Author Interviews, Genetic Research, Heart Disease, JAMA, Lipids / 25.04.2019

MedicalResearch.com Interview with: Florian Kronenberg, MD Division of Genetic Epidemiology Department of Medical Genetics, Molecular and Clinical Pharmacology Medical University of Innsbruck, Innsbruck, Austria MedicalResearch.com: What is the background for this study? Response: Lp(a) is one of the most prevalent lipoprotein risk factors for cardiovascular disease. Roughly 20% of the general Caucasian population have concentrations above 50 mg/dL and the 10% with the highest concentrations have a 2 to 3-fold increased risk for myocardial infarction. There is strong evidence from genetic studies that high Lp(a) concentrations are causally related to cardiovascular outcomes. Until recently there was no drug available which lowers Lp(a) without any effects on other lipoproteins. This has recently changed by the development of drugs that block the production of Lp(a) in an impressive way. These drugs have to be studied in randomized controlled trials whether they not only lower Lp(a) concentrations but also cardiovascular outcomes. For the planning of such studies it is crucial to estimate the amount of Lp(a) lowering required to show a clinical benefit. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, Red Meat / 22.04.2019

MedicalResearch.com Interview with: Marta Guasch-Ferre, PhD Research Scientist, Dept of Nutrition Harvard TH Chan School of Public Health Instructor of Medicine, Channing Division of Network Medicin Harvard Medical School Boston, MA, 02115   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Previous findings from randomized controlled trials evaluating the effects of red meat on cardiovascular disease risk factors have been inconsistent. But our new study, which makes specific comparisons between diets high in red meat versus diets high in other types of foods, shows that substituting red meat with high-quality protein sources lead to more favorable changes in cardiovascular risk factors. That is, to properly understand the health effects of red meat, it’s important to pay attention to the comparison diet. People do not simply eat more or less meat – it will almost always be in substitution with other foods.  (more…)
AHA Journals, Author Interviews, Clots - Coagulation, Heart Disease, Stroke / 19.04.2019

MedicalResearch.com Interview with: Martine Jandrot-Perrus MD, PhD. Emeritus Research Professor Inserm University Paris Diderot Acticor Biotech Hôpital Bichat France  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Blood platelets are key actors in thrombosis a leading cause of global mortality estimated to account for 1 in 4 death worldwide in 2010. Thrombosis is associated with cardiovascular diseases (myocardial infarction, stroke, lower limb ischemia, venous thromboembolism), and with numerous pathologies such as cancer, infections or inflammatory diseases. Currently available antiplatelet drugs are the cornerstone of therapy for patients with acute coronary syndromes. However, these drugs all carry an inherent risk of bleeding that restricts their use in sensitive populations and when arterial thrombosis occurs in the cerebral territory. At present the only acute treatment option available for ischemic stroke consists in revascularization by thrombolysis, and/or mechanical thrombectomy. But the number of patients eligible to these treatments is low (» 15% of all patients) and the success rate does not exceed 50%. The responsibility of platelets in the failure for thrombolysis / thrombectomy to restore vascular patency is strongly suspected. There is thus a clear medical need for new antiplatelet drugs with an improved safety profile. We set out to develop ACT017, a novel, first in class, therapeutic antibody to platelet glycoprotein VI with potent and selective antiplatelet effects. The interest of GPVI resides in the fact that it's a receptor involved in the development of occlusive thrombi but that it is not strictly required for physiological hemostasis. (more…)
Author Interviews, Exercise - Fitness, Gender Differences, Heart Disease, JAMA, Johns Hopkins, Women's Heart Health / 14.04.2019

MedicalResearch.com Interview with: Erin D. Michos, MD, MHS, FACC, FAHA, FASE Associate Professor of Medicine and Epidemiology Associate Director of Preventive Cardiology Ciccarone Center for the Prevention of Heart Disease Johns Hopkins School of Medicine Victor Okunrintemi, MD, MPH Department of Internal Medicine East Carolina University Greenville, North Carolina  MedicalResearch.com: What is the background for this study?   Response: Women are less physically active than men on average, and the lack of regular physical activity has been associated with increased risk of cardiovascular disease and poorer health outcomes. Although recommendations encouraging regular physical activity has been in place for decades, we do not know how much of these recommendations are met, particularly among high risk women with established cardiovascular disease for secondary prevention. This study was therefore designed with the aim of describing the 10-year trends for the proportion of women with cardiovascular disease who do not meet these recommend physical activity levels, overall and by key sociodemographic groups, and the associated cost implications. (more…)
Author Interviews, BMJ, Heart Disease, Karolinski Institute / 11.04.2019

MedicalResearch.com Interview with: Huan Song, PhD Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Stockholm, Sweden MedicalResearch.com: What is the background for this study?   Response: Cardiovascular disease (CVD) presents a group of diseases that are common and sometimes fatal in general population. The possible role of stress-related disorders in the development of CVD has been reported. However, the main body of the preceding evidence was derived from male samples (veterans or active-duty military personnel) focusing mainly on posttraumatic stress disorder (PTSD) or self-reported PTSD symptoms. Data on the role of stress-related disorders in CVD in women were, until now, limited. Although incomplete control for familial factors and co-occurring psychiatric disorder, as well as the sample size restriction, limit the solid inference on this association, especially for subtypes of CVD. (more…)
Author Interviews, Heart Disease, JACC / 10.04.2019

MedicalResearch.com Interview with: Susana Ravassa PhD Program of Cardiovascular Diseases, CIMA University of Navarra, and IdiSNA Navarra Institute for Health Research Pamplona, Spain  MedicalResearch.com: What is the background for this study? Response: Atrial fibrillation (AF) is an evolving epidemic responsible for substantial morbidity, mortality and health-care expenditure. In particular, when AF and heart failure (HF) occur in combination, clinical evolution is particularly poor. Left atrial (LA) myocardial interstitial fibrosis (MIF) is the main structural lesion in AF and considered as the main factor responsible for the perpetuation of this pathology. In addition, it is known that MIF is associated with a lower effectiveness of the treatment of AF by pulmonary vein isolation with catheter ablation. Therefore, the identification of biomarkers related to MIF, as an affordable and minimally invasive approach, is of great interest to detect patients at risk of AF, as well as to monitor their response to the LA ablation therapy. We had previously demonstrated that the deleterious impact of MIF in the heart is due to alterations in both the quality (i.e., extent of cross-linking among collagen fibrils and type of collagen fibers that determine their rigidity and resistance to degradation [collagen cross-linking or CCL]) and the quantity (i.e., extent of collagen fibers that occupy the myocardial tissue [collagen deposition or CD]) of fibrotic tissue. We have shown that certain circulating biomarkers related to collagen type I metabolism are associated with CCL and CD. On the one hand, the serum carboxy-terminal propeptide of procollagen type I (PICP), released during the conversion of procollagen type I into fibril-forming mature collagen type I, is directly correlated with myocardial CD. On the other hand, the ratio of serum carboxy-terminal telopeptide of collagen type I to serum matrix metalloproteinase-1 (serum CITP:MMP-1 ratio) is inversely correlated with myocardial CCL, as the higher is the cross-linking among collagen type I fibrils the lower will be the cleavage of CITP by MMP-1 during the process of degradation of the fiber. Interestingly, we have previously reported that the combination of these biomarkers identifies patients with heart failure presenting with a complex pattern of MIF characterized by both increased CCL and CD (CCL+CD+) showing a higher risk of adverse clinical evolution as compared with heart failure  patients without this combination of biomarkers. As both increased CCL and CD have been found in the left atrial myocardium in patients with AF, we designed this investigation to explore whether the CCL+CD+ combination of biomarkers is associated with AF. (more…)
Author Interviews, Heart Disease, Nutrition, Red Meat / 04.04.2019

MedicalResearch.com Interview with: Saeed Mastour Alshahrani, MPH, PhD School of Public Health, Loma Linda University, California, USA College of Applied Medical Sciences, King Khalid University Abha, Saudi Arabia  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: -The consumption of red and processed meat has been associated with risks of importance to public health including cardiovascular diseases and cancer. Several studies have found that red and processed meat intake was associated with an increased risk of mortality. However, levels of meat intake in those studies were relatively high. It remains of interest whether even relatively low intake levels of red and processed meat might be associated with greater mortality, compared to zero intake.  (more…)
Allergies, Author Interviews, Dermatology, Heart Disease, JAMA / 03.04.2019

MedicalResearch.com Interview with: Amber Reck Atwater, M.D. Dermatology Residency Program Director Associate Professor of Dermatology Director, Contact Dermatitis Clinic Duke Dermatology  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We completed an evaluation of our Duke Dermatology patients who underwent patch testing for possible allergy to their cardiac devices - pacemakers and defibrillators. From March 1, 2012 to September 15, 2017 we saw 11 patients with suspected allergy to their devices.  Concern for allergy, skin eruption, skin symptoms, and concern for infection were common. 73% of patients had erythema at their implant scars; pruritus and pain were also noted.  Six of our patients had relevant reactions, and the most common allergies were metals, silicone and rubber accelerators.  (more…)
AHA Journals, Author Interviews, Heart Disease, Karolinski Institute / 02.04.2019

MedicalResearch.com Interview with: Gabriel Riva, Graduate Student Department of Medicine, Solna (MedS), Karolinka Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: During the last decade there has been a gradual adoption of compression-only CPR, as an option to conventional CPR with chest compressions and rescue breaths, in international CPR guidelines. The simplified technique is recommended for bystanders who are untrained and in "telephone assisted CPR". One of the reasons was the assumption that more people would actually do CPR with the simplified technique.  We could in this nationwide study running over 3 guideline periods demonstrate a 6-fold higher proportion of patients receiving compression-only CPR and a concomitant almost doubled rate of CPR before emergency medical services arrival over time. This very large increase in simplified CPR was surprising to us, especially considering there has never been any public campaigns promoting compression-only CPR in Sweden and training still include compressions and ventilations.  (more…)
Author Interviews, Diabetes, Genetic Research, Heart Disease, Nature / 02.04.2019

MedicalResearch.com Interview with: Eirini Marouli William Harvey Research Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London MedicalResearch.com: What is the background for this study?   Response: Epidemiological studies suggest that shorter stature is associated with increased risk of coronary artery disease (CAD) or type 2 diabetes (T2D). It is not clear though whether these associations are causal or there are other factors mediating these effects. When randomized trials are inappropriate or impossible, we can use Mendelian Randomisation as a good alternative to study the causal relationship between a trait and a disease. Here, we examined over 800 places in the human genome known to be associated with adult height and evaluated how genetically predicted height can affect the risk of CAD or T2D. Furthermore, we evaluated the role of several risk factors including, cholesterol, triglycerides, blood pressure, body mass index, fat percentage, socio-economic parameters including education and income as well as lung function. Lung function was assessed by spirometry measures including FEV1: forced expiratory volume in 1 second, FVC: forced vital capacity. (more…)
Author Interviews, Heart Disease, JAMA, Lipids / 02.04.2019

MedicalResearch.com Interview with: Victor Wenze Zhong, Ph.D. Postdoctoral fellow Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago, IL 60611  MedicalResearch.com: What is the background for this study? Response: Dietary cholesterol is a common nutrient in human diet. Eggs, specially egg yolks, are the single richest source of dietary cholesterol among all commonly consumed foods. The associations between dietary cholesterol consumption and cardiovascular disease and mortality remain controversial despite decades of research. Eating less than 300 mg of dietary cholesterol per day was the guideline recommendation before 2015. However, the most recent 2015-2020 Dietary Guidelines for Americans no longer include a daily consumption limit for dietary cholesterol and recommend weekly egg consumption as part of the healthy US-style eating pattern. Whether these recommendations are appropriate have been intensely debated. (more…)
Author Interviews, Breast Cancer, Exercise - Fitness, Heart Disease, JAMA, UCLA / 29.03.2019

MedicalResearch.com Interview with: Christina M. Dieli-Conwright, PhD, MPH, FACSM, CSCS Assistant Professor of Research Director, Integrative Center for Oncology Research in Exercise Division of Biokinesiology & Physical Therapy, Ostrow School of Dentistry Department of Medicine, Keck School of Medicine University of Southern California Los Angeles, CA 90033  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study was designed to assess the effects of an aerobic and resistance exercise on metabolic dysregulation in sedentary, obese breast cancer survivors, however we further examined the effects on cardiovascular disease risk measured by the Framingham Risk Score, reported here. Our findings indicated that exercise, indeed, reduces the risk of cardiovascular disease in this population.  (more…)
Author Interviews, Diabetes, Heart Disease, UCSD / 28.03.2019

MedicalResearch.com Interview with: H. Kirk Hammond, MD Professor of Medicine at University of California San Diego Basic research scientist and cardiologist San Diego Veterans' Affairs Healthcare System Dr. Hammond is winner of the 2017 William S. Middleton Award – the highest research honor in the U.S. Department of Veterans Affairs  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Worldwide, 9% of adults have diabetes, predominantly due to insulin resistance, known as Type 2 diabetes. It is associated with obesity and diets high in fat and carbohydrates. In this gene transfer study we showed that a single injection of a vector encoding a natural hormone (urocortin 2, Ucn2) increased glucose disposal and improved heart function in a model of diet-induced Type 2 diabetes in mice.  (more…)
Anesthesiology, Author Interviews, Heart Disease, NEJM, Surgical Research / 27.03.2019

MedicalResearch.com Interview with: Dr. Giovanni Landoni Intensive Care and Anesthesia Unit Associate professor Università Vita-Salute San Raffaele  MedicalResearch.com: What is the background for this study?   Response: Patients undergoing cardiac surgery are still at risk for perioperative complications. Studies to improve clinical outcomes this setting are important. Inhaled anesthetics have pharmacological properties which reduce myocardial infarction size by 50% in laboratory and animal studies and which might decrease postoperative mortality according to aggregated published randomized data. (more…)
Author Interviews, Brigham & Women's - Harvard, Dermatology, Heart Disease, JAMA / 27.03.2019

MedicalResearch.com Interview with: Seoyoung C. Kim, MD, ScD, MSCE Director, Program in Rheumatologic, Immunologic, and Musculoskeletal PharmacoEpidemiology Associate Professor of Medicine Division of Pharmacoepidemiology & Pharmacoeconomics Division of Rheumatology, Immunology and Allergy Brigham and Women's Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? Response: Given a high cardiovascular (CV) risk among patients with psoriasis and psoriatic arthritis, it is important to have more information with regard to potential effect of different treatment agents on CV risk. As the number of treatment options for psoriasis and psoriatic arthritis has been rising over the few decades, it is even more crucial to have high-quality evidence on comparative safety of different treatment options so physicians and patients can choose an agent based on the benefit-risk profile of each drug they are considering. (more…)
Author Interviews, Brigham & Women's - Harvard, Flu - Influenza, Heart Disease, JAMA / 27.03.2019

MedicalResearch.com Interview with: Sonja Kytomaa MA Research Associate Brigham and Women’s Hospital Scott D. Solomon, MD The Edward D. Frohlich Distinguished Chair Professor of Medicine Harvard Medical School Senior Physician Brigham and Women’s Hospital International Associate Editor, European Heart Journal   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Influenza is associated with an increased risk of cardiovascular events, yet few studies have explored the temporal association between influenza activity and hospitalizations, especially due to heart failure (HF). Our aim with this study was to explore the temporal association between influenza activity and hospitalizations for HF and myocardial infarction (MI) in the general population. We related the number of MI and HF hospitalizations by month, which were sampled from 4 US communities and adjudicated in the surveillance component of the Atherosclerosis Risk in Communities (ARIC) study, to monthly influenza-like illness activity, as reported by the Centers for Disease Control and Prevention. We found that a 5% increase in influenza activity was associated with a 24% increase in HF hospitalizations rates, while overall influenza was not significantly associated with MI hospitalizations. Influenza activity in the months before hospitalization was not associated with either outcome. (more…)
Author Interviews, Heart Disease, JAMA, Stem Cells / 26.03.2019

MedicalResearch.com Interview with: Annetine C. Gelijns, PhD Professor and System Chair Population Health Science and Policy Icahn School of Medicine at Mount Sinai Alan J Moskowitz, MD Professor of Population Health Science and Policy Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Where do these mesenchymal cells come from?  Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery. Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients. (more…)
Author Interviews, Clots - Coagulation, Duke, Heart Disease, NEJM / 21.03.2019

MedicalResearch.com Interview with: Renato D. Lopes MD, MHS, PhD Professor of Medicine Division of Cardiology Duke University Medical Center Duke Clinical Research Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: In patients with acute coronary syndromes (ACS), approximately 20% to 30% of those with nonvalvular atrial fibrillation (NVAF) have concomitant coronary artery disease (CAD), and 5 to 10% of patients who undergo PCI have NVAF. These patients often receive both antiplatelet therapy and oral anticoagulants; and how best to combine these agents to minimize bleeding risk without compromising protection against thrombosis is an important unanswered question. Analysis of results for bleeding indicated no significant interaction between the two randomization factors permitting independent analysis of results for the two key comparisons. The first showed that apixaban was both non-inferior and significantly superior to VKA for the primary outcome with a 31% reduction in the relative risk for bleeding. Aspirin significantly increased the relative risk for bleeding versus placebo by 89%. Results for the composite of death and hospitalization showed that apixaban resulted in a relative risk reduction of 17%, primarily driven by a reduction in all cause hospitalization. There was no significant difference between results for aspirin versus placebo for this outcome. Analysis of the composite of death and ischemic events indicated no significant differences in results for apixaban versus VKA or aspirin versus placebo. (more…)
Author Interviews, Duke, Heart Disease, JAMA / 21.03.2019

MedicalResearch.com Interview with: Renato D. Lopes MD, MHS, PhD Professor of Medicine Division of Cardiology Duke University Medical Center Duke Clinical Research Institute Alexander C. Fanaroff, MD, MHS Division of Cardiology and Duke Clinical Research Institute Duke University, Durham, North Carolina MedicalResearch.com: What is the background for this study? What are the main findings? Response: About ten years ago, a group of researchers examined the evidence supporting guideline recommendations in cardiology for the first time. Quite surprisingly, they found that only 11% of recommendations in American College of Cardiology/American Heart Association (ACC/AHA) guidelines were supported by evidence from randomized controlled trials, the highest level of evidence. The researchers called for greater collaboration among investigators and funders in identifying key research questions, development of streamlined clinical trial methods, and expansion of funding for clinical research. Over the past 10 years, some of these steps have been taken, but it is unclear how the evidence supporting guideline recommendations has changed. We therefore analyzed the 51 current cardiovascular guideline documents -- 26 from the ACC/AHA and 25 from the European Society of Cardiology (ESC) -- including 6,329 recommendations. Overall, 8.5% of recommendations in ACC/AHA guidelines and 14.3% of recommendations in ESC guidelines were supported by evidence from randomized controlled trials. When looking specifically at guidelines that have been updated, we found no significant changes in the proportion of recommendations supported by evidence from randomized controlled trials. (more…)
Author Interviews, Erectile Dysfunction, Heart Disease / 20.03.2019

MedicalResearch.com Interview with: Jagat Narula, MD, PhD Philip J. and Harriet L. Goodhart Professor of Medicine (Cardiology) Associate Dean for Global Health Director of the Cardiovascular Imaging Program Mount Sinai Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atherosclerosis has been linked to causing erectile dysfunction (ED) in the majority of patients with this cardiovascular condition, but researchers have not had the means of demonstrating atherosclerosis in penile arteries until now.  This unique study uses advanced imaging to detect how strong the association actually is.  For the first time, researchers have used advanced imaging of penile arteries to show a link between atherosclerosis and erectile dysfunction (ED). (more…)
Author Interviews, Heart Disease, JACC, Technology / 20.03.2019

MedicalResearch.com Interview with: Annapoorna Kini, MD Zena and Michael A Wiener Professor of Medicine Director of the Cardiac Catheterization Laboratory Mount Sinai Heart at Mount Sinai Hospital MedicalResearch.com: What is the background for this study?  
  • Expanding indication and use of Transcatheter aortic valve replacement (TAVR) poses a unique problem of coronary access after valve implantation.
  • Troubleshooting tools and techniques have been published but are not available at the fingertips of the user at all the times.
  • We tried to address this unique problem with an innovative educational mobile application (app) called "TAVRcathAID".
(more…)
Author Interviews, Heart Disease, JAMA / 19.03.2019

MedicalResearch.com Interview with: Dr. Carina Blomström-Lundqvist, MD Professor of Cardiology Department of Cardioloy Institution of Medical Science Uppsala, Sweden MedicalResearch.com: What is the background for this study?   Response: While all previous trials comparing atrial fibrillation (AF) ablation and antiarrhythmic drugs to our best knowledge have evaluated the efficacy of these treatments in terms of atrial fibrillation (AF) recurrences (with an AF episode of 30 seconds duration as standard primary endpoint) we wanted to use quality of Life (QoL) - general health - as primary endpoint, since the indication for treatment is improving QoL. This was important since, despite the fact that the indication for treatment is to improve (QoL) and reduce symptom, all prior trials have used 30 seconds AF episodes as standard primary endpoint, which if occurred it would be defined as a failed treatment. We also wanted to assess effects on various clinical outcome events. We know from registries such as ORBIT AF registry that around 60 % of AF patients have symptoms resulting in repeated hospitalisation visits in at least 30-40% of patients annually, and that only around 5 % of the AF population are being referred for AF ablation. Previous trials have used intermittent 24 hours Holter recordings whioch does not give the true AF burden (% of time in AF). We therefore also wanted to assess and compare treatments effects on true AF burden by implanting an implantable cardiac monitor (ICM) which continuosly records the heart rhythm. We would then be able to prove that improvement in QoL was directly related to a reduction in AF burden and that treatment differences in QoL was related to a difference in reduction in AF burden. We also wanted to study an AF population in their early AF disease state so that we could offer atrial fibrillation ablation to a broader AF population before their atria have become remodelled and too damaged for a pulmonary vein isolation to be effective.  (more…)
Author Interviews, Heart Disease / 19.03.2019

MedicalResearch.com Interview with: Mandeep R. Mehra, MD, MSc, FRCP (London) The William Harvey Distinguished Chair in Advanced Cardiovascular Medicine Medical Director, Heart and Vascular Center Brigham and Women’s Hospital Executive Director Center for Advanced Heart Disease Brigham and Women’s Hospital Professor of Medicine, Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The MOMENTUM 3 trial is the largest study of LVAD therapy in Advanced Heart Failure with over 1000 randomized patients followed to at least 2 years. This trial tested a novel fully magnetically levitated LVAD, the HeartMate 3 pump against a mechanical bearing containing LVAD, the HeartMate II pump in patients suffering from advanced heart failure (85% of whom were on continuous intravenous Inotropic therapy or IABP device at the time of randomization). While LVADs have improved survival for such patients, the morbidity has remained excessive due to serious complication as a result of problems with hemocompatibility. The principal concerns revolve around complications of pump thrombosis requiring surgical replacement, strokes and bleeding events, especially gastrointestinal bleeding. The trial has previously reported two interim analyses which suggested signals for superiority on pump replacement and even a decrease in ischemic stroke. This final full report concludes convincingly that all three domains of hemocompatibility related adverse events are reduced with the novel LVAD with near elimination of pump thrombosis, halving of strokes of any kind and any severity and a marked decrease in bleeding complications. (more…)
Author Interviews, Heart Disease, Infections, Opiods / 18.03.2019

MedicalResearch.com Interview with: Serena Day, MD Ohio State University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The idea for this research came from my own observations of patients that I was caring for in the hospital first as an Internal Medicine Resident and now as a senior Cardiology Fellow. I did my residency here at Ohio State and noticed a marked increase in the number of patients with endocarditis that we were caring for just in my short time here as a trainee. Over 5 years, we saw an increase of 436% in intravenous drug use related endocarditis. How this disease is treated as changed as well. It used to be that if a patient was a good surgical candidate, we would offer a replacement valve. Now, we see that these patient's have such a high rate of recurrent intravenous drug use and reinfection of their heart valves that we now treat with antibiotics only rather than surgery. In many cases, the infection never goes away because we can't offer definitive therapy with surgery due to their high relapse and reinfection rates of nearly 50%. (more…)
Author Interviews, Clots - Coagulation, Heart Disease / 18.03.2019

MedicalResearch.com Interview with: Stavros V. Konstantinides, MD, PhD, FESC, FRCP(Glasg) Professor, Clinical Trials, and Medical Director Center for Thrombosis and Hemostasis (CTH) Johannes Gutenberg University Mainz Mainz, Germany MedicalResearch.com: What is the background for this study? What are the main findings? Response: Acute pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. It encompasses a wide spectrum of clinical symptoms and severity, ranging from massive, immediately life-threatening PE with hemodynamic collapse to the low-risk, stable patient with very few symptoms. These latter patients with acute low-risk PE may qualify for early discharge from hospital (e.g., within 48 hours) and continuation of treatment at home. This is a very promising strategy, because it may not only increase patient satisfaction and quality of life, but also help to reduce hospital-related complications and costs. However, it needed to be clearly determined, and tested in a prospective management trial, who are the appropriate candidates for an effective and safe home treatment approach. To this date, trials suggesting favorable clinical outcomes with home treatment of PE are small and date back to the era of vitamin K antagonists. Direct oral anticoagulants permitting a single drug treatment of PE are more promising in this regard, as they may make an early transition from hospital to ambulatory care both safer and more convenient. The international Home Treatment of Pulmonary Embolism (HoT-PE) phase 4 management trial tested the efficacy and safety of early discharge and ambulatory anticoagulation treatment with the direct factor Xa inhibitor rivaroxaban in patients with acute low-risk PE. Patients were identified on the basis of
  • clinical criteria or PE severity, comorbidity, and contraindications; and
  • the absence of right heart failure or intracardiac thrombi on cardiac imaging. Early termination of the study was possible following the prespecified interim analysis, which was performed after recruitment and 3-month evaluation of 525 patients (50% of the planned trial population). At the interim analysis, the primary efficacy outcome of symptomatic recurrent venous thromboembolism or PE-related death occurred in only 3 (0.6%) patients (compared to an estimated 1.7% rate based on historical data). This rate was sufficiently low to reject the primary hypothesis as predefined in the statistical analysis plan. None of the recurrent events was nonfatal.Major bleeding occurred in 6 (1.2%) patients of the safety population. The study could therefore be terminated early for efficacy. 
(more…)
Accidents & Violence, Author Interviews, Heart Disease, Inflammation, JACC, Lipids / 18.03.2019

MedicalResearch.com Interview with: Dr. George Dangas MD PhD Professor of Medicine, Cardiology Mount Sinai Health System MedicalResearch.com: What is the background for this study? Response: Widespread use of statins targeted to decrease levels of low density lipoprotein cholesterol (LDL-C) below 70mg/dL are recommended by guidelines. However, residual cholesterol risk may only be one part of the residual risk equation. Indeed, Biological inflammation has long been known as a pathophysiological mechanism of atherosclerosis and the recent CANTOS trial opened new therapeutic perspective by demonstrating that inflammation modulation via selective interleukin-1β inhibition could result in improved diagnosis in patients with coronary artery disease. However, the prevalence and impact of a residual inflammatory biological syndrome in patients with controlled cholesterol risk is unclear. (more…)
Author Interviews, Biomarkers, BMJ, Heart Disease / 18.03.2019

MedicalResearch.com Interview with: Prof. Nick Curzen  BM(Hons) PhD FRCP Professor of Interventional Cardiology/Consultant Cardiologist University Hospital Southampton Southampton MedicalResearch.com: What is the background for this study? Response: The commonest blood test now used to assess whether a patient has had a heart attack or not is called high sensitivity troponin (hs trop).  The test is supplied with an Upper Limit of Normal, which is based upon results from relatively healthy people.  When doctors take the hs trop, they then use this ULN to decide if the patient had has a heart attack. This study set out to see what the hs trop level is in a large number of patients attending the hospital for any reason, either inpatient or outpatient, in most of whom there was no clinical suspicion of heart attack at all.  We therefore took hs trop measurements on 20,000 consecutive patients attending our hospital and having a blood sample for any reason.  (more…)
Author Interviews, Genetic Research, Heart Disease, Lipids, NEJM, Statins / 13.03.2019

MedicalResearch.com Interview with: Brian A Ference, MD, MPhil, MSc, FACC, FESC Professor and Director of Research in Translational Therapeutics Executive Director, Centre for Naturally Randomized Trials Strangeways Research Laboratory University of Cambridge Cambridge, UK MedicalResearch.com: What is the background for this study? Response: Bempedoic acid is a novel therapy currently in development that lowers LDL-C by inhibiting ATP-citrate lyase, an enzyme in the same cholesterol biosynthesis pathway as HMG-CoA reductase (the target of stains).  However, whether lowering LDL-C by inhibiting ATP-citrate lyase will reduce the risk of cardiovascular events to the same extent as lowering LDL-C by inhibiting HMG-CoA reductase with a statin is unknown. We conducted a “naturally randomized trial” using Mendelian randomization in more than 650,000 participants who experienced more than 100,000 cardiovascular events to evaluate the potential clinical benefit of lowering LDL-C by inhibiting ATP-citrate lyase as compared to lowering LDL-C by inhibiting HMG-CoA reductase. (more…)
Author Interviews, Heart Disease, Imperial College, Lipids, NEJM, Statins / 13.03.2019

MedicalResearch.com Interview with: Prof. Kosh Ray, MB ChB, MD, MPhil Faculty of Medicine, School of Public Health Chair in Public Health (Clinical) Imperial College London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Bempedoic acid is the first in class of a new therapy for lowering LDL cholesterol. This is the largest and longest study to date with this therapy and involved about 2200 pts with patients with either established cardiovascular disease or familial hypercholestrolaemia and in whom LDL was > 70mg/dl or 1.8 mmol/L despite maximally tolerated statins. %0% were on high intensity statins and the majority of the rest on moderate intensity. The aim was to show long term safety 1 year and efficacy at 24 weeks and at 1 year.  (more…)