Wearable Device Study Confirms Moderate-to-Vigorous Physical Activity Linked To Decreased Mortality

MedicalResearch.com Interview with:

I-Min Lee, MD, ScD Professor of Medicine, Harvard Medical School Professor of Epidemiology, Harvard T.H. Chan School of Public Health Brigham and Women's Hospital Boston, MA 02215

Dr. Lee

I-Min Lee, MD, ScD
Professor of Medicine, Harvard Medical School
Professor of Epidemiology, Harvard T.H. Chan School of Public Health
Brigham and Women’s Hospital
Boston, MA 02215

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

Response: The fact that physical activity lowers the risk of premature mortality is not a new fact – we have many studies showing this.  However, previous studies have primarily relied on self-reported physical activity, and self-reports tend to be imprecise.  Based on these self-report studies, we know that physical activity is associated with a 20-30% reduction in mortality rates.  And, these self-report studies also have focused on moderate-to-vigorous intensity physical activity, since they are more reliably reported than lighter intensity activity.  We have little information on whether light-intensity activities (e.g., light household chores, very slow walking such as when strolling and window shopping) are associated with lower mortality rates.

We now have “wearables” – devices that can more precisely measure physical activity at low (as well as higher) intensities, and sedentary behavior.  The present study, conducted between 2011 and 2015, investigated a large cohort of older women (n=16,741; mean age, 72 years)  who were asked to wear these devices for a week – thus, providing detailed physical activity and sedentary behavior measures.  During an average follow-up of about two-and-a-half years, 207 women died.  The study confirmed that physical activity is related to lower mortality rates.

What is new and important is how strong this association is when we have more precise measures of physical activity – the most active women had a 60-70% reduction in mortality rates, compared with the least active, during the study.  For context, non-smokers have about a 50% risk reduction, compared to smokers, which is why patients (and doctors) should pay attention to being physically active.

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Hormones Affect Carotid Plaque Stability and Stroke Vulnerability

MedicalResearch.com Interview with:

Marija Glisic Epidemiology, Erasmus MC

Marija Glisic

Marija Glisic
Epidemiology, Erasmus MC 

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

Response: Carotid atherosclerosis is one of most important risk factors for developing stroke. Carotid atherosclerotic plaques characterized by lipid core presence and intraplaque haemorrhage are considered to be unstable, and therefore more prone to rupture and lead to consequent stroke. Sex differences have been observed in carotid plaque composition as well as in stroke incidence. Sex hormones, particularly estrogen and testosterone actions are suggested to underlie the observed sex differences in atherosclerosis. Experimental evidence suggests a direct action of estradiol and testosterone on the vascular system, affecting various mechanisms that may impact plaque composition and subsequently stroke risk.

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In Euthyroid Individuals, Higher Free Thyroid Levels Linked To Greater Risk of Atrial Fibrillation

MedicalResearch.com Interview with:
Christine Baumgartner MD
Inselspital
Universitätsspital Bern
Bern, Switzerland
Research Fellow, Division of Hospital Medicine
UCSF

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

Response: Overt and subclinical hyperthyroidism increase the risk of atrial fibrillation, but it is unclear whether subclinical hypothyroidism, which is known to increase cardiovascular events, or thyroid function in the normal range are also associated with incident atrial fibrillation. Given the high prevalence of atrial fibrillation and its associated morbidity and mortality, identifying potentially modifiable risk factors is important. Therefore, we aimed to assess the risk of atrial fibrillation in individuals with subclinical hypothyroidism or variations of thyroid function within the normal range.

Our main findings are that higher free thyroxine levels are associated with an increased risk of atrial fibrillation in euthyroid individuals, but thyroid-stimulating hormone levels within the euthyroid or subclinical hypothyroid range was not related to atrial fibrillation risk.

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Interventional Cardiologists Can Face Risks To Brain From Unprotected Radiation Exposure

MedicalResearch.com Interview with:

Dr. Maria Grazia Andreassi

Dr. Andreassi

Dr. Maria Grazia Andreassi, PhD
Director, Genetics Research Unit
CNR Institute of Clinical Physiology, Pisa- Italy

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

Response: In recent years, there has been a growing concern about the health risks for contemporary interventional cardiologists who have a high and unprecedented levels of occupational ionizing radiation (IR) exposure. Because dysregulation of microRNAs (miRNAs) have been shown in many human diseases, we investigated the differential expression of miRNAs in the plasma of interventional cardiologists professionally exposed to IR and unexposed controls.

In this study, our microarray analysis with 2,006 miRNAs and subsequent validation identified brain-specific miR-134 as one of the miRNAs that is highly dysregulated in the response to ionizing radiation exposure, supporting the notion that the brain damage is one of the main potential long-term risks of unprotected head irradiation in interventional cardiologists, with possible long-lasting cognitive consequences. Indeed, miR-134 was first identified as a brain-specific miRNA, which is involved in synapse development and directly implicated in learning and memory.

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Tall Height Is a Risk Factor For Venous Thromboembolism

MedicalResearch.com Interview with:
Bengt Zöller, MD, PhD
Associate professor in Internal Medicine
Specialist Physician in Clinical Chemistry
Specialist Physician in Family Medicine
Lund University/ Region Skåne
Center for Primary Health Care Research
University Hospital, Malmö, Sweden

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

Response: Previous studies have suggested an association between height and venous thromboembolism but association might be confounded. We therefore permed a Nationwide study including a cohort of siblings -a co sibling analysis to adjust for familial confounders (genetic and shared familial environmental factors).

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Familial Hypercholesterolemia: “Junk” RNA May Facilitate Gene Therapy

MedicalResearch.com Interview with:

Tamer Sallam, MD PhD Assistant Professor of Medicine Co-Director UCLA Center for Lipid Management Lauren B. Leichtman and Arthur E. Levine CDF Investigator Assistant Director, STAR Program Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles, California 90095-1679 

Dr. Sallam

Tamer Sallam, MD PhD
Assistant Professor of Medicine
Co-Director UCLA Center for Lipid Management
Lauren B. Leichtman and Arthur E. Levine CDF Investigator
Assistant Director, STAR Program
Division of Cardiology, Department of Medicine
David Geffen School of Medicine at UCLA
Los Angeles, California 90095-1679

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

Response: This study is extension of our previous work published in Nature showing that a gene we named LeXis (Liver expressed LXR induced sequence) plays an important role in controlling cholesterol levels. What is unique about  LeXis is that it belongs to a group of newly recognized mediators known as long noncoding RNAs. These fascinating factors were largely thought to be unimportant and in fact referred to as “junk DNA” prior the human genome project but multiple lines of evidence suggest that they can be critical players in health and in disease.

In this study we tested whether we can use  LeXis “gene therapy”  to lower cholesterol and  heart disease risk. This type of approach is currently approved or in testing for about 80 human diseases.

Our finding was that a single injection of LeXis compared with control significantly  reduced heart disease burden in mouse subjects. Although the effect size was moderate we specifically used a model that mimics a very challenging to treat human condition known as familial hypercholesterolemia..Familial hypercholesterolemia is one of the most common genetic disorders affecting up to 2 million Americans and characterized by 20 fold  fold increase risk of early heart attacks and often suboptimal response to currently available treatments.

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Children from Socially and Economically Disadvantaged Families Have Increased Cardiovascular Risks

MedicalResearch.com Interview with:
Lead author, Dr Richard Liu, MCRI Ph.D. student and
Senior author – Professor David Burgner PhD
The Child Health CheckPoint Investigator Group
Murdoch Children’s Research Institute
The Royal Children’s Hospital
Parkville, Victoria, Australia

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

Response: The socioeconomic gradient in cardiovascular disease is well recognised in adults. The more disadvantaged someone is, the higher their risk of heart attack and stroke. The mechanisms by which this occurs are not well understood, but we know the pathological process underlying this, thickening of the arteries, or atherosclerosis, begins very early in life. Our current understanding of the early development of atherosclerosis has previously been limited mainly to autopsy studies. Non-invasive imaging is increasingly being used to examine the early development of atherosclerosis.

We wanted to determine if there was an association between socioeconomic disadvantage and the thickness of the carotid artery wall in mid-childhood, which in adults is a proxy for atherosclerosis and indicates higher risk for heart attack and stroke in later life. We analysed both family and neighbourhood socioeconomic position data from 1477 Australian families, which included data on income, education and occupation of parents, as well as the relative socioeconomic status of the immediate neighbourhood.

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Obesity Paradox: Overweight and Mildly Obese Stroke Patients Have Better Prognosis

MedicalResearch.com Interview with:

Hugo J. Aparicio, MD, MPH Assistant Professor Vascular Neurology, Department of Neurology Investigator, The Framingham Heart Study www.framinghamheartstudy.org Boston University School of Medicine Boston, MA 02118-2526

Dr. Aparicio

Hugo J. Aparicio, MD, MPH
Assistant Professor
Vascular Neurology, Department of Neurology
Investigator, The Framingham Heart Study
www.framinghamheartstudy.org
Boston University School of Medicine
Boston, MA 02118-2526

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

Response: The association of body weight with survival after stroke has been studied before and is a controversial topic. Results have varied between studies and have often been contradictory. The observational findings that carrying extra weight can be protective after having a disease, like stroke or heart attack, has been called an obesity paradox, since obesity in itself is a risk factor for cardiovascular disease and mortality in the general population. Stroke research has focused on hospitalized stroke patients with weight measured at the time of the stroke. BMI is often missing in this group of patients, especially when a stroke is severe or the patients cannot report their weight. In the FHS we have data regarding weight prior to stroke, obtained during regularly scheduled research exams, with multiple data points on body weight and vascular risk factors over time. All before the stroke occurs. And have also compared survival outcomes with a group of control participants, those without stroke, to see if the so-called ‘obesity paradox’ is a non-specific finding seen in older adults or seen specifically in stroke patients.

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Increase In Risk Factors Contribute To More Strokes in Rural Areas

MedicalResearch.com Interview with:

George Howard, Dr.PH PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study Department of Biostatistics University of Alabama at Birmingham Birmingham, AL

Dr. Howard

George Howard, Dr.PH
PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Department of Biostatistics
University of Alabama at Birmingham
Birmingham, AL

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

Response: Rural areas have been known to have a higher death rate than urban, and higher death from stroke in rural areas is a major contributor to this disparity.

The goal of the research was to assess if the higher deaths from stroke was because rural people are more likely to have a stroke, or more likely to die from a stroke once it occurs.   This distinction is critically important, since intervention to reduce stroke deaths in rural area would focus on stroke prevention if the former, but would focus on improving stroke care (after the stroke) if the latter.

We found that the higher mortality from stroke appears to be almost completely due to more people having stroke.   As such, we need to focus on efforts to reduce the risk of rural areas.   While there are well-documented differences in stroke care between urban and rural areas, resolving these differences will not be likely reduce the rural excess death from stroke.

It would seem that the higher risk of having a stroke could be due to the observation that those in rural areas are more likely to have major stroke risk factors, including hypertension, diabetes and cigarette smoking; however, the higher prevalence of these risk factors don’t seem to explain the higher risk.   So what causes the higher risk remains a mystery.

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Cirrhosis May Raise Risk of Hemorrhagic Stroke

MedicalResearch.com Interview with:
Neal S. Parikh, M.D.
Administrative Chief Resident
Department of Neurology
Weill Cornell Medicine & NewYork-Presbyterian Hospital

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

Response: In contrast to the gastrointestinal and systemic hemorrhagic and thrombotic complications of cirrhosis, little was known about the risk of cerebrovascular complications.

In this analysis of Medicare beneficiaries’ claims data, we found cirrhosis to be associated with stroke, with associations appearing to be stronger for hemorrhagic stroke than for ischemic stroke. We controlled for demographic variables and stroke risk factors and relevant comorbidities, and our results were essentially unchanged in multiple sensitivity analyses.

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Acupuncture Therapy and Incidence of Depression After Stroke

MedicalResearch.com Interview with:
Chung-Yen Lu, MD, PhD

Assistant Professor
Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan; Department of Chinese Medicine, Taipei Hospital, Ministry of Health and Welfare,
New Taipei, Taiwan 

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

Response: Post-stroke depression is a common mood complication of patients with stroke and may deteriorate motor function and cognitive function. Acupuncture therapy is an alternative and supplementary medical care often used worldwide. Previous studies have reported that acupuncture therapy for post-stroke depression may involve multiple therapeuticeffects including treating neurological disorders and physical disabilities following stroke, which are predictors of post-stroke depression. However, population-based evaluations on the association between acupuncture treatment and prevention of post-stroke depression are rare.  Continue reading

Most Strokes In Women With Preeclampsia During Pregnancy Occur After Delivery

MedicalResearch.com Interview with:

Eliza Miller, M.D. Vascular neurology fellow New York-Presbyterian Hospital/Columbia University Medical Center New York City

Dr. Eliza Miller

Eliza Miller, M.D.
Vascular neurology fellow
New York-Presbyterian Hospital/Columbia University Medical Center
New York City 

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

Response: Preeclampsia is a common disorder that causes high blood pressure during pregnancy. It affects about 1 in 20 pregnant women. Women with preeclampsia are at higher risk for stroke during pregnancy and post-partum, but it’s very difficult to predict who is going to have a stroke. Our study looked at a large dataset of billing data from New York State, and compared women who had preeclampsia and strokes to women who had preeclampsia but did not have a stroke.

We found that preeclamptic women with urinary tract infections, bleeding or clotting disorders, or preexisting high blood pressure were at higher risk of having strokes during pregnancy or postpartum.

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Normalizing Testosterone With Replacement Therapy Reduced Atrial Fibrillation Risk

MedicalResearch.com Interview with:

Rajat S. Barua, MD; PhD; FACC; FSCAI Associate Professor of Medicine (Cardiology), University of Kansas School of Medicine Director, Cardiovascular Research, Dept. of Cardiology, Kansas City VA Medical Center Director, Interventional Cardiology & Cardiac Catheterization Laboratory Kansas City VA Medical Center

Dr. Barua

Rajat S. Barua, MD; PhD; FACC; FSCAI
Associate Professor of Medicine (Cardiology), University of Kansas School of Medicine
Director, Cardiovascular Research, Dept. of Cardiology, Kansas City VA Medical Center
Director, Interventional Cardiology & Cardiac Catheterization Laboratory
Kansas City VA Medical Center

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

Response: Atrial fibrillation is the most common cardiac arrhythmia worldwide, with significant morbidity, mortality and financial burden. Atrial fibrillation is known to increase with age and is higher in men than in women. Although the underlying mechanisms of this sex difference are still unclear, one preclinical and several small clinical studies have suggested that testosterone deficiency may play a role in the development of atrial fibrillation. To date, no studies have investigated the effect of testosterone-level normalization on incidence of new atrial fibrillation in men after testosterone replacement therapy.

In this study, we investigated the incidence of atrial fibrillation in hypogonadal men with documented low testosterone levels. We compared the incidence of atrial fibrillation among patients who did not receive any testosterone replacement therapy, those who received testosterone replacement therapy that resulted in normalization of total testosterone, and those who received testosterone replacement therapy but that did not result in normal total testosterone levels.

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SPRINT Trial: Intensive Blood Pressure Control Reduces Risk of LVH

MedicalResearch.com Interview with:

Elsayed Z. Soliman MD, MSc, MS, FAHA, FACC Director, Epidemiological Cardiology Research Center (EPICARE) Professor, Department of Epidemiology and Prevention Professor, Department of Internal Medicine, Cardiology Section Wake Forest School of Medicine Medical Center Blvd, Winston Salem, NC 27157

Dr. Soliman

Elsayed Z. Soliman MD, MSc, MS, FAHA, FACC
Director, Epidemiological Cardiology Research Center (EPICARE)
Professor, Department of Epidemiology and Prevention
Professor, Department of Internal Medicine, Cardiology Section
Wake Forest School of Medicine
Medical Center Blvd, Winston Salem, NC 27157

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

Response: We already know that left ventricular hypertrophy (LVH, which is the most common complication of high blood pressure, is associated with an increased risk of cardiovascular disease (CVD). We also know that successful management of high blood pressure (BP) leads to regression of LVH and improved CVD outcomes in patients with hypertension. However, it is unknown whether intensive BP lowering beyond that recommended would reduce the risk of LVH in patients with hypertension, and whether reducing the risk of LVH explains the reported CVD benefits of intensive BP lowering in this population. Therefore, we examined the differential impact of intensive BP lowering (target systolic BP (SBP).

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Improving Statin Adherence Would Reduce Need For Expensive PCSK9 Inhibitors

MedicalResearch.com Interview with:
Julia M. Akeroyd, MPH

Center for Innovations in Quality, Effectiveness, and Safety (IQuESt)
Michael E. DeBakey Veteran Affairs Medical Center
Salim S Virani, MBBS, Ph.D.
Baylor College of Medicine

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

Response: In the recently published Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) trial, treatment with evolocumab resulted in a 15% relative (1.5% absolute) risk reduction of major cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD) at a median follow-up of 2.2 years. Given the high cost of evolocumab, there is a need to identify what proportion of ASCVD patients would qualify for evolocumab based on FOURIER entry criteria and how eligibility would change if maximal doses of evidence-based lipid lowering therapies were required.

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Three Distinct Cardiac Stem Cell Populations Isolated from a Single Human Heart Biopsy

MedicalResearch.com Interview with:

Megan M. Monsanto, B.S. Joint Doctoral Student Department of Cell and Molecular Biology San Diego State University & University of California San Diego

Megan Monsanto

Megan M. Monsanto, B.S.
Joint Doctoral Student
Department of Cell and Molecular Biology
San Diego State University &
University of California San Diego

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

Response: In the field of cardiovascular research there is ongoing debate regarding the optimal cell population(s) to use for the treatment of patients with heart failure. A major reason being, the lack of understanding of the actions and synergism between distinct myocardial-derived stem cell populations. This prompted our group to establish a protocol to isolate multiple stem cell populations from a single human myocardial tissue sample that will allow for the discovery of new insights at the cellular level, with the ultimate goal being to achieve true myocardial regeneration upon injection back into the patient.

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Blood Pressure Medications In Elderly Require Personalized Approach

MedicalResearch.com Interview with:

Dr. Rathi Ravindrarajah PhD Division of Health and Social Care Research Faculty of Life Sciences & Medicine  Guy’s Campus King’s College London

Dr. Ravindrarajah

Dr. Rathi Ravindrarajah PhD
Division of Health and Social Care Research
Faculty of Life Sciences & Medicine
Guy’s Campus
King’s College London

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

Response: Clinical trials show that it is beneficial to lower systolic blood pressure (SBP) in adults aged 80 and over, but non-randomized epidemiological studies suggest that lower systolic blood pressure may be associated with a higher risk of mortality.

Our main findings were that there was a terminal decline in systolic blood pressure in the final 2 years of life suggesting that the higher mortality in those with a low SBP shown in non-randomized epidemiological studies might be due to reverse causation.

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Effects of ICD Shock and Anti-Tachycardia Pacing on Anxiety and Quality of Life

MedicalResearch.com Interview with:
Alessandro Paoletti Perini, MD, PhD and

Valentina Kutyifa MD, PhD
University of Rochester Medical Center
Heart Research Follow-Up Program
Rochester, New York, 14642

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

Response: The present study is a pre-specified sub-study of the Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT), which was published on the New England Journal of Medicine in 2012. The main trial showed that innovative ICD programming was associated with reduction in inappropriate ICD therapy and mortality.

In the present investigation we focused on the detrimental effects that ICD firings, either appropriate or inappropriate, may have on patients’ psychological well-being.

We observed that multiple appropriate and inappropriate shocks are associated with increased levels of ICD-related anxiety, a specific kind of psychological disorder which affects patients implanted with an ICD. Multiple appropriate ATP were also proved associated with higher anxiety, although not as much as shocks. On the other hand, we did not find a significant association with anxiety for multiple inappropriate ATP.

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Discovery of New Gene That Causes Sudden Death in Young Athletes

MedicalResearch.com Interview with:
Lia Crotti, MD, PhD

Department of Cardiovascular, Neural and Metabolic Sciences
San Luca Hospital
IRCCS Istituto Auxologico Italiano

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

Response: Sudden cardiac death in one of the major cause of death in Western Countries and among the causes of these deaths in young people under the age of 35, inherited forms of cardiomyopathy have a prominent role. Among these cardiomyopathies, Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) plays a major role. In ARVC, the heart tissue is replaced by fatty and fibrous tissue. This process encourages the development of life-threatening arrhythmias, such as ventricular fibrillation, that causes a cardiac arrest and sudden death in few minutes without a ready device to shock the heart. Intense physical activity favors the progression of the disease and arrhythmias are frequently triggered by adrenergic activation: those are the reason why young athletes with this disease are at high risk.

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Natural History of Ruptured But Untreated Intracranial Aneurysms

MedicalResearch.com Interview with:
Dr. Miikka Korja
Chief Innovation Officer
Neurosurgeon
Associate Professor of Neurosurgery
HUS, Helsinki University Hospital

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

Response: Helsinki University Hospital, one of the largest hospital organizations in industrialized countries, has a very long history in conducting studies on brain aneurysms and aneurysmal subarachnoid hemorrhage. The one and only study on the natural history of ruptured aneurysms has also been conducted in Helsinki 50 years ago (published in 1967). The term “natural history” refers to an approach where the cause of a patient’s disease is not treated at all. In this case, it means that ruptured aneurysms in patients with devastating brain hemorrhage, aneurysmal subarachnoid hemorrhage, were left untreated.

Therefore, these patients have a high risk of a rebleeding from the once ruptured aneurysm. As ruptured aneurysms are nowadays unexceptionally treated, if the patient survives the primary bleeding event, such natural history studies are impractical to conduct.

We wanted to update the 50 years old data by using a historical patient registry. Back in the old days, many of aneurysmal subarachnoid hemorrhage patients were not treated because for example surgery was considered too risky or patients were classified as too old for surgery. By using the historical data, we showed that aneurysmal SAH, if not treated, is even more devastating disease than believed. Based on our results, we can state that 75-89% of today’s patients die in a year without treatments.

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Aspirin Desensitization in Patients With Coronary Artery Disease

MedicalResearch.com Interview with:

Roberta Rossini, MD, PhD USC Cardiologia, Cardiovascular Department Bergamo, Italy

Dr. Rossini

Dr. Roberta Rossini, MD, PhD
USC Cardiologia, Cardiovascular Department
Bergamo, Italy 

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

Response: Aspirin (ASA) is stilll the cornerstone of antithrombotic therapy in patients with coronary artery disease, especially after PCI, both

in the acute and the chronic phase of treatment. However, ≈2% of patients have hypersensitivity to ASA. ASA desensitization may represent a valid approach. Desensitization protocols generally involve gradual increases in patient exposure to ASA with the goal of mitigating or abolishing immune-mediated reaction. However, many desensitization protocols require several days to be completed, making them unpractical. This may also contribute to the limited experience with applying ASA desensitization protocols in real-world practice in patients with CAD.

We previously reported the results of a pilot investigation supporting the feasibility of performing a rapid (<6 hours)

Aspirin desensitization protocol in patients undergoing PCI with stent implantation (Rossini R, Angiolillo DJ, Musumeci G, Scuri P, Invernizzi P, Bass TA, Mihalcsik L, Gavazzi A. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol. 2008;101:786–789. doi: 10.1016/j.amjcard.2007.10.045). The encouraging findings from our pilot feasibility investigation prompted the design of a larger scale multicenter investigation aimed to assess the safety and efficacy of a rapid aspirin  desensitization protocol in patients with a history of ASA hypersensitivity undergoing coronary angiography.

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Paracardial Fat Linked To Postmenopausal Coronary Artery Calcification

MedicalResearch.com Interview with:

Samar R. El Khoudary, Ph.D., M.P.H. Assistant professor Department of Epidemiology University of Pittsburgh Graduate School of Public Health

Dr. El Khoudary,

Samar R. El Khoudary, Ph.D., M.P.H.
Assistant professor
Department of Epidemiology
University of Pittsburgh Graduate School of Public Health

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

Response: Our study revealed a previously unknown, menopause-specific indicator of heart disease risk. For the first time, we’ve pinpointed the type of heart fat, linked it to a risk factor for heart disease and shown that menopausal status and estrogen levels are critical modifying factors of its associated risk in women.

My team evaluated clinical data, including blood samples and heart CT scans, on 478 women from Pittsburgh and Chicago enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were in varying stages of menopause, averaged 51 years old and were not on hormone replacement therapy.

In a previous study, we showed that a greater volume of paracardial fat, but not epicardial fat, after menopause is associated with a decline in the sex hormone estradiol—the most potent estrogen—in women. The higher volume of epicardial fat was tied to other risk factors, such as obesity.

In the new study, we built on those findings to discover that not only is a greater paracardial fat volume specific to menopause, but—in postmenopausal women and women with lower levels of estradiol—it’s also associated with a greater risk of coronary artery calcification, an early sign of heart disease that is measured with a heart CT scan.

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Medtronic Pipeline Embolization Device Found Safe For Smaller Aneurysms

MedicalResearch.com Interview with:

Ricardo A Hanel, MD PhD Endovascular and Skull Base Neurosurgery Director, Baptist Neurological Institute Endowed Chair, Stroke and Cerebrovascular Surgery Jacksonville, FL

Dr. Hanel

Ricardo A Hanel, MD PhD
Endovascular and Skull Base Neurosurgery
Director, Baptist Neurological Institute
Endowed Chair, Stroke and Cerebrovascular Surgery
Jacksonville, FL

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

Response: Medtronic Pipeline Embolization Device has been approved for carotid artery aneurysms over 10mm in size, from the petrous to clinoid segment but given the efficacy of results on these larger lesions, it has been widely utilized for treatment of smaller lesions. PREMIER came from the need of assessing the results , safety and efficacy, of pipeline for use of aneurysms under 12mm, located on the carotid artery, all segments, and V3 segment of the vertebral artery.
PREMIER enrolled 141 patients treated at 22 centers (21 US, 1 Canada). Primary Safety effectiveness defined as total aneurysm occlusion, core lab adjudicated , at 1 year was 83.5%; with safety endpoint of major stroke/death at 30 days of 1.4% (2 patients), with 1-year major stroke and death rate of 2.1%.

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Intensive Systolic Blood Pressure Control Would Risk Side Effects But Save Lives

MedicalResearch.com Interview with:

Dr. Adam Bress, PharmD, MS. Assistant Professor, Population Health Sciences Division of Health System Innovation and Research University of Utah

Dr. Adam Bress

Dr. Adam Bress, PharmD, MS.
Assistant Professor, Population Health Sciences
Division of Health System Innovation and Research
University of Utah

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

  • Observational studies show a strong and graded association between higher blood pressure, beginning at 115 mm Hg systolic, and increased cardiovascular disease events.
  • Despite this, hypertension is diagnosed and treated among people with a blood pressure threshold, typically 140/90 mm Hg SBP/DBP.
  •  Until recently, randomized trials did not provide definitive evidence supporting lower SBP goals in high-risk sub-populations.
  • The Systolic Blood Pressure Intervention Trial showed that among U.S. adults at high cardiovascular disease risk but without diabetes, stroke, or heart failure, treating to a systolic blood pressure goal of 120 mm Hg compared to the standard goal of 120 mm Hg compared to the standard goal of <140 mm Hg, resulted in a 27 % reduction in all-cause mortality.
  • However, intensive treatment cause a higher rate of treatment-related serious adverse events (SAEs).

MedicalResearch.com: What are the main findings?

  • To quantify the potential benefits and risks of SPRINT intensive goal implementation, we estimated the deaths prevented and excess SAEs incurred if the SPRINT intensive SBP goal (i.e., – Based on population estimates of U.S adults that would have been eligible for the SPRINT trial and their observed 5-year mortality rate and the treatment effects observed in SPRINT, we found that if intensive treatment is widely adopted and achieved in all of these people, about 100,000 deaths per year could be prevented.
  • It could also give rise to about 56,100 episodes of hypotension, 34,400 episodes of syncope, 43,400 serious electrolyte disorders, and 88,700 cases of acute kidney injury per year compared to standard blood pressure treatment.

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

  • The public health impact of wide-spread implementation of intensive blood pressure treatment in the right patients is large.
  • However, careful patient selection and implementation are important because intensive treatment is associated with increased risk of hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

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

  • More research is needed to determine which patients derive the largest absolute benefit from intensive blood pressure treatment in order to maximize health benefits and minimize harms.
  • Research and development of tools to enhance shared decision making between providers and patients is also needed to maximize the positive public health impact of intensive blood pressure treatment.

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

Response: I am a member of the SPRINT Research Group

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

Citation:

Circulation. 2017 Feb 13. pii: CIRCULATIONAHA.116.025322. doi: 10.1161/CIRCULATIONAHA.116.025322. [Epub ahead of print]
Potential Deaths Averted and Serious Adverse Events Incurred from Adoption of the SPRINT Intensive Blood Pressure Regimen in the U.S.: Projections from NHANES.
Bress AP1, Kramer H2, Khatib R3, Beddhu S4, Cheung AK4, Hess R5, Bansal VK6, Cao G3, Yee J7, Moran AE8, Durazo-Arvizu RA3, Muntner P9, Cooper RS3

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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Heart Disease Costs Expected To Top $1Trillion Per Year By 2035

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Olga Khavjou RTI International

Olga Khavjou

Olga Khavjou
RTI International

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

Response: Cardiovascular disease (CVD) is the leading cause of death in the United States and is one of the costliest chronic diseases. As the population ages, CVD costs are expected to increase substantially. To improve cardiovascular health and control health care costs, we must understand future prevalence and costs of CVD.

In 2015, 41.5% (more than 100 million people) of the U.S population was estimated to have some form of CVD. By 2035, the number of people with CVD is projected to increase to over 130 million people, representing a 30% increase in the number of people with CVD over the next 20 years. Between 2015 and 2035, real total direct medical costs of CVD are projected to more than double from $318 billion to $749 billion and real indirect costs (due to productivity losses) are projected to increase from $237 billion to $368 billion. Total costs (medical and indirect) are projected to more than double from $555 billion in 2015 to $1.1 trillion in 2035.

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PCSK9 Inhibition with Alirocumab Increases Removal of LDL Cholesterol

MedicalResearch.com Interview with:
Henry N. Ginsberg, MD

Irving Institute for Clinical and Translational Research
Columbia University
Columbia College of Physicians and Surgeons
New York, NY

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

Response: Previous studies in mice and cells have identified increased hepatic low density lipoprotein (LDL) receptors as the basis for LDL lowering by PCSK9 inhibitors, but there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism, particularly effects on very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL) or LDL metabolism.

This study in 18 healthy subjects, found that alirocumab decreased the number of IDL and LDL particles in the circulation, and their associated cholesterol and apoB levels by increasing efficiency of the clearance of IDL and LDL. There were not effects on VLDL metabolism. The increased clearance of IDL meant that less LDL was produced from IDL, which is the precursor of LDL. Thus, the dramatic reductions in LDL cholesterol resulted from both less LDL being produced and more efficient clearance of LDL. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition.

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Low-Dose Blood Pressure Medication Effectively Treated PreHypertension

MedicalResearch.com Interview with:

Sandra Costa Fuchs, MD, PhD

Dr. Sandra Costa Fuchs

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

Response: High blood pressure is the worldwide leading cause of cardiovascular disease. It has been estimated that more than 50%, maybe as much as 70%, of cardiovascular diseases are due to hypertension. Approximately 30% among the Brazilian adult population has hypertension and can reach 70% of individuals over 60 years of age.

Prehypertension (systolic BP 120–139 or diastolic BP 80–89 mm Hg) conveys three potentially deleterious consequences.

  • First, it substantially increases the risk of developing hypertension.
  • Second, patients with prehypertension have evidence of end-organ damage, such as left ventricular geometric and functional abnormalities.
  • Third, there are evidence that adults with prehypertension are at a substantially higher risk of cardiovascular mortality.

The PREVER-Prevention study aimed to assess the efficacy and safety of a low-dose diuretic versus placebo for the prevention of hypertension and end-organ damage.

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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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PCSK9 Inhibitor Praluent Substantially Reduced LDL-C Cholesterol

MedicalResearch.com Interview with:

Dr. Eli M. Roth MD, FACC President, Medical Director Sterling Research Group Cincinnati, OH

Dr. Eli Roth

Dr. Eli M. Roth MD, FACC
President, Medical Director
Sterling Research Group
Cincinnati, OH

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

Response: At this year’s AHA 2016, we presented a pharmacodynamics analysis of ODYSSEY CHOICE I, which evaluated the effects of Praluent 300 mg administered every four weeks (Q4W) for 24 weeks in hypercholesterolemia patients at moderate to very high cardiovascular risk who were on maximally tolerated statin or no statin and/or other lipid-lowering therapies.

The pharmacodynamic analysis of CHOICE I in patients on statins supports the use of Praluent 300 mg Q4W as an alternative starting dose for patients who prefer a Q4W dosing regimen and demonstrates the value of LDL-C based dosing interval adjustment. The findings from this analysis were consistent with prior ODYSSEY Phase 3 studies, showing that Praluent substantially reduced circulating free PCSK9 concentration, resulting in significant LDL-C reductions. Additionally, Praluent was generally well tolerated.

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Delayed Epinephrine Linked To Worse Survival From In-Patient Cardiac Arrest

MedicalResearch.com Interview with:
Rohan Khera, MD

Cardiology Fellow, T32 Clinical-Investigator Pathway
UT Southwestern Medical Center
Dallas, TX

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

Response: Nearly 200 thousand people have an in-hospital cardiac arrest in the US each year. Of these, the vast majority have a non-shockable initial rhythm – either pulseless electric activity (PEA) or asystole. The survival of this type of arrest remains poor at around 12-14%. Moreover, even after accounting for differences in case mix, there is a wide variation in survival across hospitals – and this serves as a potential avenue for targeting quality improvement strategies at poor performing hospitals.

Recent data suggest that a shorter time from the onset of cardiac arrest to the first dose of epinephrine is independently associated with higher survival. Against this background of wide hospital variation in cardiac arrest survival, and patient-level data suggesting an association between time to epinephrine and patient survival, we wanted to assess (A) if there were differences in time to epinephrine administration across hospitals, and (B) if a hospital’s rate of timely epinephrine use was associated with its cardiac arrest survival rate. Within Get With The Guidelines-Resuscitation, we identified nearly 104-thousand adult patients at 548 hospitals with an in-hospital cardiac arrest attributable to a non-shockable rhythms. delays to epinephrine,

We found that (a) proportion of cardiac arrests with delayed epinephrine markedly across hospitals, ranging from no arrests with delay (or 0%) to more than half of arrests at a hospital (54%).

There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge and survival with functional recovery – compared to a low-performing hospitals, survival and recovery was 20% higher at hospitals that performed best on timely epinephrine use.

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