Metformin Associated With Lower Mortality in CKD, CHF and Chronic Liver Disease

MedicalResearch.com Interview with:

Matthew J. Crowley, MD, MHS Assistant Professor of Medicine Member in the Duke Clinical Research Institute Duke University Medical Center

Dr. Matthew Crowley

Matthew J. Crowley, MD, MHS
Assistant Professor of Medicine
Member in the Duke Clinical Research Institute
Duke University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although metformin is widely considered to be the first-line drug for type 2 diabetes, concerns about lactic acidosis have traditionally limited its use in some populations. However, FDA now indicates that metformin may be used safely for patients with mild-moderate chronic kidney disease and other historical contraindications like congestive heart failure. With the lactic acidosis question addressed for these groups, this review asked “what do we know about how metformin affects mortality and other outcomes for patients with historical contraindications and precautions?”

The main take-home message is that metformin appears associated with lower mortality in patients with mild-moderate chronic kidney disease, congestive heart failure, and chronic liver disease.

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Marital History Linked to Survival After Stroke

MedicalResearch.com Interview with:

Matthew E. Dupre, Ph.D. Associate Professor Department of Community and Family Medicine & Duke Clinical Research Institute (DCRI) Duke University

Dr. Mathew Dupre

Matthew E. Dupre, Ph.D.
Associate Professor
Department of Community and Family Medicine &
Duke Clinical Research Institute (DCRI)
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke.

We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses.

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Hearing Loss Linked To Increased Depression and Dementia Risk

MedicalResearch.com Interview with:

Dr-Frank-Lin.jpg

Dr. Lin

Frank Robert Lin, M.D., Ph.D.
Associate Professor of Geriatric Medicine, Head and Neck Surgery
Johns Hopkins Medicine

MedicalResearch.com Editor’s note: Dr. Lin discussed his research during Cochlear’s Global Research Symposium, which brought together international experts from the audiology community.

MedicalResearch.com: Is there a link between hearing loss and the risk of developing dementia?

Response: In the last few years, we have investigated the link between hearing loss and dementia in large studies of older adults who have been followed for many years. In these studies, we and others have found that those with greater hearing loss have a higher risk of developing dementia even after we account for factors like age, education, medical comorbidities, etc. We think this is because there are some pathways through which hearing loss can directly affect our thinking and memory abilities

MedicalResearch.com: Is there an association between hearing loss and cognitive decline or premature death?

Response: There is a link between hearing loss and accelerated cognitive decline. There is also external research that links hearing loss and premature death (Friburg 2014, Contrera 2015). Hearing loss can also increase a person’s chance of using medical and social services

MedicalResearch.com: How is hearing loss linked to increased social isolation and depression in the elderly?

Response: Older people with hearing loss are at a greater risk of social isolation due to their difficulty communicating with people. These individuals may be less likely to go out, particularly to settings where listening can be difficult (e.g., restaurants), and even if they do go out, they may feel isolated from the conversation and not able to engage with others.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should understand that we’re increasingly understanding that hearing loss can detrimentally impact our thinking and memory abilities, risk of dementia, and our ability to remain engaged with others. Ongoing research is now studying to what extent our current hearing loss therapies can reduce and mitigate these risks and promote healthy aging.

MedicalResearch.com: Is there anything else you would like to add?

Response: Readers should know that hearing loss is a growing public health issue. It has been estimated that by 2050 1.2 billion people will suffer from hearing loss, underscoring the need for us to address it and recognize the burden of hearing loss on wider health. To learn more visit,www.linresearch.org and www.nas.edu/hearing

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Cochlear’s Global Research Symposium October 2016

Disclosure:  Symposium supported by Cochlear Limited (ASX: COH), together with Macquarie University and the Australian Hearing Hub

www.cochlear.com

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Do People Wearing Activity Trackers Really Exercise More?

MedicalResearch.com Interview with:
Aarti Sahasranaman, PhD
Duke-NUS Gradaute Medical School
Singapore

MedicalResearch.com: What is the background for this study?

Response: More than half of adults in developed countries do not achieve recommended levels of physical activity. Despite the popularity of activity trackers as a tool for motivating and monitoring activity levels, little research exists on whether they can help people lead healthier lives, or if financial incentives could encourage people to wear them for longer and achieve higher fitness levels. One in ten US adults owns an activity tracker but research suggests that about a third of people abandon them within 6 months of purchase.

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Brain Scans Can Predict Specific Spontaneous Emotions

MedicalResearch.com Interview with:

Kevin S. LaBar, Ph.D. Professor and Head, Cognition & Cognitive Neuroscience Program Co-Director of Undergraduate Studies in Neuroscience Center for Cognitive Neuroscience Duke University Durham, NC

Dr. Kevin LaBar

Kevin S. LaBar, Ph.D.
Professor and Head, Cognition & Cognitive Neuroscience Program
Co-Director of Undergraduate Studies in Neuroscience
Center for Cognitive Neuroscience
Duke University
Durham, NC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Emotion research is limited by a lack of objective markers of emotional states. Most human research relies on self-report, but individuals may not have good insight into their own emotions. We have developed a new way to identify emotional states using brain imaging and machine learning tools. First, we induced emotional states using film and music clips while individuals were in an MRI scanner. We trained a computer algorithm to identify the brain areas that distinguished 7 emotions from each other (fear, anger, surprise, sadness, amusement, contentment, and a neutral state). This procedure created a brain map for each of the 7 emotions. Then, a new group of participants self-reported their emotional state every 30 seconds in an MRI scanner while no stimuli were presented. We could predict which emotion was spontaneously reported by the subjects by comparing their brain scans to each of the 7 emotion maps. Finally, in a large group of 499 subjects, we found that the presence of the fear map during rest predicted state and trait anxiety while the presence of the sadness map predicted state and trait depression.

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Most Gastric Bypass Patients Keep Weight Off After Surgery

MedicalResearch.com Interview with:

Matthew Leonard Maciejewski, PhD Professor in the Division of General Internal Medicine Department of Medicine Duke University School of Medicine Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care Durham VA Medical Center

Dr. Matt Maciejewski

Matthew Leonard Maciejewski, PhD
Professor in the Division of General Internal Medicine
Department of Medicine
Duke University School of Medicine
Research Career Scientist and Director of the Health Economics and Policy Unit in the Center for Health Services Research in Primary Care
Durham VA Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: No study based on a US cohort undergoing current procedures has examined weight change comparing surgical patients and nonsurgical patients for as long as we have. This is the first study to report 10-year outcomes on gastric bypass patients and compare them to matched patients who did not get surgery. At 1 year, gastric bypass patients lost 31% of their baseline weight compared controls who only lost 1.1% of their baseline weight. At 10 years, gastric bypass had lost 28% of their baseline weight.

We also compared weight loss at 4 years for Veterans who received the 3 most common procedures (gastric bypass, sleeve gastrectomy, and adjustable gastric banding). At 4 years, patients undergoing gastric bypass lost more weight than patients undergoing sleeve gastrectomy or gastric banding. Given that few high quality studies have examined sleeve gastrectomy to 4 years, the 4-year sleeve outcomes contribute to filling this important evidence gap as the sleeve gastrectomy is now the most commonly performed bariatric procedure worldwide.

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Persistent Postpartum Pain Linked To Higher Risk of Depression

MedicalResearch.com Interview with:
MS WEI DU, First author
Third Year Medical Student
DUKE-NUS Medical School and
DR BAN LEONG SNG, Senior Author
Senior Consultant Department of Women’s Anesthesia KK
Women’s and Children’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

MS WEI DU: We performed a cohort study involving 200 healthy women who received epidural pain relief during the deliveries of their firstborns to investigate the relationship between persistent childbirth pain, psychological and pain vulnerability with postnatal depression. Postnatal depression was evaluated using the Edinburgh Postnatal Depression Score (EPDS).

Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

DR BAN LEONG SNG: Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

MedicalResearch.com: What should readers take away from your report?

MS WEI DU: We concluded that greater pain vulnerability and stress during intrapartum period, and presence of persistent pain or higher anxiety during postpartum period are positively associated with higher scores on postnatal depression tests.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

DR BAN LEONG SNG: The research findings support the need to address pain comprehensively to lessen the risk of developing postnatal depression. We are currently conducting a larger study to evaluate the impact of pain and postnatal depression in pregnant women.

MedicalResearch.com: Is there anything else you would like to add?

DR BAN LEONG SNG: Postnatal evaluation and management of childbirth pain and postnatal depression is important in our care of mothers and their newborns.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

World Congress of Anaesthesiologists abstract discussing:

Persistent childbirth pain increases risk of postnatal depression

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Same Genes Predict Educational Attainment and Socioeconomic Success

MedicalResearch.com Interview with:

Daniel Belsky, PhD Assistant Professor of Medicine Duke University School of Medicine Durham, NC 27708

Dr. Daniel Belsky

Daniel Belsky, PhD
Assistant Professor of Medicine
Duke University School of Medicine
Durham, NC 27708

MedicalResearch.com: What is the background for this study?

Dr. Belsky: The genome-wide association study
(GWAS) of educational attainment by the Social Science Genetic Association Consortium was the first large-scale genetic investigation of a human social/behavioral trait. Follow-up studies, including studies some of us were involved in, established that the genetic signature uncovered by this GWAS was highly reproducible; people who carried more education-associated alleles completed more schooling—and this was true even when studies compared siblings in the same family. Because getting a good education requires many of the same skills and abilities needed to get ahead in life more generally, we hypothesized that the same genetics that predicted success in schooling would predict success in life.

To ask this question, we designed a study to do three things.
• First, we wanted to test if the genetics of success in schooling would predict social and economic success through midlife (better jobs, salaries, and credit scores, fewer financial problems, etc.).
• Second, if the genetics of educational success did predict broader economic outcomes, we wanted to test how this came about:
o When and how did differences develop between children whose genomes predicted more educational success and children whose genomes predicted less success?
o The goal of this analysis was to try and learn something about pathways to success – pathways that any child could take advantage of, regardless of their genetics.
• Third, we wanted to know what kinds of psychological characteristics linked genetics with behavior. The goal of this analysis was to begin building a bridge between statistical models of the genome and the biological mechanisms that connect DNA sequence with behavior.

MedicalResearch.com: What are the main findings?

Dr. Belsky: There are four major take home points:
(1) Genetic discoveries for educational attainment are not discoveries for education only. The same genetics predict socioeconomic success well beyond the completion of schooling.
(2) Genetic discoveries were associated with social mobility — children with higher polygenic scores tended to achieve more socioeconomic success even if they were born poor.
(3) The psychological characteristics that mediated genetic associations with life outcomes included intelligence, but also self-control and interpersonal skills, for example being friendly.
(4) The pattern of characteristics and behaviors that connects DNA sequence with life outcomes begins early in life and extends through adulthood. Kids with higher polygenic scores started talking and reading earlier, and they had higher IQ scores, more self-control, and were more skilled interpersonally. As they grew into adolescence and adulthood, they were more ambitious, more willing to move away from home in search of opportunity, more successful in attracting better educated and higher earning spouses, and better at managing their money.

MedicalResearch.com: What should readers take away from your report?

Dr. Belsky: Our research speaks to three audiences. To scientists — behavioral/social and genetic — our results highlight the need for interdisciplinary collaborations to untangle genetic influences on human outcomes. We found that children’s genes shaped the environments they grew up in, suggesting that social and behavioral scientists may need to pay more attention to genetics. We also found that genes influenced life outcomes through patterns of behavior that are also affected by environmental circumstances, suggesting that geneticists may need to pay more attention to the social and behavioral sciences.
To policy makers, our research highlights the importance of developing regulations for the use of genetic information. “Precision education” or other tailoring of environments to children’s genomes is not possible with the data we have in hand today. But our findings suggest that such data may someday become available. It is vital to have the conversation about what that might mean and how we will deal with it BEFORE it happens.
Finally, to the general public, our research emphasizes the small effects of known-genetics on important human outcomes. Our findings provide a provocative window into how our genes may shape our lives. But we can make only very weak predictions about how far a child can go in life based on their genes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Belsky: Two big questions are “How do children’s environments affect the relationship between their genomes and their outcomes as adults?” and “How may genetics linked to educational success affect adult health and aging?”

MedicalResearch.com: Is there anything else you would like to add?

Dr. Belsky: I was most surprised to find the very same genetics that predicted better cognitive and social functioning in children were unrelated to their physical health. When we tested if the polygenic score predicted children’s physical health – measured from repeated clinical exams across childhood – we found no association whatsoever.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

D. W. Belsky, T. E. Moffitt, D. L. Corcoran, B. Domingue, H. Harrington, S. Hogan, R. Houts, S. Ramrakha, K. Sugden, B. S. Williams, R. Poulton, A. Caspi. The Genetics of Success: How Single-Nucleotide Polymorphisms Associated With Educational Attainment Relate to Life-Course Development. Psychological Science, 2016; DOI:10.1177/0956797616643070

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Epigenetic Changes Link Environmental Deprivation to Depression

MedicalResearch.com Interview with:
Dr. Johnna Swartz, PhD
Postdoctoral researcher in the lab of Ahmad Hariri
Duke postdoctoral researcher in the lab of Ahmad Hariri

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Swartz: Prior research has shown that low socioeconomic status is a risk factor for the development of depression. In this study, we examined whether this risk factor was associated with changes in an epigenetic tag near the gene coding for the serotonin transporter, which has previously been linked to depression. We found that adolescents growing up in families with lower socioeconomic status accumulated more of these tags over time, which may lead to decreased gene expression. Moreover, we found that more of these tags were associated with increased activity in the amygdala, a brain region that plays an important role in the stress response.

Finally, we found that adolescents with increased activity in the amygdala were more likely to develop depression symptoms a year later, particularly if they had a close relative with a history of depression. This is some of the first research to draw a link from an environmental risk factor to changes in depression symptoms through changes in epigenetic markers and brain function.

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Medicare Patients May Have Better Outcomes with Carotid Endarterectomy Than Stenting

MedicalResearch.com Interview with:
Jessica J. Jalbert PhD
From the Division of Pharmacoepidemiology and Pharmacoeconomics
Department of Medicine, Brigham and Women’s Hospital
Harvard Medical School, Boston, MA
LASER Analytica
New York, NY

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Jalbert: Landmark clinical trials have demonstrated that carotid artery stenting (CAS) is a safe and efficacious alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. Clinical trials, however, tend to enroll patients that are younger and healthier than the average Medicare patient. We therefore sought to compare outcomes following CAS and CEA among Medicare patients.

MedicalResearch.com: What are the main findings?

Dr. Jalbert: We found that outcomes among real-world Medicare patients undergoing CAS and CEA were similar. While our results were inconclusive due to small sample size, we also found some evidence suggesting that patients over the age of 80 and those with symptomatic carotid stenosis may have better outcomes following carotid endarterectomy than CAS.

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PCSK9 Antibody May Revolutionize Treatment of Atherosclerosis and Acute Coronary Syndrome

MedicalResearch.com Interview with:

Paul A. Gurbel, M.D. Director, Inova Center for Thrombosis Research and Drug Development Director, Cardiovascular Medicine Research Director, Interventional Cardiology Inova Heart and Vascular Institute Falls Church, VA Professor of Medicine, Johns Hopkins University School of Medicine Adjunct Professor of Medicine, Duke University School of Medicine

Dr. Paul Gurbel

Paul A. Gurbel, M.D.
Director, Inova Center for Thrombosis Research and Drug Development
Director, Cardiovascular Medicine Research
Director, Interventional Cardiology
Inova Heart and Vascular Institute
Falls Church, VA
Professor of Medicine,
Johns Hopkins University School of Medicine
Adjunct Professor of Medicine,
Duke University School of Medicine 

MedicalResearch.com: What is the background for this review? What are the main findings?

Dr. Gurbel: In current practice, treatment with statins and antiplatelet agents is the primary strategy to reduce death and ischemic cardiovascular events following ACS (acute coronary syndrome)/PCI. Immediately following ACS, many patients are incompletely responsive to potent current therapy and remain at high risk for recurrent thrombotic events. Treatment with monoclonal antibodies that target proprotein convertase subtilisin/kexin type 9 (PCSK9) is a new potent lipid lowering therapy. Recent studies have shown that PCSK9 antibodies combined with statins provided marked additional benefits in reducing atherogenic lipid fractions. In a recent meta-analysis, PCSK9 antibody therapy was also associated with a reduction in mortality and no increase in serious adverse events. In the current Narrative Review, we focused on novel pathways affected by PCSK9 antibodies that may make them appropriate for immediate treatment in patients with acute coronary syndrome.

MedicalResearch.com: What are the main findings?

Dr. Gurbel: PCSK9 antibodies, in addition to markedly reducing LDL levels, may also reduce pro-inflammatory oxidized LDL levels and platelet function. The latter properties, in addition to plaque stabilization, may provide antithrombotic properties favorably influencing clinical outcomes following acute administration at the time of  acute coronary syndrome.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Gurbel: In addition to a potent lipid lowering effect, PCSK9 antibody therapy when administered immediately at the time of acute coronary syndrome in addition to standard statin and antiplatelet therapy may provide additional antithrombotic effects. The latter novel properties of PCSK9 antibodies may be associated with improved patient outcomes. However, at this time there is no direct evidence for recommending PCSK9 antibody therapy in patients at the time of presentation with acute coronary syndrome .

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Gurbel: A large scale randomized study assessing the clinical effects of PCSK9 antibody therapy on top of current statin and antiplatelet therapy is needed. In addition, mechanistic studies to further delineate anti-inflammatory and antithrombotic effects of PCSK9 antibody therapy are also needed.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Gurbel: PCSK9 antibody therapy provides marked lowering of LDL. The latter property may revolutionize the treatment of patients with atherosclerosis. The potential antithrombotic effects of PCSK9 antibody therapy, in turn, may revolutionize acute therapy of ACS. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Navarese EP, Kołodziejczak M, Kereiakes DJ, Tantry US, O’Connor C, Gurbel PA. Proprotein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies for Acute Coronary Syndrome: A Narrative Review. Ann Intern Med. [Epub ahead of print 22 March 2016] doi:10.7326/M15-2994

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Dr. Paul Gurbel (2016). PCSK9 Antibody May Revolutionize Treatment of Atherosclerosis and Acute Coronary Syndrome MedicalResearch.com

Risk/Benefits of Sildenafil For Swimming-Induced Pulmonary Edema

MedicalResearch.com Interview with:

Richard Moon, MD, CM, MSc, FRCP(C), FACP, FCC Medical Director, Hyperbaric Center Professor of Anesthesiology Department / Division Anesthesiology / GVTU Division Medicine / Pulmonary Duke University School of Medicine

Dr. Richard Moon

Richard Moon, MD, CM, MSc,
FRCP(C), FACP, FCCP

Medical Director, Hyperbaric Center
Professor of Anesthesiology
Department / Division
Anesthesiology / GVTU Division
Medicine / Pulmonary
Duke University School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Moon: This study was performed to investigate the reason why young, fit individuals develop a condition usually associated with severe heart disease: pulmonary edema. Immersion pulmonary edema (also known as swimming-induced pulmonary edema, SIPE) develops in certain susceptible individuals while swimming or scuba diving, usually in cold water. Some SIPE-susceptible people include highly conditioned triathletes and Navy SEAL trainees. The prevalence of SIPE in triathletes is around 1.5%, and in open sea swimming trials in naval special forces trainees has been reported to be 1.8-60%. SIPE often requires hospitalization and has caused death.

Medical Research: What should clinicians and patients take away from your report?

Dr. Moon: We directly measured arterial pressure, pulmonary artery pressure (PAP) and PA wedge pressure (PAWP) during submersed exercise in cold water. We found that both PAP and PAWP were higher in swimming-induced pulmonary edema-susceptible individuals compared with a group of volunteers of similar age who had never experienced SIPE. This confirmed that SIPE is a form of hemodynamic pulmonary edema, which is curious since all of the people we studied had normal hearts. We hypothesized that the cause could be differences between the groups in venous tone or LV diastolic compliance. When we retested the SIPE-susceptibles under the same conditions after a dose of sildenafil, pulmonary artery pressures were decreased, with no adverse effects on hemodynamics. We concluded that by dilating pulmonary vessels and systemic venous sildenafil could be an effective prophylaxis against SIPE.  Continue reading