Annals Internal Medicine, Author Interviews, Brigham & Women's - Harvard, Diabetes, Heart Disease / 07.06.2022
First-Line Treatment of Type 2 Diabetes: Cardiovascular Outcomes of SGLT-2 Inhibitors vs Metformin
MedicalResearch.com Interview with:
[caption id="attachment_59221" align="alignleft" width="150"] Dr. HoJin Shin[/caption]
HoJin Shin, BPharm, PhD
Postdoctoral Research Fellow
Division of Pharmacoepidemiology and Pharmacoeconomics
Department of Medicine
Brigham and Women's Hospital and Harvard Medical School
Boston, Massachusetts
MedicalResearch.com: What is the background for this study?
Response: The public health burden of cardiovascular disease has been increasing in people with diabetes along with the burden of diabetes itself.
Dr. HoJin Shin[/caption]
HoJin Shin, BPharm, PhD
Postdoctoral Research Fellow
Division of Pharmacoepidemiology and Pharmacoeconomics
Department of Medicine
Brigham and Women's Hospital and Harvard Medical School
Boston, Massachusetts
MedicalResearch.com: What is the background for this study?
Response: The public health burden of cardiovascular disease has been increasing in people with diabetes along with the burden of diabetes itself.
- Cardiovascular disease affects approximately one-third of the population with type 2 diabetes and accounts for 50%–80% of their mortality
- 1 in 10 people in the US has diabetes
Dr. Duffy[/caption]
Jeanne Duffy, MBA, PhD
Associate Professor of Medicine
Division of Sleep and Circadian Disorders
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Aging is associated with changes in sleep timing, quality and duration, and even older adults without chronic medical problems have shorter and more disrupted sleep than young adults. Many prescription sleep aids increase the risk of nighttime falls, have
adverse effects on next‐day cognition, and are associated with increased mortality, and so are not recommended for long-term use in older adults. In previous studies, we and others have shown that melatonin, a hormone secreted at night, increases sleep duration in young adults but only when administered during the day when endogenous melatonin levels are low. We wanted to explore whether melatonin could improve the sleep of healthy adults and whether, like young adults, its impact depends on when during the day the person is trying to sleep.
Dr. Stern[/caption]
Robert A. Stern, Ph.D.
Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology
Director of Clinical Research, BU CTE Center
Senior Investigator, BU Alzheimer’s Disease Research Center
Boston University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: The link between playing American football at the professional level and later-life brain disorders like chronic traumatic encephalopathy – or CTE -- and ALS has received increasing attention over the past 15 years. Previous research has shown that former NFL players are more likely to die from CTE and amyotrophic lateral sclerosis (ALS) and more likely to report cognitive impairment, behavioral changes, and dementia during life. Despite previous research focusing on the later-life effects of playing American football at the professional level, the long-term effects of college football participation remain largely unknown.
We had two goals for this new investigation. The first was to conduct a survey of the current overall health status, including cognitive and other neurological disorders, of older former college American football players compared with men in the general population. The second goal was to examine the mortality rate and causes of death in a cohort of older former college football players. The target population for this study was all 447 former Notre Dame football players who were listed as seniors on the varsity rosters during the 1964-1980 seasons. This was the era of legendary coaches Ara Parseghian and Dan Devine. I should add that this study was fully independent of the University of Notre Dame.
Dr. Sesso[/caption]
Howard D. Sesso, ScD, MPH
Associate Professor of Medicine
Division of Preventive Medicine
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study? How does the amount of flavanols in the study arm compare to what might be obtained in a typical diet?
Response: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled clinical trial that tested the effects of two promising dietary supplements on cardiovascular disease (CVD) and cancer in 21,442 older adults. Cocoa flavanols have been shown to have favorable vascular effects in small and short-term clinical trials. The 500 mg/day flavanols tested in COSMOS exceeds that readily obtained in the diet typically from cocoa, tea, grapes, and berries. Of note, flavanol content in not typically listed on food labels.
COSMOS also tested a multivitamin, the most common dietary supplement taken by US adults and previously linked with a potential modest reduction in cancer in a previous long-term trial of men conducted by our research group at the Division of Preventive Medicine at Brigham and Women’s Hospital.
Dr. Dickerman[/caption]
Dr. Barbra Dickerman, PhD
CAUSALab investigator and instructor
Department of Epidemiology
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Early randomized trials showed that the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines were both remarkably effective at preventing symptomatic disease, when comparing each vaccine with no vaccine. However, head-to-head comparisons of these vaccines have been lacking, leaving open the question of which vaccine is more effective.
In this study, we analyzed the VA’s high-quality databases in a way that emulated the design of the hypothetical trial that would have answered this question. Specifically, we used the findings from the original trials to benchmark our methods and then extended them to provide novel evidence for the comparative effectiveness of these two vaccines in a real-world setting and across diverse subgroups and different time periods.
Dr. Singer[/caption]
Daniel E. Singer, MD
Professor of Medicine, Harvard Medical School
Professor in the Department of Epidemiology
Harvard T.H. Chan School of Public Health
Division of General Internal Medicine
Massachusetts General Hospital
Boston, MA, 02114
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation (AF) raises the risk of ischemic stroke 4-5-fold and this risk is largely reversible by oral anticoagulants (OAC). These facts are part of the core knowledge of internal medicine and the basis of multiple guidelines. They are based on studies of patients with persistent or predominantly “heavy burden” paroxysmal AF completed in the 1990s.
More recent studies using cardiac implantable devices (CIEDs: implantable defibrillators, pacemakers, etc) which have the capacity to monitor heart rhythm continuously have found that many older patients have brief, often undiagnosed, episodes of AF. Several of these studies have found that strokes occur during periods of sinus rhythm temporally distant from a preceding episode of AF. This has led to a widespread suspicion that AF is not a direct causal risk factor but a risk “marker” indicating the presence of other truly causal features like a diseased left atrium (atrial myopathy). If the risk marker hypothesis is correct, then long-term anticoagulation is needed even for brief and rare episodes of AF (assuming the patient’ s CHA2DS2-VASc score is high enough). The key problem with prior prospective studies using CIEDs was that only a small number of strokes were observed leading to inadequate statistical power.
Our study addressed this power problem by linking the very large Optum electronic health record database which could identify ischemic strokes with the Medtronic CareLink database of long-term, continuous heart rhythm records of patients with CIEDs. We ended up studying 891 individuals who had an ischemic stroke and had 120 days of continuous heart monitoring prior to the stroke.
Dr, Ferguson[/caption]
Michael Ferguson, PhD
Instructor in Neurology | Harvard Medical School
Lecturer on Neurospirituality | Harvard Divinity School
Center for Brain Circuit Therapeutics
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: Over 80% of the global population consider themselves religious with even more identifying as spiritual, but the neural substrates of spirituality and religiosity remain unresolved.
MedicalResearch.com: What are the main findings? Where is this circuit located in the brain? What other effects does this circuit control or influence?
Response: We found that brain lesions associated with self-reported spirituality map to a human brain circuit centered on the periaqueductal grey.
Dr. Salciccioli[/caption]
Justin Salciccioli, MBBS, MA
Research Fellow in Medicine
[caption id="attachment_57392" align="alignleft" width="150"]
Dr. Israel[/caption]
Elliot Israel, MD
Professor of Medicine, Harvard Medical School
Pulmonary and Critical Care, Rheumatology, Medicine
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: Asthma attacks account for almost 50% of the cost of asthma care, which costs $80 billion each year in the United States. Asthma is more severe in African-American/Black and Hispanic/Latinx patients, with these groups having double the rates of attacks and hospitalizations as the general population. The PREPARE study is an ongoing national clinical trial for African American/Black and Hispanic/Latinx adults with moderate-to-severe asthma from different U.S. cities in which reporting of asthma control and asthma exacerbations was monitored entirely remotely.
With the arrival of the Covid19 pandemic, several studies suggested that asthma exacerbations may have decreased during the pandemic. However, multiple reports have suggested people were avoiding health services because of the pandemic, making it difficult to tell whether exacerbations truly decreased or whether people were simply avoiding their doctors. This is the first study done to assess asthma exacerbations before and during the pandemic that is unlikely to be impacted by patient healthcare avoidance.