Author Interviews, Heart Disease / 05.02.2021

MedicalResearch.com Interview with: Sumeet S. Chugh MD Price Professor and Associate Director, Smidt Heart Institute Medical Director, Heart Rhythm Center Director, Center for Cardiac Arrest Prevention Director, Division of Artificial Intelligence in Medicine, Dept of Medicine Cedars-Sinai, Los Angeles MedicalResearch.com: What is the background for this study? Response: For a variety of reasons, sudden cardiac arrest during nighttime hours is the most perplexing and challenging form of this problem and needs to be investigated in detail. Patients are in a resting state, with decreased metabolism, heart rate, blood pressure, and in the absence of daytime triggers, presumably at the lowest likelihood of dying suddenly. The event can often go unrecognized, even by others sleeping in close proximity. Finally, survival from cardiac arrest at night is significantly lower compared to the daytime. There are no community-based studies out there. Small studies of rare heart disease conditions report that men are more likely to suffer this affliction but the reality is that there were not enough women in those studies to do justice to sex-specific analyses. (more…)
Author Interviews, Cost of Health Care, CT Scanning, Heart Disease, JACC, Statins / 14.01.2021

MedicalResearch.com Interview with: Prasanna Venkataraman MBBS Thomas H. Marwick MBBS, PhD Baker Heart and Diabetes Research Institute Monash University, Melbourne Melbourne, Australia MedicalResearch.com: What is the background for this study?
  • Coronary artery calcium score (CAC) quantifies coronary calcium as determined by computed tomography and is a good surrogate marker for overall coronary plaque burden. It can help to reclassify patients at intermediate risk – many of whom are actually at low risk and can be reassured. Conversely, the finding of coronary calcium can also motivate patients (and their clinicians) to more aggressively control their cardiovascular risk factors. This is particularly problematic in those with a family history of premature coronary artery disease, where standard risk prediction tools are less accurate. However, CT CAC does not routinely attract third party payer support limiting its access and utilisation.
  • We screened 1084 participants who have a family history of premature coronary disease and a 10-year Pooled cohort Equation (PCE) cardiovascular risk >2% with CAC. We then assessed the cost-effectiveness of commencing statins in those with any coronary calcium compared to a strategy of no CAC testing and commencing statins if their PCE risk was ≥7.5% consistent with current guidelines.
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AHA Journals, Author Interviews, Heart Disease, Women's Heart Health / 30.11.2020

MedicalResearch.com Interview with: Justin A. Ezekowitz, MBBCh, MSc Professor, Department of Medicine Co-Director, Canadian VIGOUR Centre Director, Cardiovascular Research, University of Alberta Cardiologist, Mazankowski Alberta Heart Institute MedicalResearch.com: What is the background for this study? What are the main findings? Are women older, sicker when they experience heart disease? Response: Previous research looking at sex-differences in heart health has often focused on recurrent heart attack or death, however, the vulnerability to heart failure between men and women after heart attack remains unclear. Our study includes all patients from an entire health system of over 4 million people and includes information not usually available in other analyses. Women were nearly a decade older and more often had a greater number of other medical conditions when they presented to hospital for their first heart attack, and were at greater risk for heart failure after the more severe type of heart attack (also known as a ST-elevation MI). This gap between men and women has started to narrow over time. (more…)
AHA Journals, Author Interviews, Heart Disease, University of Michigan / 17.11.2020

MedicalResearch.com Interview with: Sara Saberi, MD, MS Assistant Professor Inherited Cardiomyopathy Program Frankel Cardiovascular Center University of Michigan Hospital Michigan Medicine MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by HCM? How common is it and whom does it affect? Response: HCM is short for hypertrophic cardiomyopathy, the most common genetic myocardial disorder. It occurs in 1:500 people worldwide and because it is inherited in an autosomal dominant fashion, it affects men and women equally. HCM is characterized by unexplained left ventricular (LV) hypertrophy, hypercontractility, myofibrillar disarray and myocardial fibrosis with associated abnormalities in LV compliance and diastolic function. In some patients, there is progressive adverse cardiac remodeling, associated with chronic heart failure and atrial fibrillation as a result of diastolic dysfunction, left ventricular outflow tract (LVOT) obstruction, or less commonly, LV systolic dysfunction. Current medical management of obstructive HCM (oHCM) is limited to the use of beta blockers and non-dihydropyridine calcium channel blockers, or disopyramide, none of which have been shown to modify disease expression or outcomes after onset. Mavacamten is a first-in-class, small molecule, selective inhibitor of cardiac myosin specifically developed to target the underlying pathophysiology of HCM by reducing actin–myosin cross-bridge formation. The phase 3 EXPLORER-HCM trial showed that mavacamten improved exercise capacity, LVOT gradients, symptoms, and health status compared with placebo in patients with symptomatic oHCM. At selected study sites, participants were enrolled in a cardiac magnetic resonance (CMR) imaging substudy. CMR is the gold standard for measurement of ventricular mass, volumes and noninvasive tissue characterization, making it an ideal imaging modality to assess the effect of mavacamten on cardiac structure and function in patients with HCM. (more…)
Author Interviews, COVID -19 Coronavirus, Heart Disease / 17.11.2020

MedicalResearch.com Interview with: Benjamin D. Horne, PhD Cardiovascular and Genetic Epidemiologist Intermoumtain Health MedicalResearch.com: What is the background for this study? Response: The Intermountain Mortality Risk Score (IMRS) is a risk prediction tool developed in 2009 and repeatedly validated over the last decade to predict death, major adverse health events such as heart attack and stroke, and the onset of major chronic diseases. IMRS is computed using sex-specific weightings of parameters from the complete blood count (CBC) and basic metabolic profile (BMP), and age. The CBC and BMP are commonly-ordered clinical laboratory panels that include hemoglobin, white blood cell count, glucose, creatinine, sodium, calcium, and other factors whose testing is standardized and the results are objective and quantitative with no need to know what diagnoses a patient may have. IMRS is known to be a superior predictor of death compared to comorbidity-based risk scores and has been found to predict health outcomes in people with no chronic disease diagnoses as well as patients with coronary heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and various other diagnoses. IMRS has not been evaluated as a predictor of health outcomes for people with COVID-19, but if it does it could be useful for people to use to evaluate their own risk of poor outcomes if they are infected with SARS-CoV-2, for clinical personnel to guide the care of patients with COVID-19, and for public health professionals to use to determine who among those never diagnosed with COVID-19 is at higher risk of poor health outcomes and should be the first to receive a COVID-19 immunization. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Circadian Rhythm / 05.11.2020

MedicalResearch.com Interview with: Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC, FJCS Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Shimotsuke, Tochigi, 329-0498, JAPAN MedicalResearch.com: What is the background for this study? Response: To date, it remains unclear whether disrupted blood pressure (BP) circadian rhythm is associated with adverse outcomes independent of nighttime BP. The JAMP study includes 6359 outpatient population who had ambulatory BP monitoring to evaluate the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events in patients with hypertension. (more…)
AHA Journals, Author Interviews, Heart Disease, Surgical Research / 30.10.2020

MedicalResearch.com Interview with: Stavros G. Drakos, MD, PhD, FACC Professor of Cardiology Univ. of Utah Healthcare & Medical School and the Salt Lake VA Medical Center. Dr. Drakos is Medical Director of the University's Cardiac Mechanical Support/Artificial Heart Program Co-Director Heart Failure & Transplant and Director of Research for the Division of Cardiology MedicalResearch.com: What is the background for this study? Response: Heart transplantation and LVADs are first line therapies for advanced chronic heart failure. There were some earlier anecdotal observations and single center small studies from several programs in the US and overseas that left ventricular assist devices (LVADs) significantly reduce the strain on failing hearts and in some cases, using LVADs for limited periods of time has allowed hearts to “rest” and remodel their damaged structures. As a result of these repairs, described as “reverse remodeling,” heart function can improve to the point that the LVAD can be removed. The new study sought to broaden the reach of the research with a multicenter trial involving physicians and scientists at the University of Utah Health, the University of Louisville, University of Pennsylvania, the Albert Einstein College of Medicine/Montefiore Medical Center, the Cleveland Clinic, and the University of Nebraska Medical Center. (more…)
Author Interviews, Cost of Health Care, Emory, Heart Disease, JAMA, Surgical Research / 21.09.2020

MedicalResearch.com Interview with: David H. Howard, PhD Professor, Health Policy and Management Rollins School of Public Health Emory University, Atlanta, Georgia MedicalResearch.com: What is the background for this study? Response: Application of the False Claims Act (FCA) to medically unnecessary care is controversial, both in the courts and in the Department of Justice. Although there haven’t been many FCA suits against hospitals and physicians for performing unnecessary percutaneous coronary interventions (PCIs), the suits that have occurred have been against some of the highest-volume hospitals and physicians. Some cardiologists have been sentenced to prison. (more…)
Author Interviews, Heart Disease, Lipids, PAD, Women's Heart Health / 27.08.2020

MedicalResearch.com Interview with: First Author: Dhruv Mahtta, DO, MBA Cardiovascular Disease Fellow Baylor College of Medicine Houston, TX Senior & Corresponding Author Dr. Virani Salim S. Virani, MD, PhD, FACC, FAHA, FASPC Professor, Section of Cardiovascular Research Director, Cardiology Fellowship Training Program Baylor College of Medicine Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center Co-Director, VA Advanced Fellowship in Health Services Research & Development at the Michael E. DeBakey VA Medical Center, Houston, TX Investigator, Health Policy, Quality and Informatics Program Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation Houston, TX @virani_md MedicalResearch.com: What is the background for this study? What are the main findings? What do you think accounts for the gender differences? Response: We know that women with ischemic heart disease (IHD) have lower prescription rates for statin and high-intensity statin therapy. In this study, we assessed whether the same trends hold true for women with other forms of atherosclerotic cardiovascular disease (ASCVD) i.e. women with peripheral artery disease (PAD) or ischemic cerebrovascular disease (ICVD). Maximally tolerated statin therapy is a Class-I indication in patients with clinical ASCVD which includes PAD and ICVD. We also assessed statin adherence among men and women with PAD and ICVD. Lastly, we performed exploratory analyses to assess whether statin therapy, statin intensity, and statin adherence in women with PAD and ICVD were associated with cardiovascular outcomes and/or mortality. (more…)
Author Interviews, Endocrinology, Heart Disease, Women's Heart Health / 05.08.2020

MedicalResearch.com Interview with: Dr. Clare Oliver-Williams PhD University of Cambridge MedicalResearch.com: What is the background for this study? Response: Women with PCOS are known to be at greater risk of CVD, however the some symptoms (menstrual irregularity) of PCOS are specific to reproductive age women. This raises the question of whether CVD risk varies across by age, which was the focus of my research with colleagues at the University of Copenhagen. MedicalResearch.com: What should readers take away from your report? Response: Women with PCOS were at 19% higher CVD risk than women without CVD, however once the association was stratified by age, there was no evidence for a higher CVD risk for women older than 50. (more…)
Author Interviews, COVID -19 Coronavirus, Heart Disease, JAMA, MRI / 28.07.2020

MedicalResearch.com Interview with: Assoc. Prof. Dr. Valentina Puntmann, MD, PhD, FRCP Deputy Head Goethe CVI Fellowship Programme Lead Consultant Physician, Cardiologist and Clinical Pharmacologist Institute for Experimental and Translational Cardiovascular Imaging DZHK Centre for Cardiovascular Imaging - Goethe CVI Department of Cardiology, Division of Internal Medicine University Hospital Frankfurt, Germany MedicalResearch.com: What is the background for this study? Response: Patients who recently recovered from COVID19 have been identified through the testing centre and invited to be screened for cardiac involvement with MRI. Importantly, they have not come to us because of having heart problems. In fact, none of them thought that they had had anything wrong with the heart. They were mostly healthy, sporty and well prior to their illness. A considerable proportion had been infected while on skiing vacations. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 14.07.2020

MedicalResearch.com Interview with: Mario Fl Gaudino MD Professor of Cardiothoracic Surgery Department of Cardiothoracic Surgery Weill Cornell Medicine MedicalResearch.com: What is the background for this study? Response: The radial artery is currently used in less than 10% of CABG procedures in the US. MedicalResearch.com: What are the main findings? Response: The JAMA paper provides convincing evidence that the use of the radial artery rather than the saphenous vein to complement the internal thoracic artery for CABG is associated with improved long-term outcomes. (more…)
Author Interviews, Heart Disease, Lipids / 01.04.2020

MedicalResearch.com Interview with: Professor F. J. Raal, FRCP, FCP(SA), Cert Endo, MMED, PhD Director, Carbohydrate & Lipid Metabolism Research Unit Professor & Head, Division of Endocrinology & Metabolism, Faculty of Health Sciences, University of the Witwatersrand MedicalResearch.com: What is the background for this study? How does Evinacumab differ from the three drugs used in triple therapy for this severe form of hypercholesterolemia? Response: Despite available lipid lowering therapies, the vast majority of patients with homozygous familial hypercholesterolemia are unable to achieve desirable LDL-cholesterol levels and remain at high risk for premature atherosclerotic cardiovascular disease. Unlike statins and PCSK9-inhibitors which act mainly by upregulating LDL receptor activity on the cell surface, evinacumab, a monoclonal antibody inhibitor of ANGPTL3, acts independent of the LDL receptor. (more…)
AstraZeneca, Author Interviews, Diabetes, Heart Disease, JAMA / 01.04.2020

MedicalResearch.com Interview with: John J. V. McMurray, MD FRCP FESC FACC FAHA FRSE FMedSci British Heart Foundation Cardiovascular Research Centre University of Glasgow Glasgow, United Kingdom Kieran F Docherty DAPA-HF investigator British Heart Foundation Cardiovascular Research Centre, University of Glasgow     MedicalResearch.com: What is the background for this study? Response: DAPA-HF was a double-blind randomized controlled trial comparing dapagliflozin 10 mg once daily with placebo in 4744 patients with heart failure and reduced ejection fraction (HFrEF). The primary outcome was a composite of time to occurrence of a worsening heart failure event (principally heart failure hospitalization) or cardiovascular death, whichever came first. Dapagliflozin reduced the primary outcome by 26% and reduced the risk of each of heart failure hospitalization and cardiovascular death individually, as well as overall mortality. Patient symptoms were also improved. The aim of the present report was to examine the effect of dapagliflozin separately in patients with and without type 2 diabetes at baseline (45/55% split in the trial). The reason for this was that dapagliflozin was originally introduced as a glucose-lowering medication for the treatment of type 2 diabetes. We find that dapagliflozin was equally beneficial in patients with and without diabetes and was as well tolerated in patients without diabetes as in those with diabetes. More remarkably, among the patients without diabetes, dapagliflozin was as effective in participants with a completely normal glycated haemoglobin (HbA1c) as in those with prediabetes. In patients with a normal HbA1c, dapagliflozin did not lead to any reduction in HbA1c, but did improve clinical outcomes. (more…)
Author Interviews, Heart Disease, NEJM, Stanford / 31.03.2020

MedicalResearch.com Interview with: David J. Maron, MD, FACC, FAHA Clinical Professor of Medicine Chief, Stanford Prevention Research Center Director, Preventive Cardiology Stanford University School of Medicine MedicalResearch.com: What is the background for this study? Response: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. The goals of treating patients with stable coronary disease are to reduce their risk of death and ischemic events and to improve their quality of life. All patients with coronary disease should be treated with guideline-based medical therapy (GBMT) to achieve these objectives. Before the widespread availability of drug-eluting stents, strategy trials that tested the incremental effect of revascularization added to medical therapy did not show a reduction in the incidence of death or myocardial infarction. In one trial, fractional flow reserve–guided percutaneous coronary intervention (PCI) with drug-eluting stents, added to medical therapy, decreased the incidence of urgent revascularization but not the incidence of death from any cause or myocardial infarction at a mean of 7 months, whereas the 5-year follow-up showed marginal evidence of a decrease in the incidence of myocardial infarction. (more…)
Author Interviews, Columbia, Heart Disease, Mediterranean Diet, Women's Heart Health / 13.03.2020

MedicalResearch.com Interview with: Dr. Riddhi Shah, PhD AHA SFRN Postdoctoral Research Fellow Division of Cardiology Columbia University Medical Center New York, New York MedicalResearch.com: What is the background for this study? Response: The Mediterranean Diet, characterized by higher intakes of plant foods including plant proteins, monounsaturated fat, fish, and lower consumption of animal products and saturated fat, has long been associated with reduced cardiovascular risk and greater longevity, but the molecular mechanisms underlying these associations have not been fully elucidated. We evaluated associations of an Alternate Mediterranean Diet Score, reflective of adherence to this diet pattern and adapted for US populations, and its components with markers of endothelial inflammation directly measured in endothelial cells harvested from women, including oxidative stress, nuclear factor kappa B (NFκB), and endothelial nitric oxide synthase (eNOS) gene expression. (more…)
Author Interviews, Heart Disease, Science / 31.01.2020

MedicalResearch.com Interview with: Steven R. Houser, PhD, FAHA Senior Associate Dean, Research Vera J. Goodfriend Endowed Chair, Cardiovascular Research Chair and Professor, Physiology Director, Cardiovascular Research Center (CVRC) Professor, Medicine Deborah M Eaton Deborah M Eaton Doctorate Student / Research Assistant Temple University MedicalResearch.com: What is the background for this study? Response: Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for approximately 50% of cases of HF and to date clinical trials with HFpEF patients have failed to produce positive outcomes. Part of this is likely due to the lack of HFpEF animal models for preclinical testing. Our lab addressed this gap in knowledge by developing an animal model that mimics critical features of the human HFpEF phenotype. We performed an in-depth cardiopulmonary characterization highlighting that the model has characteristics of human disease. We then tested the effects of a pan-HDAC inhibitor, vorinostat/SAHA, in collaboration with Dr. Timothy McKinsey, who is an expert in HDAC inhibitors and recently published work1 that laid the foundation for this study. (more…)
Author Interviews, Cannabis, Columbia, Heart Disease, JACC / 21.01.2020

MedicalResearch.com Interview with: Ersilia DeFilippis, MD Second-year cardiology fellow Columbia University Irving Medical Center and NewYork-Presbyterian MedicalResearch.com: What is the background for this study? Response: Marijuana use has been increasing significantly and is the most commonly illicit drug used in the United States. In recent years, more states have been legalizing its use for both recreational and medicinal purposes. We have all seen news reports regarding the rise of vaping-related health hazards. Yet, data are limited regarding the cardiovascular effects of marijuana which is what drove us to explore this topic. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA, UCLA / 09.01.2020

MedicalResearch.com Interview with: Olujimi A. Ajijola, MD, PhD Neurocardiology Research Center of Excellence Cardiac Arrhythmia Center University of California, Los Angeles MedicalResearch.com: What is the background for this study? Response: It hadn’t been understood why some people with basic heart failure might live longer than others despite receiving the same medications and medical device therapy. Through this research we set out to determine whether a biomarker of the nervous system could help explain the difference. This study revealed a biomarker that can specifically predict which patients with “stable” heart failure have a higher risk of dying within one to three years. (more…)
Author Interviews, Heart Disease, NEJM / 28.12.2019

MedicalResearch.com Interview with: Jean-Claude Tardif CM, MD, FRCPC, FCCS, FACC, FAHA, FESC, FCAHS Director, Montrel Heart Institute Research Center Professor of medicine Canada Research Chair in translational and personalized medicine University of Montreal endowed research chair in atherosclerosis Montreal Heart Institute MedicalResearch.com: What is the background for this study? Response: Inflammation appears to play an important role in atherosclerosis. Inhibition of interleukin-1ß by canakinumab reduced the rate of cardiovascular events by 15% CANTOS. In contrast, methotrexate did not affect cardiovascular outcomes or plasma markers of inflammation in CIRT. Colchicine is an inexpensive, orally administered, potent anti-inflammatory medication that has been used for centuries. Colchicine is currently indicated for the management of patients with gout, familial Mediterranean fever and pericarditis. In the LODOCO study, patients with stable coronary disease treated with colchicine 0.5 mg once daily experienced fewer cardiovascular events as compared with those not receiving colchicine. However, that study enrolled only 532 patients and was not placebo-controlled. Because acute coronary syndromes are associated with higher risks of recurrent events and exacerbated inflammation, we conducted the COLchicine Cardiovascular Outcomes Trial (COLCOT) in patients with a recent myocardial infarction to evaluate the effects of colchicine on cardiovascular outcomes and its long-term safety and tolerability. (more…)
Author Interviews, Heart Disease, Surgical Research / 21.11.2019

MedicalResearch.com Interview with: Chayakrit Krittanawong, MD Section of Cardiology Baylor College of Medicine Houston, TX MedicalResearch.com: What is the background for this study? Response: Transcatheter Aortic valve Implantation (TAVI) has emerged as equally effective alternative to surgical aortic valve replacement (SAVR) to treat severe aortic stenosis (AS) in all risk groups. In particular, less is known about the heart failure (HF) patients who undergo TAVI. Whether certain subtypes of HF respond differently after TAVI remains a mystery. In this study, we sought to assess and compare the incidence and predictors of in-hospital mortality among patients with heart failure with preserved ejection fraction (HFREF) versus heart failure with preserved ejection fraction (HFPEF). (more…)
Author Interviews, Heart Disease / 20.11.2019

MedicalResearch.com Interview with: Matthew Budoff MD Professor of Medicine, UCLA Endowed Chair of Preventive Cardiology Lundquist Institute Torrance, CA 90502 MedicalResearch.com: What is the background for this study? Response: We present the nine-month interim analysis results from the EVAPORATE mechanistic study of Icosapent Ethyl, after benefits were seen with the REDUCE-IT Trial, demonstrating 25% event reduction. This trial was a serial multi-detector computed tomographic (MDCT) study to look at plaque progression between icosapent ethyl (4 gm/day) and matching placebo. (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity / 30.10.2019

MedicalResearch.com Interview with: Michelle Morse, MD, MPH Founding Co-Director, EqualHealth Soros Equality Fellow Assistant Professor, Harvard Medical School Co-Founder, Social Medicine Consortium MedicalResearch.com: What is the background for this study?
  • Response: Frontline clinicians have a unique vantage point to identify and characterize inequities in care. This study was inspired by internal medicine residents’ first-hand clinical experiences of black and Latinx patients who were frequently admitted to the general medicine service, as opposed to the cardiology service, with an ultimate diagnosis of HF.
  • Research has shown that structural inequities are pervasive throughout healthcare delivery systems and across many services, within both the inpatient and outpatient arenas. We hope other institutions and clinicians will be equally committed to addressing inequities in their own contexts, systems, and care settings and that patients will identify opportunities for self-advocacy in their care.
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Author Interviews, Heart Disease, Women's Heart Health / 29.08.2019

MedicalResearch.com Interview with: Amy Ferry Cardiology Research Nurse Centre for Cardiovascular Science The University of Edinburgh MedicalResearch.com: What is the background for this study? Response: The fourth universal definition of myocardial infarction now recommends the use of sex-specific diagnostic criteria. This approach has revealed a population of patients with myocardial infarction (predominantly women) who were previously unrecognised. The impact of these diagnostic criteria on the presentation and clinical features of men and women with suspected acute coronary syndrome is unknown. (more…)
Author Interviews, Heart Disease, Pharmaceutical Companies, Stem Cells, Technology / 12.08.2019

MedicalResearch.com Interview with: Misti Ushio, Ph.D. Chief Executive Officer Michael Graziano, PhD Chief Scientific Officer TARA Biosystem MedicalResearch.com: What is the background for this study? Response: Almost half of all drug recalls are due to cardiac toxicity that was not picked up during early screens. These human cardiac liabilities can go undetected because historically it has been challenging to predict how human hearts will respond to potentially cardiotoxic drugs despite rigorous testing in both animals and in vitro systems throughout drug development. Traditional in vitro systems and animal models do not translate well to humans, and human donor tissue availability is limited for in vitro testing. There is great potential for human-induced pluripotent stem cell cardiomyocytes (iPSC-CMs) to bridge this human translation gap, but it’s been a challenge to train these cells to recapitulate pharmacology seen in mature human heart cells. This stems from the fact that existing experimental models utilize immature human iPSC-CMs which lack relevant physiological hallmarks of adult human cardiac muscle and therefore fail to predict drug responses seen in the clinic. (more…)
BMJ, Gender Differences / 25.07.2019

MedicalResearch.com Interview with: Dr Crystal Lee BMedSc(Hons), MIPH, PhD, MBiostat Senior Research Fellow School of Psychology and Public Health La Trobe University Honorary Research Fellow The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders The University of Sydney Adjunct Senior Research Fellow School of Public Health | Curtin University MedicalResearch.com: What is the background for this study? Response: Coronary heart disease (CHD) is a leading cause of death and disability worldwide. Primary care has been shown to play an important role in the secondary prevention of cardiovascular disease. Yet, studies in Australia and elsewhere from as far back as two decades ago identified gaps in the management of CHD patients in primary care. We analysed records of 130,926 patients with a history of CHD from 438 general practices across Australia to determine whether sex disparities exist in the management of CHD according to current clinical guidelines. (more…)
Author Interviews, Genetic Research, Heart Disease, Imperial College, JAMA / 12.07.2019

MedicalResearch.com Interview with: Ben Cordon, PhD NIHR Post-doctoral Academic Clinical Fellow Specialist Registrar training in cardiology James S. Ware, PhD, MRCP Reader in Genomic Medicine Group head within the Cardiovascular Genetics & Genomics Unit Imperial College London MedicalResearch.com: What is the background for this study? Response: Non-ischaemic dilated cardiomyopathy is a common cause of heart failure and carries the risk of life-threatening ventricular arrhythmia. An implantable cardioverter defibrillator (ICD) can be life-saving in this condition. However, the decision to implant an ICD is not one that can be taken lightly - ICD insertion carries its own risks, such as infection or inappropriate shocks, and our ability to predict who will benefit from a device is currently far from perfect. Genetic sequencing is affordable and widely available and for DCM, like many diseases, it is hoped that genetic stratification may one day help deliver personalised management. In DCM, variants in the Lamin A/C gene for example are known to cause a phenotype with early and severe arrhythmias and, as a result, international guidelines advocate a lower threshold for ICD insertion in these patients. However, Lamin A/C is an infrequent cause of DCM. The commonest known genetic cause of DCM are protein-truncating variants in the gene encoding Titin (TTNtv), accounting for ~15% of DCM cases. We wanted to know if this group had a higher risk of arrhythmia than the general DCM population. Earlier work from our group on this topic found that patients with TTNtv-associated DCM were more likely to have a clinical history of arrhythmia (composite of atrial and ventricular arrhythmia, including NSVT), at the time of their initial DCM diagnosis. But it was unclear if this was driven by ventricular arrhythmia, atrial arrhythmia, or both or if it would translate into a long-term risk of potentially dangerous ventricular arrhythmia of the sort for which an ICD can be life-saving. In another study we analysed a larger cohort of ambulant DCM patients but did not find an increased risk of ventricular arrhythmia – but this was a relatively low-risk group, with comparatively mild symptoms (NHYA I/II heart failure) and moderately impaired LV function. As a result, the overall arrhythmic event rate was low, meaning that the power to detect differences between the TTNtv and non-TTNtv groups was reduced. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Medical Imaging / 17.06.2019

MedicalResearch.com Interview with: Quinn R Pack, MD Assistant Professor of Medicine University of Massachusetts Medical School - Baystate Adjunct Assistant Professor of Medicine Tufts University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Because echocardiograms are non-invasive, very low risk, and nearly universally available, it is easy to over-use this technique. In myocardial infarction, echo is also recommended in guidelines. However, in our lab, we frequently find echocardiograms that are ordered purely out of routine, without any thought as to the likelihood of finding an abnormality. Prior studies also suggested that as many as 70% of echocardiograms provide no additional diagnostic value. When spread across the approximate 600,000 patients in the United States each year, this low diagnostic yield represents an opportunity to reduce costs by reducing echocardiograms. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, University of Pennsylvania / 07.06.2019

MedicalResearch.com Interview with: Sameed Khatana, MD, MPH Fellow, Cardiovascular Medicine, Perleman School of Medicine Associate Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: The Affordable Care Act (ACA) led to the largest increase in Medicaid coverage since the beginning of the program. However, a number of states decided not to expand eligibility. Studies of prior smaller expansions in Medicaid, such as in individual states, have suggested evidence of improved outcomes associated with Medicaid expansion. Additionally, studies of Medicaid expansion under the ACA of certain health measures such as access to preventive care and medication adherence have suggested some improvements as well. However, there have been no large, population-level studies to examine whether Medicaid expansion under the ACA led to changes in mortality rates. Given, a high burden of cardiovascular risk factors in the uninsured, we examined whether states that had expanded Medicaid had a change in cardiovascular mortality rates after expansion, compared to states that have not expanded Medicaid. (more…)