Cardiovascular Risk and Gout Treatment: Febuxostat v. Allopurinol

MedicalResearch.com Interview with:
“Gout in my foot” by vagawi  is licensed under CC BY 2.0Seoyoung C. Kim, MD, ScD, MSCE
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? What are the main findings? 

Response: Since patients with gout are at an increased risk of cardiovascular events, we wanted to examine comparative cardiovascular safety of the two most commonly used urate-lowering drugs – febuxostat and allopurinol.

Using claims data from US Medicare, we conducted a cohort study of 24,936 febuxostat initiators PS-matched to 74,808 allopurinol initiators.

We found the risk of the primary cardiovascular endpoint (MI or stroke) was similar between the two groups. Analyses on secondary endpoints as well as all-cause mortality showed similar findings except that febuxostat was associated with a modestly reduced risk of heart failure exacerbation among patients with preexisting heart failure. In our sensitivity analysis, the risk of all-cause mortality associated with long-term use of febuxostat v. allopurinol appears to be increased but statistically not significant.

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Red Meat Allergy Caused by Lone Star Tick Linked to Coronary Artery Disease

MedicalResearch.com Interview with:
“Lone Star Tick” by Katja Schulz is licensed under CC BY 2.0Jeffrey Wilson, MD, PhD

Research Fellow, Allergy & Immunology
University of Virginia 

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

Response: Galactose-α-1,3-galactose (α-Gal) represents an oligosaccharide that is present in mammalian products and is the causal allergen in a syndrome of delayed red meat allergy (commonly called α-Gal syndrome). Sensitization to this allergen has been linked to tick bites, specifically the lone star tick in the United States.

Thus, sensitization to α-Gal (and the prevalence of subjects with symptomatic red meat allergy) is relatively common where the lone star tick is common, i.e- the southeast.

For a variety of reasons we hypothesized that specific immune sensitization (which relates to IgE antibody production) to α-Gal would be a risk factor for coronary artery disease. To address this possibility we measured IgE specific to α-Gal in 118 adults subjects from central Virginia who had undergone advanced cardiac imaging with a technique called intravascular ultrasound. Out of the cohort 26% of the subjects in the study had the sensitivity to α-Gal.

The main finding was that subjects with the IgE sensitization to α-Gal had greater amounts of atherosclerosis, as well as atherosclerotic plaques with more unstable characteristics. This association was significant when controlled for traditional cardiovascular risk factors such as hypertension, diabetes and lipids levels.

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Tobacco Flavorings On Their Own May Cause Heart Disease

MedicalResearch.com Interview with:
“fathers day” by James Simkins is licensed under CC BY 2.0Jessica L. Fetterman, PhD

Assistant Professor of Medicine
Boston University School of Medicine

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

Response: In our study, we studied endothelial cells, the cells that line the inside of the blood vessels. We collected endothelial cells from smokers both who use menthol and non-menthol cigarettes are impaired compared to non-smokers and we could make the non-smoker cells look like the endothelial cells of smokers by treating with menthol or eugenol (provides a clove spice-flavoring).

To test a wider variety of commonly used flavoring additives, we treated cultured (outside of the body in a dish) endothelial cells with some of the most commonly used flavoring additives in tobacco products and at different concentrations/doses. We then evaluated the effects of flavoring additives by looking at measures of cell death, oxidative stress, inflammation, and the ability of the cells to produce nitric oxide, a cardio-protective chemical made by endothelial cells that is lost when the cells become damaged.

We found that the flavoring additives used in tobacco products like e-cigarettes are toxic to the cells that line the blood vessels (endothelial cells). Our works suggests that the flavoring additives used in tobacco products may be harmful to the cardiovascular system.

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Under New Lower Blood Pressure Guidelines, More Stroke Victims Would Survive

MedicalResearch.com Interview with:

Dr. Alain Lekoubou Looti, MD Msc Clinical Neurophysiology Department of Neurosciences College of Medicine Medical University of South Carolina

Dr. Lekoubou

Dr. Alain Lekoubou Looti, MD Msc
Clinical Neurophysiology
Department of Neurosciences
College of Medicine
Medical University of South Carolina

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

Response: Hypertension is strongly associated with stroke. Individuals who suffer a stroke are more likely to have another stroke. They also die at a rate twice as high as those who experience a first event. We have evidence that treating hypertension reduces the risk of recurrence stroke among stroke survivors.

Prior hypertension guidelines defined hypertension for a systolic blood pressure (top number) equal or greater than 140 and a diastolic blood pressure (lower number) equal or greater than 90. The American college of cardiology/American heart association have published a new guideline to help healthcare providers identify and treat blood pressure including among stroke survivors. The threshold to define blood pressure has been lowered to 130 for the top number and 80 for the lower number for everyone. Unlike the general population, pharmacological treatment for stroke survivors is now recommended for systolic blood pressure greater than or equal than 130 and diastolic blood pressure greater than or equal to 80. In the same line achieving a blood pressure of less than 130/80 mmHg in stroke survivors is now recommended. In the stroke community, there has been mounting evidence to suggest that achieving lower blood pressure goal was desirable. When the new guidelines were published, we could not wait any longer to see the impact of the new guidelines on the proportion of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target. We were also curious to see how the new guidelines would potentially affect mortality among stroke survivors. 

We have found that the new guidelines would result in a nearly 67% (from 29.9% to 49.8%) to relative increase in the proportion of U.S. stroke survivors diagnosed with hypertension and 54% (from 36.3% to 56%) relative increase in those not within the recommended BP target.  We have also found that if the new guidelines were applied, this would result in a 33% relative drop in mortality.  Continue reading

More Protein Associated With Moderate Increase in Heart Failure in Men (except for fish and eggs)

MedicalResearch.com Interview with:
“mmmm Meat” by Glen MacLarty is licensed under CC BY 2.0
Jyrki Virtanen, PhD
Adjunct professor of nutritional epidemiology
Heli Virtanen, MSc

University of Eastern Finland
Institute of Public Health and Clinical Nutrition
Kuopio, Finland 


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

Response: Previous studies have found that animal sources of protein may have an adverse impact on the risk of cardiovascular diseases, like myocardial infarct, whereas plant sources of protein have had an opposite impact.

In this study we investigated that how protein intake from different dietary sources is associated with developing heart failure in men during the study’s follow-up. During the mean follow-up time of about 22 years, 334 men developed heart failure.

The main finding of the study was that higher protein intake was associated with a moderately higher risk of heart failure and the findings were similar with protein from most dietary sources, although the association was stronger with protein from animal sources. Only protein from fish and eggs were not associated with the risk in our study. Continue reading

LPA Gene Variants Linked To Cardiac Events Despite Statins

MedicalResearch.com Interview with:

Wei-Qi Wei, MD, PhD Assistant Professor Department of Biomedical Informatics Vanderbilt University Nashville, TN 37203

Dr. Wei-Qi Wei

Wei-Qi Wei, MD, PhD
Assistant Professor
Department of Biomedical Informatics
Vanderbilt University
Nashville, TN 37203

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

Response: The study was motived by the clinical observation that some patients develop coronary heart disease events despite taking statins, one of our most effective drugs to reduce cardiovascular risk. We collected data within the eMERGE network of people taking statins and monitored them for development of coronary heart disease events over time.  We  conducted a genome-wide association study of those with events compared to those without events.

Our results showed that single nucleotide polymorphisms (SNPs) on the LPA gene were associated with a significantly increased risk of coronary heart disease events. Individuals with the variant were 50% more likely to have an event. More importantly, even among patients who achieved ideal on-treatment LDL cholesterol levels (<70 mg/dL), the association remained statistically significant.

We then did a phenome-wide association study to see if other diseases or conditions were associated with these LPAvariants. The major associated conditions were all cardiovascular. This sort of study can highlight potential other indications for a drug targeting this pathway and suggest potential adverse events that might be experienced from targeting this pathway. Clearly, more and larger studies will be needed to truly understand the potential risks and benefits of a future drug targeting this pathway.  Continue reading

Smoking: The Great Brain Drain

MedicalResearch.com Interview with:
“Stop smoking!” by Emil_95 is licensed under CC BY 2.0Janina Markidan MS III, MD Student

University of Maryland School of Medicine

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

Response: In a study of 1,145 young men, we found a strong dose-response relationship between the number of cigarettes smoked daily and the risk of ischemic stroke.

We categorized the participants as never smokers, former smokers and current smokers. Current smokers were divided into groups based on the number of cigarettes smoked daily, 1 to 10, 11 to 20, 21 to 39, or 40 or more.

We found that men who smoked were 88 percent more likely to have a stroke than men who never smoked. Among current smokers, men who smoked fewer than 11 cigarettes daily were 46 percent more likely to have a stroke than those who never smoked. But the heavier smokers, smoking at least two packs a day, were nearly 5 times (466%) more likely to have a stroke than those who never smoked.  Continue reading

Healthy Lifestyle Keys to a Longer Life

MedicalResearch.com Interview with:
Yanping Li PhD, Research Scientist
Department of Nutrition
Harvard T.H. Chan School of Public Health

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

Response: It is well known that a  healthy lifestyle is associated with less chance of premature mortality; however, it is not clear how much it will improve the longevity.

We are working on a quantity estimation of the prolonged life expectancy that could be potentially saved by a healthier lifestyle among US adults.

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

Response: Two key taking home message:

(1)    Each heathy lifestyle was associated with around 2-3 years of prolonged life expectancy. The more the healthy lifestyle factors, the longer of the life expectancy.

(2)    For each health lifestyle factor, the healthier of each lifestyle, the longer life expectancy would be.

There is not too less or too much of the healthy lifestyle, everybody should find the level that most suitable for themselves. There will be a great pay back of prolonged life expectancy with each small step toward a heathier lifestyle.

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

Response: Future research regarding how to be more healthier would be welcome, especially the practical strategies.

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

Citation:

Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population

Yanping Li, An Pan, Dong D. Wang, Xiaoran Liu, Klodian Dhana, Oscar H. Franco, Stephen Kaptoge, Emanuele Di Angelantonio, Meir Stampfer, Walter C. Willett, Frank B. Hu

https://doi.org/10.1161/CIRCULATIONAHA.117.032047
Circulation. 2018;CIRCULATIONAHA.117.032047
Originally published April 30, 2018

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

 

 

 

 

 

 

Stroke: Mr Clean Study of Endovascular Treatment

MedicalResearch.com Interview with:
J.H.L. Mulder, MD PhD
Neurology resident
Erasmus MC 

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

Response: Current information about safety and efficacy of endovascular treatment (EVT) for acute ischemic stroke is primarily derived from patients treated in the setting of a randomized controlled trial. However, inherent to this setting, external validity of the results can be jeopardized by patient selection and intensive monitoring.

Therefore, an important question remained unanswered: could the positive effect of endovascular treatment be reproduced in standard clinical practice?  Continue reading

Every Minute Counts! Short Bursts of Physical Activity Reduces Mortality

MedicalResearch.com Interview with:

Pedro F. Saint-Maurice, Ph.D. Postdoctoral Fellow Metabolic Epidemiology Branch Division of Cancer Epidemiology and Genetics National Cancer Institute, NIH, HHS Rockville, MD 20850

Dr. Saint-Maurice

Pedro F. Saint-Maurice, Ph.D.
Postdoctoral Fellow
Metabolic Epidemiology Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute, NIH, HHS
Rockville, MD 20850

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

 Response: The 2008 Physical Activity Guidelines for Americans recommends adults do 150 minutes/week of moderate intensity physical activity (PA) in increments of at least 10 minutes at a time. However, there is limited epidemiologic evidence supporting the use of the 10-minute increment and whether shorter increments (for instance walking up the stairs) can also be beneficial for health in adults. We looked at accelerometer-measured physical activity in roughly 5,000 adults (40 and older) representative of the US population and followed them prospectively (over 7 years) to determine whether physical activity accumulated in 10-minute increments, but also accumulated in shorter bursts, were associated with lower risk of death (mortality data came from the National Death Index). Continue reading