Author Interviews, Brigham & Women's - Harvard, Electronic Records, JACC, Stroke / 11.05.2015

Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public HealthMedicalResearch.com Interview with: Karen E. Joynt, MD MPH Cardiovascular Division, Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management Harvard T.H. Chan School of Public Health MedicalResearch: What is the background for this study?  What are the main findings? Dr. Joynt: While there is a great deal of optimism about the potential of Electronic Health Records (EHRs) to improve health care, there is little national data examining whether hospitals that have implemented EHRs have higher-quality care or better patient outcomes.  We used national data on 626,473 patients with ischemic stroke to compare quality and outcomes between hospitals with versus without EHRs.  We found no difference in quality of care, discharge home (a marker of good functional status), or in-hospital mortality between hospital with versus without EHRs.  We did find that the chances of having a long length of stay were slightly lower in hospitals with EHRs than those without them. (more…)
Author Interviews, Electronic Records, Emergency Care, Heart Disease, JACC / 07.05.2015

Justin A. Ezekowitz, MBBCh MScAssociate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Director, Heart Function Clinic Cardiologist, Mazankowski Alberta Heart InstiMedicalResearch.com Interview with: Justin A. Ezekowitz, MBBCh MSc Associate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Director, Heart Function Clinic Cardiologist, Mazankowski Alberta Heart Institute Medical Research: What is the background for this study? Dr. Ezekowitz: Heart Failure is a prevalent health issue that carries high morbidity and mortality. Most epidemiologic research derives information from hospital discharge abstracts, but emergency department visits are another source of information. Many have assumed this code is accurate in the emergency department but uncertainty remains. In our study, we assessed patients at their presentation to Emergency Department, which is usually the first medical contact for acutely ill patients with heart failure. The objective of our study was to compare administrative codes for acute heart failure (I50.x) in the emergency department against a gold standard of clinician adjudication. Medical Research: What are the main findings? Dr. Ezekowitz: Emergency department administrative data is highly correlated with a clinician adjudicated diagnosis. The positive predictive value of acute heart failure as the main diagnosis was 93.3% when compared to clinician adjudication, supported by standardized scoring systems and elevated BNP. (more…)
Author Interviews, Heart Disease, JACC, Stroke, University of Pennsylvania / 25.04.2015

Jay Giri, MD MPH Director, Peripheral Intervention Assistant Professor of Clinical Medicine University of PennsylvaniaMedicalResearch.com Interview with Jay Giri, MD MPH Director, Peripheral Intervention Assistant Professor of Clinical Medicine University of Pennsylvania MedicalResearch: What is the background for this study? What are the main findings? Dr. Giri: Carotid artery stents are placed by vascular surgeons or interventional cardiologists to decrease the risk of long-term stroke in patients with severe atherosclerotic disease of the carotid artery.  When these procedures are performed, there is a risk of releasing small amounts of debris into the brain’s circulation, causing a stroke around the time of the procedure (peri-procedural stroke).  In order to mitigate this issue, embolic protection devices (EPD) have been developed to decrease the chances of small debris reaching the brain. Two types of EPD exist.  The first is a small filter meant to catch the debris released by placement of the carotid stent (distal filter EPD). The second is a more complex device type that leads to transient halting of blood flow to the brain in the carotid artery being stented (proximal EPD). Debris-containing blood is removed from the body prior to allowing normal blood flow to proceed back to the brain after stent placement. Our prior research has shown that nearly all (>95%) of domestic carotid stenting procedures are performed with utilization of one of these devices.  We sought to compare important clinical outcomes of stroke and death between these 2 device types within a large national sample of patients undergoing carotid stenting. Some small prior studies have investigated whether the total amount of debris reaching the brain is less with proximal embolic protection devices.  These studies have shown mixed results.  However, no prior study has investigated important clinical outcomes of stroke and death in relation to these devices. We found that overall uptake of proximal embolic protection devices utilization in America has not been robust.  Less than 7% of all domestic CAS procedures are performed with this technology.   Our analysis showed that in-hospital and 30-day stroke/death rates with proximal EPD and distal filter EPD were similar (1.6% vs. 2.0%, p = 0.56 and 2.7% vs. 4.0%, p = 0.22, respectively). (more…)
Author Interviews, CDC, Cost of Health Care, Heart Disease, JACC, Stroke / 22.04.2015

Guijing Wang, PhD Senior health economist Division for Heart Disease and Stroke Prevention Centers for Disease Control and PreventionMedicalResearch.com Interview with: Guijing Wang, PhD Senior health economist Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Medical Research: What is the background for this study? What are the main findings? Dr. Wang: Our study is one of the first to analyze the impact of hospital costs related to atrial fibrillation (or AFib) in a younger stroke population. To determine these findings, we examined more than 40,000 hospital admissions information involving adults between the ages of 18 and 64 with a primary diagnosis of ischemic stroke between 2010 and 2012. Although AFib is more common among those ages 65 and older, with strokes among younger adults on the rise in the U.S., we wanted to take a comprehensive look at AFib’s impact on hospital costs for these patients. AFib is associated with a 4- to 5-fold increased risk of ischemic stroke, which is the most common type of stroke. Overall, our research found that AFib substantially increased hospital costs for patients with ischemic stroke – and that was consistent across different age groups and genders of those aged 18-64. Of the 33,500 first-time stroke admissions, more than seven percent had AFib, and these admissions cost nearly $5,000 more than those without the condition. In addition, we found that both the costs of hospitalization, as well as the costs associated with AFib, were higher among younger adults (18-54) than those aged 55 to 64. (more…)
Author Interviews, Heart Disease, JACC, NYU, Obstructive Sleep Apnea, Sleep Disorders / 22.04.2015

Dr. Larry Chinitz MD Professor of Medicine and Director, Cardiac Electrophysiology NYU Langone Medical CenterMedicalResearch.com Interview with: Dr. Larry Chinitz MD Professor of Medicine and Director, Cardiac Electrophysiology NYU Langone Medical Center MedicalResearch: What is the background for this study? What are the main findings? Dr. Chinitz: The treatment algorithms proposed currently for maintenance of sinus rhythm in patients with atrial fibrillation focus on use of anti-arrhythmic drugs and catheter ablation. Data available to evaluate the effect of modification of known adverse clinical factors on atrial fibrillation recurrence is scant. Obstructive sleep apnea in a known factor associated with both new onset atrial fibrillation as well as its recurrence after catheter ablation. Through a meta-analysis of available data we found that use of continuous positive airway pressure in patients with sleep apnea was associated with a 42% relative risk reduction in recurrence of atrial fibrillation. This effect was similar across patient groups irrespective of whether they were medically managed or with catheter ablation. (more…)
Author Interviews, Duke, Heart Disease, JACC, Women's Heart Health / 15.04.2015

Matthew E. Dupre, PhD Associate Professor of Medicine Department of Community and Family Medicine Department of Sociology Duke Clinical Research InstituteMedicalResearch.com Interview with: Matthew E. Dupre, PhD Associate Professor of Medicine Department of Community and Family Medicine Department of Sociology Duke Clinical Research Institute MedicalResearch: What is the background for this study? What are the main findings? Dr. Dupre: The negative health consequences of divorce have been known for some time. However, we showed that lifetime exposure to divorce can have a lasting impact on ones’ cardiovascular health, particularly in women. This is a good example of why people going through a divorce need a good divorce lawyer chicago in order to keep their stress levels down and help their cardiovascular health. Results from our study showed that risks for acute myocardial infarction (AMI) were significantly higher in women who had one divorce, two or more divorces, and among the remarried compared with continuously married women after adjusting for multiple risk factors. Risks for AMI were elevated only in men with a history of two or more divorces relative to continuously married men. We were especially surprised to find that women who remarried had risks for AMI that were nearly equivalent to that of divorced women. Men who remarried had no significant risk for acute myocardial infarction. The results of this study provide strong evidence that cumulative exposure to divorce increases the risk of acute myocardial infarction in older adults. Also somewhat unexpected was that the associations remained largely unchanged after accounting for a variety socioeconomic, psychosocial, behavioral, and physiological factors. However, we lacked information on several factors that we suspect may have contributed to the risks related to divorce – such as elevated stress, anxiety, and the loss of social support; as well as possible changes is medication adherence or other prophylactic behaviors. MedicalResearch: What should clinicians and patients take away from your report? (more…)
Author Interviews, Heart Disease, JACC / 18.03.2015

Prof. Ran Kornowski, M.D, FACC, FESC. Chairman - Division of Cardiology, Rabin Medical Center Petah-Tikva, IsraelMedicalResearch.com Interview with: Prof. Ran Kornowski, M.D, FACC, FESC Chairman - Division of Cardiology, Rabin Medical Center Petah-Tikva, Israel MedicalResearch: What is the background for this study? Prof. Kornowski: Over the years, the PCI procedure went-through many progresses. Among those are some angioplasty techniques, generalize use of stents and drug eluting stents, and adjuvant novel antithrombotic therapy. Unmistakably, these were associated with an overall improved PCI outcome. As many of the data on PCIs’ adverse outcomes predictors come from predates studies, we sought to update this matter. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety / 17.03.2015

MedicalResearch.com Interview with: Stephen W. Waldo, MD Research Fellow in Medicine Massachusetts General Hospital MedicalResearch: What is the background for this study? What are the main findings? Dr. Waldo: Public reporting is intended to improve outcomes for our patients.  Proponents of public reporting applaud the increased transparency that it offers, allowing both patients and physicians to objectively evaluate health care outcomes for a given institution or individual provider.  Previous research has demonstrated, however, that public reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention for critically ill patients.  The present study sought to evaluate the association between public reporting of outcomes with procedural management and clinical outcomes among patients with acute myocardial infarction.  As the data demonstrate, public reporting of outcomes is associated with a lower rate of percutaneous revascularization and increased overall in-hospital mortality among patients with an acute myocardial infarction, particularly among those that do not receive percutaneous intervention.  This may reflect risk aversion among physicians in states that participate in public reporting, an unintended consequence of this policy. (more…)
Author Interviews, Chocolate, Exercise - Fitness, Heart Disease, JACC, UCLA, UCSD / 17.03.2015

Pam R. Taub, MD, FACC Assistant Professor of Medicine UC San Diego Health System Division of Cardiology Encinitas, CA 92024MedicalResearch.com Interview with: Pam R. Taub, MD, FACC Assistant  Professor of Medicine UC San Diego Health System Division of Cardiology Encinitas, CA 92024 Medical Research: What is the background for this study? Dr. Taub: Epidemiological studies indicate that the consumption of modest amounts of dark chocolate (DC), which contains the natural cacao flavanol (-)-epicatechin (Epi,) is associated with reductions in the incidence of cardiovascular diseases (CVD). The health benefits of dark chocolate have been attributed to Epi. Clinical studies using cocoa and/or DC in normal volunteers or subjects with CVD have reported improvements in peripheral and coronary vascular endothelial function, blood pressure, lipids, insulin resistance, and inflammatory markers. The mechanism underlying these improvements is thought to be due to increased nitric oxide levels and improved endothelial function. We have also shown that capacity of Epi to favorable impact mitochondria under normal and disease states. We previously conducted pilot study in five patients with heart failure and type II diabetes, and showed that in skeletal muscle (SkM) biopsies there is a severe reduction in mitochondrial volume and cristae, as well as, in structural/functional proteins. After treatment with Epi rich dark chocolate , there was a significant recovery of SkM mitochondrial cristae, structural/functional proteins (e.g. mitofilin), as well as in regulators of mitochondrial biogenesis. However, no studies have examined the capacity of Epi rich dark chocolate to enhance exercise capacity in normal subjects and assess its impact on mitochondrial and oxidative control systems. Medical Research: What are the main findings? Dr. Taub: Seventeen subjects were randomized to placebo (n=8) or DC groups (n=9) and consumed 2 squares of chocolate (20 g, provided by Hershey) for 3 months. We showed in the chocolate group subjects had improved levels of HDL cholesterol and enhanced exercise capacity that is linked to the stimulation of SkM metabolic control endpoints which enhance mitochondrial function. (more…)
Author Interviews, Heart Disease, JACC, Obstructive Sleep Apnea, Stroke / 01.02.2015

Dmitry Yaranov, MD Danbury Hospital Western Connecticut Health NetworkMedicalResearch.com Interview with: Dmitry Yaranov, MD Danbury Hospital Western Connecticut Health Network Medical Research: What is the background for this study? What are the main findings? Dr. Yaranov: Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke (CVA) that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation. The aim of this study was to investigate the impact of OSA on CVA rate in patients with atrial fibrillation. We found that Obstructive sleep apnea in patients with atrial fibrillation is an independent predictor of CVA and this association may have important clinical implications in CVA risk stratification. (more…)
Author Interviews, Heart Disease, JACC, Lipids / 28.01.2015

MedicalResearch.com Interview with: Dong Zhao MD.PhD Deputy Director & Professor andDong Zhao MD.PhD Deputy Director & Professor and Dr. Que Qi, MD.PhD Assistant Professor Beijing Institute of Heart,Lung & Blood Vessel Diseases Capital Medical University Beijing Anzhen HospitalDr. Que Qi, MD.PhD Assistant Professor Beijing Institute of Heart,Lung & Blood Vessel Diseases Capital Medical University Beijing Anzhen Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Dong Zhao: Lower serum HDL-C level used to be considered as a key risk factor of atherosclerotic cardiovascular diseases. This knowledge was based on very consistent findings from researcher of basic science and observational studies of epidemiology. HDL-C has been also introduced as "good cholesterol" to the public. However, this well accepted knowledge was challenged when two large RCTs demonstrated that increased serum HDL-C by CETP inhibitor (ILLUMINATE and dal-OUTCOMES) failed to show benefits on reducing the risk of atherosclerotic cardiovascular disease. Therefore, many researchers questioned whether serum HDL-C can fully represent the capacity of cholesterol reverse transport of HDL particle, an underpinning of the anti-atherogenic function of HDL. And HDL particle number was considered to be better than HDL-C as a proper parameter to assess the function of HDL. In fact, RCTs that increased serum HDL-C substantially by CETP inhibitor had little effect on HDL particle number, thus resulting in increased cholesterol-overloaded HDL particle. Previous experimental studies observed that cholesterol-overloaded HDL particle exerted a negative impact on cholesterol reverse transport. However, it remains unclear whether cholesterol-overloaded HDL is involved in the development of atherosclerosis in humans. In our study, we measured HDL particle number using nuclear magnetic resonance spectroscopy, and calculated the ratio of HDL-C to HDL particles number to estimate the cholesterol content per HDL particle (HDL-C/P ratio). We found that cholesterol-overloaded HDL particles, indicated by high HDL-C/P ratio, are independently associated with the progression of carotid atherosclerosis in asymptomatic individuals from a community-based cohort study of the Chinese Multi-provincial Cohort Study-Beijing Project. (more…)
Author Interviews, Heart Disease, JACC, Outcomes & Safety / 25.01.2015

Herbert Aronow, MDMedicalResearch.com Interview with: Herbert D. Aronow, MD, MPH, FACC, FSCAI, FSVM Governor, American College of Cardiology (ACC) – Michigan Chapter Chair, ACC Peripheral Vascular Disease Section Trustee, Society for Vascular Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Aronow: Psychomotor and cognitive performance may be impaired by sleep deprivation.  Interventional cardiologists perform emergent, middle-of-the-night procedures, and may be sleep-deprived as a consequence.  Whether performance of middle-of-the-night percutaneous coronary intervention (PCI) procedures impacts outcomes associated with PCI procedures performed the following day is not known.  (more…)
Author Interviews, Heart Disease, JACC, Statins / 20.01.2015

Dr. Robert S. Rosenson, MD Professor, Cardiology Icahn School of Medicine at Mount Sinai Cardiovascular Institute New York, New York 10029MedicalResearch.com Interview with: Dr. Robert S. Rosenson, MD Professor, Cardiology Icahn School of Medicine at Mount Sinai Cardiovascular Institute New York, New York 10029 Medical Research: What is the background for this study? What are the main findings? Dr. Rosenson: High intensity statin therapy is evidence-based and guideline directed for patients with acute coronary syndromes.  In a 5 percent random sample of Medicare patients, we investigated the utilization of high vs low-moderate dosage statin in older adjusts who were admitted with an acute myocardial infarction of severe myocardial ischemia requiring hospitalization for a revascularization procedure (PCI or CABG). We report that only 27 percent of hospitalized patients received high-intensity statin therapy based on their first outpatient fill for a statin medication.  The most important determinant for the utilization of statin therapy is the dosage of the statin previously prescribed as an outpatient.  When patients were started on a high-intensity statin, the continued use diminished in the ensuing year (more…)
Author Interviews, Cost of Health Care, Heart Disease, JACC, Outcomes & Safety / 19.01.2015

Dr. P. Michael Ho, MD PhD Denver Veteran Affairs Medical Center, University of Colorado, Denver, Section of Cardiology Denver, Colorado 80220.MedicalResearch.com Interview with: Dr. P. Michael Ho, MD PhD Denver Veteran Affairs Medical Center, University of Colorado, Denver, Section of Cardiology Denver, Colorado 80220. Medical Research: What is the background for this study? What are the main findings? Dr. Ho: There is increasing interest in measuring health care value, particularly as the healthcare system moves towards accountable care. Value in health care focuses on measuring outcomes achieved relative to costs for a cycle of care. Attaining high value care - good clinical outcomes at low costs - is of interest to patients, providers, health systems, and payers. To date, value assessments have not been operationalized and applied to specific patient populations. We focused on percutaneous coronary intervention (PCI) because it is an important aspect of care for patients with ischemic heart disease, is commonly performed and is a costly procedure. In this study, we evaluated 1-year risk-adjusted mortality and 1-year risk-standardized costs of care for all patients who underwent PCI in the VA healthcare system from 2008 to 2010. We found that median one-year unadjusted hospital mortality rate was 6.13% (interquartile range 4.51% to 7.34% across hospitals). Four hospitals were significantly above the one-year risk standardized median mortality rate, with median mortality ratios ranging from 1.23 to 1.28; no hospitals were significantly below median mortality. Median 1-year total unadjusted hospital costs were $46,302 (IQR of $37,291 to $57,886) per patient. There were 16 hospitals above and 19 hospitals below the risk standardized average cost, with risk standardized ratios ranging from 0.45 to 2.09 reflecting much larger magnitude of variability in costs compared to mortality. These findings suggest that there are opportunities to improve PCI healthcare by reducing costs without compromising outcomes. This approach of evaluating outcomes and costs together may be a model for other health systems and accountable care organizations interested in operationalizing value measurement. (more…)
Erasmus, General Medicine, Heart Disease, JACC / 18.01.2015

MedicalResearch.com Interview Invitation Dr. Eric Boersma Associate Professor of Clinical Cardiovascular Epidemiology Thoraxcenter, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands MedicalResearch: What is the background for this study? What are the main findings? Dr. Boersma: Near-infrared spectroscopy (NIRS) is a novel intracoronary imaging technique. The NIRS-derived lipid core burden index (LCBI) quantifies the lipid content within the coronary artery wall. This study was designed to evaluate the prognostic value of LCBI in patients with coronary artery disease (CAD) undergoing coronary catheterization (CAG). We learned that patients with high (above the median) LCBI values had 4 times higher risk of coronary events during 1 year follow-up than those with low values. (more…)
Author Interviews, Heart Disease, JACC / 08.01.2015

Zugui Zhang PhDMedicalResearch.com Interview with: Zugui Zhang PhD Value Institute, Christiana Care Health System Newark, Delaware MedicalResearch: What is the background for this study? Dr. Zhang: The strategies of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for revascularization have been compared in randomized clinical trials. Questions still remain concerning the comparative effectiveness of PCI and CABG. The best way to control for treatment-selection bias is to conduct a randomized trial, but such trials often have limited power to evaluate subgroups. More importantly, the results may not be generalizable, since patients are often highly selected. Nonrandomized, observational data from clinical databases can complement data from clinical trials, because observational data, if they are from a larger and more representative population, may better reflect real-world practice. ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large observational study designed to compare the long-term effectiveness of CABG and PCI to treat coronary artery disease (CAD) over 4 to 5 years. This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease. MedicalResearch: What are the main findings? Dr. Zhang: This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease.   Adjusted costs were higher for CABG for the index hospitalization, study period, and lifetime by $10,670, $8,145, and $11,575, respectively. Patients undergoing CABG gained an adjusted average of 0.2525 and 0.3801 life-years relative to PCI over the observation period and lifetime, respectively. The life-time incremental cost-effectiveness ratio of CABG compared to PCI was $30,454/QALY gained. This study shows that over a period of 4 years or longer, CABG is associated with better outcomes but at higher cost than PCI among older patients with 2- or 3-vessel CAD. Under the assumption that our analysis has fully accounted for both measured and unmeasured confounding, in patients with stable ischemic heart disease, CABG will often be considered cost-effective at thresholds of $30,000 or $50,000/QALY. (more…)
Author Interviews, Gender Differences, Heart Disease, JACC, Lifestyle & Health / 07.01.2015

Andrea Kaye Chomistek ScD Assistant Professor Epidemiology and Biostatistics Indiana University BloomingtonMedicalResearch.com Interview with: Andrea Kaye Chomistek ScD Assistant Professor Epidemiology and Biostatistics Indiana University Bloomington   Medical Research: What is the background for this study? What are the main findings? Dr. Chomistek:  Although mortality rates from coronary heart disease in the U.S. have been in steady decline for the last four decades, women aged 35-44 have not experienced the same reduction. This disparity may be explained by unhealthy lifestyle choices. Thus, the purpose of our study was to determine what proportion of heart disease cases and cardiovascular risk factors (diabetes, hypertension, and high cholesterol) could be attributed to unhealthy habits. We defined healthy habits as not smoking, a normal body mass index, physical activity of at least 2.5 hours per week, watching seven or fewer hours of television a week, consumption of a maximum of one alcoholic drink per day on average, and a diet in the top 40 percent of a measure of diet quality based on the Alternative Healthy Eating Index. We found that women who adhered to all six healthy lifestyle practices had a 92 percent lower risk of heart attack and a 66 percent lower risk of developing a risk factor for heart disease. This lower risk would mean three quarters of heart attacks and nearly half of all risk factors in younger women may have been prevented if all of the women had adhered to all six healthy lifestyle factors. (more…)
Author Interviews, JACC, Weight Research / 06.01.2015

MedicalResearch.com Interview with: Dr. Joshua Bell PhD Candidate Epidemiology & Public Health University College London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Bell: When viewed at single points in time, about one-third of obese adults show normal metabolic profiles, that is, they have normal blood pressure, cholesterol and blood sugar levels. These adults have been labeled as 'healthy', but until now we have lacked evidence on the long-term stability of this state over time. By viewing theDr. Joshua Bell PhD Candidate Epidemiology & Public Health University College London, UK natural course of healthy obesity over two decades we found that about half of healthy obese adults become unhealthy obese after 20 years, with a clear trend for increasing progression to ill-health over time. Healthy obese adults are also much more likely to become unhealthy obese than healthy or unhealthy non-obese adults, indicating that healthy obesity is often just a phase. (more…)
Author Interviews, JACC, Surgical Research / 26.12.2014

Dr. Mary T. Hawn Center for Surgical, Medical Acute Care Research, and Transitions, Birmingham Veterans Affairs Medical Center University of Alabama at Birmingham, BirminghamMedicalResearch.com Interview with: Dr. Mary T. Hawn MD, MPH Center for Surgical, Medical Acute Care Research, and Transitions, Birmingham Veterans Affairs Medical Center Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama Medical Research: What is the background for this study? What are the main findings? Dr. Hawn: Cardiac risk factors and surgical risk factors contribute to the development of postoperative adverse cardiac events, but the relative contribution of each has not been quantified. In this study, we sought to determine the incremental risk of surgery following coronary stent placement on adverse cardiac events. To answer this question we used a retrospective cohort study of VA patients with coronary stents placed during 2000-2010 undergoing non-cardiac surgery within two years of stent placement matched to patients with coronary stents not undergoing surgery.  The patients were matched on stent type (drug-eluting versus bare metal) and cardiac risk factors at the time of stent placement.  Our outcome of interest was a composite variable of myocardial infarction and coronary revascularization occurring within 30 days of surgery.  We calculated adjusted risk differences over time from stent placement using generalized estimating equations. When comparing the two cohorts, we found a higher rate of composite cardiac events in the surgical cohort compared to the cohort not undergoing surgery. The main findings in the study were that the incremental risk of surgery was greatest when the surgery occurred in the first 6 weeks following stent placement and decreased to approximately 1% after 6 months, where it remained stable out to 24 months. Surgical characteristics associated with a significant reduction in the incremental risk after 6 months following stent placement included elective, inpatient procedures, and in the setting of a drug eluting stent. (more…)
Author Interviews, Heart Disease, JACC / 18.12.2014

MedicalResearch.com Interview with: Dexter Canoy, PhD Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom Medical Research: What is the background for this study? What are the main findings? Response: Over a million middle-aged women in the UK who took part in our study between 1996 and 2001 provided information regarding their health and lifestyle, including their reproductive history such as age when they had their first menstruation. We followed them for over 10 years and identified those who developed heart disease (and other vascular diseases) by obtaining information on hospitalizations and death records. Our study demonstrates that on average, women with menarche before age 13 or after this age have slightly increased risks of developing heart disease, stroke and hospital admissions associated with hypertension. The increased risks for these vascular diseases were highest in women with menarche at age 10 years or younger, or age 17 years or older. This U-shaped association was consistently found among lean, overweight and obese women, among never, past or current smokers, or among women in low, middle or high socioeconomic group. (more…)
Author Interviews, Erasmus, JACC, Memory, Stroke / 13.12.2014

MedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD,and Ayesha Sajjad, MD Department of Epidemiology Erasmus University Medical Center, Rotterdam Rotterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The occurrence of cognitive impairment and dementia after a stroke event are already known. Since these neuro-degenerative processes and stroke share vascular pathways in their pathogenesis such as small vessel disease, we aimed to study whether early cognitive impairment can be predictive of stroke onset in the elderly. We also hypothesized that a higher cognitive reserve (due to higher education attainment) may mask early symptoms of memory loss and thus put these older individuals at a higher risk of stroke. We found that self-reported subjective memory complaints as answered by a single question: “ Do you have memory complaints?” was highly predictive of stroke especially in older persons who were highly educated. In comparison, objective measures of cognitive impairment such as MMSE did not show any association with the risk of stroke. (more…)
Author Interviews, Heart Disease, Imperial College, JACC / 13.12.2014

MedicalResearch.com Interview with: Dr. Jane A. Mitchell National Heart and Lung Institute Imperial College, London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: Anti-inflammatory drugs (NSAIDs) work by inhibiting the enzyme COX-2. COX-2 selective anti-inflammatory drugs, like Vioxx, were introduced to reduce gastrointestinal side effects associated with these drugs. However, COX-2 inhibitors as well as most older NSAIDs are associated with increased risk of heart attacks although the precise mechanisms underlying these side effects are not completely understood. The main findings of this study are: 1) COX-2 is highly expressed in the kidney where its genetic deletion leads to changes in more than 1000 genes. 2) Analysis of these genes revealed changes in 2-3 specific genes that regulate levels of ADMA, an endogenous inhibitor of the nitric oxide released by vessels, that can be reversed by giving more of the substrate for NO, L-arginine. 3) Further studies showed that ADMA was indeed increased in the plasma of mice where COX-2 gene was knocked out or in normal mice given a COX-2 inhibitor. 4) In mice where COX-2 was knocked out the release of nitric oxide from vessels was reduced and this could be reversed by supply L-arginine. 5) ADMA was also increased in human volunteers taking a COX-2 inhibitor (more…)
Author Interviews, Heart Disease, JACC, Lipids / 31.10.2014

Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public HealthMedicalResearch.com Interview with Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public Health Professor of Medicine Harvard Medical School Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Hu: There has been much confusion and sensational headlines about the role of different types of fat in coronary heart disease.  A recent meta-analysis suggested that higher saturated fat intake was not associated with coronary heart disease (CHD), but people don't consume saturated fat in isolation from other components of diet. Typically people swap for one type of fat for another. Therefore it is important to look at replacement nutrient when we talk about health effects of saturated fat. Randomized clinical trials have shown that replacing saturated fat with polyunsaturated fat reduces total and LDL cholesterol. Thus it is important to examine whether such replacement confers long-term beneficial effects on heart disease prevention. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the link between dietary intake of linoleic acid (the predominant type of polyunsaturated fat) and heart disease risk in generally healthy people. We identified 13 published and unpublished cohort studies with a total of 310,602 individuals and 12,479 total  coronary heart disease events including 5,882 CHD deaths. We found that dietary linoleic acid intake is inversely associated with  coronary heart disease risk in a dose-response manner—meaning, higher intake of linoleic acid resulted in a lower risk of CHD. Comparing the highest to the lowest level of consumption, dietary linoleic acid was associated with a 15% lower risk of  coronary heart disease events and a 21% lower risk of CHD deaths. These results were independent of common coronary heart disease risk factors such as smoking and other dietary factors such as fiber consumption. (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC / 29.10.2014

Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195MedicalResearch.com Interview with: W. H. Wilson Tang, MD FACC FAHA Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195 Medical Research: What are the main findings of the study? Dr. Tang: A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk. (more…)
Author Interviews, Heart Disease, JACC / 15.10.2014

Nils P. Johnson, M.D., M.S. Assistant Professor - Cardiovascular Medicine Department of Internal Medicine University of Texas Health Science Center Houston TexasMedicalResearch.com Interview with Nils P. Johnson, M.D., M.S. Assistant Professor - Cardiovascular Medicine Department of Internal Medicine University of Texas Health Science Center Houston Texas Medical Research: What are the main findings of the study? Dr. Johnson: Our study had 3 main findings.
  • First, the numeric fractional flow reserve (FFR) value related continuously to risk, such that clinical events increased as FFR decreased and revascularization showed larger net benefit  for lower baseline FFR values.
  • Second, fractional flow reserve measured immediately after  stenting also showed an inverse relationship with prognosis, likely due to its relationship with diffuse disease.
  • Third, an fractional flow reserve-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief. (more…)
Author Interviews, Gender Differences, Heart Disease, JACC / 13.10.2014

Zainab Samad, M.D., M.H.S. Assistant Professor of Medicine Duke University Medical Center Durham, North CarolinaMedicalResearch.com Interview with: Zainab Samad, M.D., M.H.S. Assistant Professor of Medicine Duke University Medical Center Durham, North Carolina Medical Research: What are the main findings of the study? Dr. Samad: This was a sub study of REMIT, an NHLBI funded study. Our research team headed by Dr. Wei Jiang conducted the REMIT study between 2006-2011 at the Duke Heart Center. We found that women and men differ significantly in their physiological and psychological responses to mental stress. We explored sex differences across various domains felt to have implications towards cardiovascular disease pathophysiology and prognosis. We found that women had greater negative emotion, less positive emotion, while men had greater blood pressure increases in response to mental stress. On the contrary, women showed greater platelet reactivity compared to men in response to mental stress. A greater frequency of women had cardiac ischemia in response to mental stress compared to men. (more…)
Author Interviews, Heart Disease, JACC, Mediterranean Diet, Omega-3 Fatty Acids / 03.10.2014

MedicalResearch.com Interview with: Dr. Anil Nigam MD MSc FRCPC Director, Research Program in Preventive Cardiology at ÉPIC Centre Montreal Heart Institute Associate Professor, Department of Medicine at Université de MontréalMedicalResearch.com Interview with: Dr. Anil Nigam MD MSc FRCPC Director, Research Program in Preventive Cardiology at ÉPIC Centre Montreal Heart Institute Associate Professor, Department of Medicine at Université de Montréal Medical Research: What are the main findings of the study? Dr. Nigam: The main finding is that high-dose fish oil rich in marine omega-3 fatty acids did not reduce recurrence of atrial fibrillation in individuals with paroxysmal or persistent atrial fibrillation not receiving conventional anti-arrhythmic therapy. (more…)
Author Interviews, Heart Disease, JACC / 29.09.2014

MedicalResearch.com Interview with: Katharina Mayer MD Deutsches Herzzentrum München, Technische Universität München, Munich, Germany Medical Research: What are the main findings of the study? Dr. Mayer: Patients whose platelets do not respond well to aspirin carry a higher risk of death or stent thrombosis. Platelet response to aspirin is an independent predictor of ischemic events in patients undergoing percutaneous coronary interventions (PCI). (more…)
Author Interviews, Heart Disease, JACC / 23.09.2014

Jerry D. Estep, M.D., FACC Assistant Professor of Medicine, Weill Cornell Medical College Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston Methodist HospitalMedicalResearch.com Interview with: Jerry D. Estep, M.D., FACC Assistant Professor of Medicine, Weill Cornell Medical College Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston Methodist Hospital Medical Research: What are the main findings of the study? Dr. Estep: There were two major findings: 1-Non-invasive Doppler echocardiographic and invasive measures of mean right atrial pressure (RAP) (r = 0.863; p < 0.0001), systolic pulmonary artery pressure (sPAP) (r=0.880; p<0.0001), right ventricular outflow tract stroke volume (r=0.660; p < 0.0001), and pulmonary vascular resistance (r = 0.643; p= 0.001) correlated significantly. 2-An algorithm integrating mitral inflow velocities, RAP, sPAP, and left atrial volume index was 90% accurate in distinguishing normal from elevated left ventricular filling pressures. (more…)