Author Interviews, Heart Disease, NEJM, Stanford / 31.03.2020
Stable Coronary Heart Disease: Initial Invasive or Conservative Strategy?
MedicalResearch.com Interview with:
[caption id="attachment_53694" align="alignleft" width="200"] Dr. Maron[/caption]
David J. Maron, MD, FACC, FAHA
Clinical Professor of Medicine
Chief, Stanford Prevention Research Center
Director, Preventive Cardiology
Stanford University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. The goals of treating patients with stable coronary disease are to reduce their risk of death and ischemic events and to improve their quality of life. All patients with coronary disease should be treated with guideline-based medical therapy (GBMT) to achieve these objectives. Before the widespread availability of drug-eluting stents, strategy trials that tested the incremental effect of revascularization added to medical therapy did not show a reduction in the incidence of death or myocardial infarction. In one trial, fractional flow reserve–guided percutaneous coronary intervention (PCI) with drug-eluting stents, added to medical therapy, decreased the incidence of urgent revascularization but not the incidence of death from any cause or myocardial infarction at a mean of 7 months, whereas the 5-year follow-up showed marginal evidence of a decrease in the incidence of myocardial infarction.
Dr. Maron[/caption]
David J. Maron, MD, FACC, FAHA
Clinical Professor of Medicine
Chief, Stanford Prevention Research Center
Director, Preventive Cardiology
Stanford University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. The goals of treating patients with stable coronary disease are to reduce their risk of death and ischemic events and to improve their quality of life. All patients with coronary disease should be treated with guideline-based medical therapy (GBMT) to achieve these objectives. Before the widespread availability of drug-eluting stents, strategy trials that tested the incremental effect of revascularization added to medical therapy did not show a reduction in the incidence of death or myocardial infarction. In one trial, fractional flow reserve–guided percutaneous coronary intervention (PCI) with drug-eluting stents, added to medical therapy, decreased the incidence of urgent revascularization but not the incidence of death from any cause or myocardial infarction at a mean of 7 months, whereas the 5-year follow-up showed marginal evidence of a decrease in the incidence of myocardial infarction.
Deborah M Eaton
Doctorate Student / Research Assistant
Temple University
MedicalResearch.com: What is the background for this study?
Response: Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for approximately 50% of cases of HF and to date clinical trials with HFpEF patients have failed to produce positive outcomes. Part of this is likely due to the lack of HFpEF animal models for preclinical testing. Our lab addressed this gap in knowledge by developing an animal model that mimics critical features of the human HFpEF phenotype. We performed an in-depth cardiopulmonary characterization highlighting that the model has characteristics of human disease. We then tested the effects of a pan-HDAC inhibitor, vorinostat/SAHA, in collaboration with Dr. Timothy McKinsey, who is an expert in HDAC inhibitors and recently published work1 that laid the foundation for this study. 
Dr. Kistler[/caption]
Professor Peter M Kistler MBBS, PhD, FRACP
Head of Clinical Electrophysiology Research
Baker Heart and Diabetes Institute
Head of Electrophysiology at The Alfred hospital
Professor of Medicine
University of Melbourne.
MedicalResearch.com: What is the background for this study?
Response: There is a well known association between alcohol intake and atrial fibrillation form population based studies which demonstrate that for every 1 standard drink the incidence of AFib increases by 8%.
This is the first randomised study to determine of alcohol reduction/abstinence leads to a reduction in AFib episodes and time to recurrence.
