model that adjusted for pregnancy confounders such as labor induction, diabetes mellitus, preeclampsia and obesity, PTD was independently associated with cardiovascular hospitalizations (adjusted HR 1.4, 95% CI 1.2-1.6). (more…)
Author Interviews, Biomarkers, Heart Disease / 18.07.2013

Dr Nicholas D Gollop BSc (Hons) MB BCh Norfolk and Norwich University Hospital, Norwich, NR4 7UY Norfolk, United KingdomInterview with: Dr Nicholas D Gollop BSc (Hons) MB BCh Norfolk and Norwich University Hospital, Norwich, NR4 7UY Norfolk, United Kingdom     MedicalResearch.com: What are the main findings of the study? We completed a best evidence topic in interventional cardiac surgery to investigate the significance of elevated markers of cardiac damage following percutaneous coronary intervention (PCI). We compared the clinical and prognostic relevance of the elevation of creatinine kinase-myocardial band (CK-MB) and cardiac troponin (cTn) levels during peri-procedural period and post-procedural period, respectively, following an emergency or elective PCI. We found in excess of 390 papers after a systematic literature search, of which 10 represented the best evidence to answer the clinical question. From the best evidence available we showed that the monitoring of cardiac biomarkers following PCI can provide important clinical information about the health of the myocardium, as well as prognostic information on short to mid-term outcomes of mortality up to 3 years. (more…)
Author Interviews, Cleveland Clinic, Heart Disease, Surgical Research / 17.07.2013

MedicalResearch.com Interview with Dr. Frank Sellke, MD Chief of cardiothoracic surgery and co-director of the Cardiovascular Institute at Rhode Island, The Miriam and Newport hospitals MedicalResearch.com: What are the main findings of the study? Dr. Sellke: The main findings of the study are that outcomes of repair of an ascending aortic dissection are improved under a full moon compared to other phases of the moon. This was with regard to both mortality and length of hospital stay. Interestingly, there was no correlation with season of the year. (more…)
Author Interviews, Heart Disease / 11.07.2013

MedicalResearch.com Interview with: Andrew Brenyo MD Electrophysiologist Greenville University Health System Greenville SC MedicalResearch.com: What are the main findings of the study? Dr. Brenyo: We found that BNP values at the time of CRT implant and during follow up predict response to CRT and subsequent risk of heart failure admission and death. BNP at implant and at subsequent times was strongly correlated with echocardiographic response to CRT-D along with predicting clinical outcome. (more…)
Author Interviews, Diabetes, Diabetologia, Heart Disease, Race/Ethnic Diversity / 09.07.2013

MedicalResearch.com Interview with: Dr Nazim Ghouri MBChB, MRCP UK Specialty Registrar (Diabetes/Endocrinology/GIM) and Honorary Clinical Lecturer Institute of Cardiovascular and Medical Sciences BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow G12 8TA Lower cardiorespiratory fitness contributes to increased insulin resistance and fasting glycaemia in middle-aged South Asian compared with European men living in the UK MedicalResearch.com: What are the main findings of the study? Answer: In this study we aimed to determine the extent to which increased insulin resistance and blood sugar levels in South Asian men, compared to white European men, living in the UK, was due to lower fitness and physical activity levels. We studied 100 South Asian and 100 European men aged 40-70 years living in Scotland without diagnosed diabetes and measured their blood sugar levels, insulin resistance and other risk factors. The men also undertook a treadmill exercise test to determine how much oxygen their bodies were able to use during intense exercise – a key measure of physical fitness, wore accelerometers for a week to assess their physical activity levels, and had a detailed assessment of their body size and composition. Statistical modeling was then used to determine the extent to which body size and composition, fitness and physical activity variables explained differences in insulin resistance and blood sugar between South Asians and Europeans. The results suggested that lower fitness, together with greater body fat in South Asians, explained over 80 per cent of their increased insulin resistance compared to white men with Low fitness being the single most important factor associated with the increased insulin resistance and blood sugar levels in middle-aged South Asian compared to European men living in the UK. (more…)
Author Interviews, Cancer Research, CT Scanning, Heart Disease, JACC, Lung Cancer, Medical Imaging / 08.07.2013

Dr. Pim A. de Jong, Department of Radiology University Medical Center Utrecht, Heidelberglaan 100, E.01.132, 3508GA Utrecht, the Netherlands. MedicalResearch.com: What are the main findings of the study? Dr. de Jong: The main findings of the study is that lung cancer screening CT scans can predict future cardiovascular events. MedicalResearch.com: Where any of the findings unexpected? Dr. de Jong: The unexpected aspect is that the CT scans were not-ECG gated, but even these non-gated scans were good enough to quantify arterial calcifications and predict risk. (more…)
Author Interviews, Baylor College of Medicine Houston, Cost of Health Care, Heart Disease, JAMA / 03.07.2013

 MedicalResearch.com Interview with Salim S. Virani, MD, PhD Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas MedicalResearch.com: What are the main findings of the study? Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients.  Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up. Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing. (more…)
Author Interviews, Heart Disease, JAMA, Yale / 25.06.2013

Dr. Kumar Dharmarajan MD MBA Yale School of Medicine Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart FailureMedicalResearch.com  Interview with Dr. Kumar Dharmarajan MD MBA

Yale School of Medicine Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure MedicalResearch.com: What are the main findings of the study? We found that among a large contemporary cohort of heart failure hospitalizations, beta blockers are frequently started in patients with markers of clinical instability such as residence in an intensive care unit (ICU), volume overload requiring intravenous diuresis, and poor cardiac output requiring intravenous inotropes. Approximately 40% of patients in whom a beta blocker is started has at least one of these three potential contraindications to treatment. This finding is concerning, as recent performance measures for heart failure recommend that a beta blocker be started during hospitalization for heart failure among patients with left ventricular systolic dysfunction. However, these performance measures also state that persons in whom a beta blocker is started "should not be hospitalized in an ICU, should have no or minimal evidence of fluid overload or volume depletion, and should not have required recent treatment with an intravenous positive inotropic agent." Moving forward, we are concerned that the unselective application of the new performance measure may lead to the further use of beta blocker therapy in patients at higher risk for adverse consequences of therapy. (more…)
Author Interviews, Heart Disease, Lifestyle & Health / 04.06.2013

MedicalResearch.com eInterview with: Haitham Ahmed, MD, MPH The Ciccarone Center for the Prevention of Heart Disease Johns Hopkins Hospital MedicalResearch.com: What were the main findings of the study? Dr. Ahmed: Everyone knows that healthy lifestyle habits are major factors that protect you from heart disease. What we don’t know is which habits are most important, and how exactly these habits prevent disease progression along the causal biological pathway over years and years. So we followed 6,200 men and women of various ethnic backgrounds from 6 university locations across the US. We looked at their eating habits, exercise, weight, and smoking history. We did CT scans on them at the start of the study and then a few years later (mean 3 years) and found that healthier people had lower calcium deposition in their coronaries. We then kept following them and found that these same healthy people had a trend towards less cardiovascular events. We then kept following them further and found that these same healthy people died less, by an 80% lower rate, compared to people that were unhealthy, which was incredible. So what we took away from this is that you have enormous power in changing your risk of atherosclerosis, heart disease, and death by changing your lifestyle behaviors. (more…)
Heart Disease / 03.05.2013

MedicalResearch.com eInterview with: Dugald Seely ND, MSc, FABNO
 Founder & Executive Director; Ottawa Integrative Cancer Centre
Director; Research & Clinical Epidemiology; Canadian College of Naturopathic Medicine
Affiliate Investigator; Ottawa Hospital Research Institute 
29 Bayswater Ave Ottawa, ON, K1Y 2E5 www.oicc.ca


MedicalResearch.com: What are the main findings of the study? Answer: A significant and measurable reduction in risk of developing cardiovascular disease when naturopathic care is provided alongside conventional care. This is  evidenced by a 17% reduction in prevalence of metabolic syndrome and over 3% reduction in the 10-year Framingham cardiovascular risk profile for patients receiving care from a regulated naturopathic doctor in addition to community based care with a general practitioner. (more…)
Author Interviews, Exercise - Fitness, Heart Disease, JAMA, Smoking, Tobacco Research / 16.04.2013

MedicalResearch.com Author Interview with Dr. Koon Teo, MB, PhD Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada MedicalResearch.com: What are the main findings of the study? Dr. Teo: In this study we examined the prevalence of smoking cessation or avoidance, eating a healthy diet and undertaking regular physical activities in nearly 8000 individuals who had previously experienced a coronary heart disease event or stroke, on average 5 years after their events. The individuals were recruited from over 600 communities in 17 countries with varying incomes and economic development.  We found that although these healthy lifestyle activities could reduce the risk of further heart or stroke events, about one fifth of individuals continued to smoke, only one third undertook regular leisure or work related physical activities and about two fifths ate a healthy diet. (more…)