Divorce Raises Risk of Heart Attack, Especially For Women

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? Continue reading

Heart Attack Carries Worse Prognosis In Dialysis Patients

Hemodialysis

Hemodialysis

MedicalResearch.com Interview with:
Tanush Gupta, MD

Department of Medicine, Division of Cardiology
New York Medical College, NY

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

Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.

We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.

Continue reading

Tai Chi Based Cardiac Rehabilitation Improved Functional Capacity After Heart Attack

Ricardo Stein, MD, ScD Exercise Cardiology Research Group, Cardiology Division Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, BrazilMedicalResearch.com Interview with:
Ricardo Stein, MD, ScD

Exercise Cardiology Research Group, Cardiology Division
Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre,
Porto Alegre, RS, Brazil

MedicalResearch: What is the background for this study?

Dr. Stein: Patients with a recent myocardial infarction (MI) present a reduction in functional capacity expressed as a decrease in peak oxygen consumption (VO2 peak). The impact of a Tai Chi Chuan (TCC) cardiac rehabilitation program for patients recovering from recent MI has yet to be assessed. Our goal was to evaluate functional capacity after a TCC-based cardiac rehabilitation program in patients with recent non complicated MI.

MedicalResearch: What are the main findings?

Dr. Stein:  After the 12-week study period, participants in the Tai Chi Chuan group experienced a significant 14% increase in VOpeak from baseline (21.6 ± 5.2 to 24.6 ± 5.2 mL.Kg-1.min-1), whereas control participants had a non-significant 5% decline in VOpeak (20.4 ± 5.1 to 19.4 ± 4.4 mL.Kg-1.min-1). There was a significant difference between the two groups (P<0.0001).

As a primary outcome, CPET results for the TCC and control groups at baseline and after the 12-week intervention period leading to a significant difference in peak VO2 (5.2 mL.Kg-1.min-1; 95% CI, 2.8 to 7.7, in favor to TCC group). This difference remained significant after adjustment to baseline measurements, age, gender, diabetes, and smoking (4.1 mL.Kg-1.min-1; 95% CI, 2.6 to 5.6, in favor to TCC group).

Summarizing:

–       We observed a significant increase in VO2 peak in TCC group participants.

–       Our results provide important information data from a randomized clinical trial of Tai Chi Chuan in patients with a history of recent MI.

–       Tai Chi Chuan can be an attractive alternative to cardiac rehabilitation for patients who don’t have access to conventional cardiac rehabilitation programs.

Continue reading

‘Leadership Saves Lives’ Program Aims To Reduce Heart Attack Mortality

Dr. Leslie CurryMedicalResearch.com Interview with:
Leslie Curry PhD, MPH
Senior Research Scientist in and Lecturer in Public Health (Health Policy)
Co-Director, Robert Wood Johnson Clinical Scholars Program
Yale School of Public Health

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

Dr. Curry: Quality of care for patients with acute myocardial infarction (AMI) has improved substantially in recent years due to important investments by clinicians and policymakers; however, survival rates across U.S. Hospitals still differ greatly. Evidence suggests links between hospital organizational culture and hospital performance in care of patients with AMI. Yet few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with acute myocardial infarction.  We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). We have a large team of people with backgrounds in nursing, medicine, health care administration and research working in 10 very diverse hospitals across the country in 10 states. All hospitals are members of the Mayo Clinic Care Network and are fully committed to saving lives of patients with heart attacks. Teams of 10-12 clinicians and administrators are devoting substantial energy, expertise and good will to this project.

Continue reading

NSAIDS After Heart Attack Increase Risk of Bleeding and Further Heart Attacks

MedicalResearch.com Interview with:
Anne-Marie Schjerning Olsen, MD, PhD Department of Cardiology Gentofte Hospital, University of Copenhagen DenmarkAnne-Marie Schjerning Olsen, MD, PhD
Department of Cardiology
Gentofte Hospital, University of Copenhagen
Denmark

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

Dr. Olsen: The question addressed in the study was: Do people who have had a myocardial infarction (heart attack) and are who taking drugs (known as antithrombotics) to reduce their risk of further heart attacks have an increased risk of serious bleeding, especially gastrointestinal bleeding, and of further heart attacks if they also take painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs)?

We found that taking NSAIDs, even for periods of under one week (3-4 days for bleeding), was associated with increased risks of both bleeding and of further heart attacks.

Background: People who have suffered a heart attack are prescribed medicines afterwards to reduce their risk of another one. The medicines usually include two ’antithrombotic drugs’ which make platelets in the blood less sticky – the two most commonly used drugs are aspirin and clopidogrel. A side effect of antithrombotic treatment is that the drugs increase bleeding risk.

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and inflammation. They are very effective and are among the most widely used drugs in the world. Some NSAIDs can be bought across the counter without a prescription, for example, ibuprofen. NSAIDs have side effects too. All of them increase the risk of bleeding, especially gastro-intestinal bleeding arising from damage (ulcers) caused to the gut lining. Some NSAIDs, for example diclofenac, are also associated with a small increase in the risk of heart attack – this risk matters most for people already at risk of a heart attack. The medical advice is for these patients to avoid NSAIDs and for their doctors to avoid prescribing them if possible.

But pain is a common problem and very distressing for people – so in practice, NSAIDs are used quite often by patients who have had a heart attack. If NSAIDs are to be taken by heart attack patients, then it is important that both they and their doctors know the risks so that they can weigh up the benefits and downsides and make an informed decision.

What this study did: This was a cohort study that included everyone in Denmark aged 30 years or older who had had a first heart attack and who was taking antithrombotic medicines. Using hospital and dispensing registries, we examined patients who had suffered serious bleeding (causing admission to hospital and/or death) or who had another heart attack or cardiac event to see if they had been prescribed NSAIDs or not.

Dr. Olsen: The study findings: In this study of over 60,000 patients in Denmark taking antithrombotic medicines, one third of them had at least one prescription for NSAIDs, commonly ibuprofen or diclofenac, dispensed over a median study time of 3.5 years. In the same period, 8.5% (5,288 patients or 1 in 12 of the study group) had a gastrointestinal bleed (of whom 799 or 15% died) and 30% (18,568; 1 in 3) had a new cardiac event, mostly heart attack. While these events happened to patients who were prescribed NSAIDs and also to patients were not prescribed NSAIDs, we found that the risk of bleeding was doubled when patients were taking NSAIDs compared with not taking them. The risk occurred within 3 days of starting a NSAID. The risk of a cardiac event (mainly heart attack) was increased by 40% when taking NSAIDs compared with not taking them and also occurred within days of starting a NSAID.

In other words, the NSAIDs appeared 1) to increase the bleeding risk already existing with antithrombotics and 2) to diminish the cardiac protection that antithrombotics provided.

Limitations: This is just one study, although it is a big one. It was a ’real-life’ observational study not a randomised controlled clinical trial. More studies are needed to confirm what we have found.

MedicalResearch:  Why is this important information for patients and doctors to know?

Dr. Olsen: NSAIDs were used a lot by the patients in this study – pain is a common problem and can cause great suffering. There has been a tendency to think that short-term use of NSAIDs is safe – our study suggests this in not the case and that even a few days of use is associated with increased risks of both bleeding and cardiac events, mainly heart attacks. People may be happy to take these risks to have relief from pain but it is very important that they aware of the risks and can make an informed decision about taking NSAIDs for pain relief.

Citation:

Schjerning Olsen A, Gislason GH, McGettigan P, et al. Association of NSAID Use With Risk of Bleeding and Cardiovascular Events in Patients Receiving Antithrombotic Therapy After Myocardial Infarction. JAMA. 2015;313(8):805-814. doi:10.1001/jama.2015.0809.

Anne-Marie Schjerning Olsen, MD, PhD Department of Cardiology (2015). NSAIDS After Heart Attack Increase Risk of Bleeding and Further Heart Attacks 

Two Frequent Genetic Variants Lower Risk for Heart Attack

MedicalResearch.com Interview with:
Wolfgang Sadee, Dr.rer.nat.
Felts Mercer Professor of Medicine and Chair, Pharmacology Director
and Elizabeth S Barrie, PhD
Center for Pharmacogenomics
The Ohio State University Columbus OH

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

Dr. Sadee and Dr. Barrie: We have determined that two frequent genetic variants can interact in a way that lowers the carrier’s risk for a heart attack. These genetic variants are single nucleotide polymorphisms (SNPs) – single base changes in the DNA sequence – of the dopamine-beta hydroxylase gene (DBH), which converts dopamine to norepinephrine. Both act as hormones in the periphery and as neurotransmitters vital to the brain’s activity central nervous system. Numerous studies had tested genetic variants in DBH for effects on brain functions. In contrast to expectations, however, our work demonstrates that our two genetic variants lower DBH activity primarily in the periphery, in tissues with sympathetic innervation mediated by norepinephrine, such as the heart, lung, and liver.  As a result, we searched for genetic influence on risk of various diseases of the cardiovascular system and the lung, metabolic disorders, and more.   Each of the two DBH variants alone was associated with a number of disease states; however, when considering both variants in combination, a strong protective effect on the risk for heart attacks was discovered in several clinical trials. Such combined effects arising from interactions between two genetic variants may be more common than currently realized, possibly providing a path towards effective biomarker panels for personalized medicine. Continue reading

High-Intensity Statin Therapy Underutilized After Heart Attack

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

Continue reading

Heart Attack: Off-Hours Stent Surgery Has Same Outcomes

Atsushi Sorita, MD, MPH Mayo Clinic, Division of Preventive Medicine Rochester, MN 55905.MedicalResearch.com Interview with:
Atsushi Sorita, MD, MPH

Mayo Clinic, Division of Preventive Medicine
Rochester, MN 55905.

 

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

Dr. Sorita: Prior studies have suggested that patients with heart attack who are admitted during off-hours (weekends, nights and holidays) have higher risk of death when compared with patients admitted during regular hours. In our study, we found that patients undergoing percutaneous coronary interventions for heart attack who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at a highly-integrated academic center in the United States.

Continue reading

Distance To Hospital Prevents Timely PCI and Lytic Therapy For Many Patients

 Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins UniversityMedicalResearch.com Interview with:
Dr. Amit Navin Vora MD, MPH
Third Year Cardiovascular Fellow
John Hopkins University

 

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

Response: Current guidelines recommend timely reperfusion in patients presenting with ST-elevation myocardial infarction, with primary PCI being the preferred method if delivered in an expedient fashion. Otherwise, guidelines recommend that eligible patients should be treated with fibrinolysis prior to transfer to a PCI capable hospital. In our study, we used Google Maps to estimate drive times between the initial presenting hospital and the PCI-capable hospital looked at the association between estimated drive time and reperfusion strategy (primary PCI or fibrinolysis) selection.

We found that less than half of eligible patients with an estimated drive time of more than 30 minutes received primary PCI in time, and only half of patients with more than an hour’s drive received lytics before transfer. This suggests that neither primary PCI nor pre-transfer fibrinolytic therapy is being used optimally. Among eligible patients with a drive time of 30-120 minutes, we found no significant mortality difference but higher bleeding risk among patients receiving lytics prior to transfer; this increased bleeding risk was focused in patients that required rescue PCI.
Continue reading

HbA1c Predicts LV Dysfunction in STEMI Heart Attack

MedicalResearch.com Interview with:
Dr. Arnold Ng, MBBS, PhD
Department of Cardiology
Princess Alexandra Hospital
University of Queensland, Australia

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

Dr. Arnold: The WHO and American Diabetes Association currently recommends the use of HbA1c >=6.5% as a diagnostic criterion for diabetes. HbA1c is advantageous over fasting plasma glucose and glucose tolerance testing by avoiding the need for patient fasting and inconvenient patient preparation. In addition, patients who are acutely unwell (e.g. STEMI) may develop stress hyperglycemia, complicating the diagnosis of diabetes. It is currently unclear if HbA1c (indicative of overall glycemic control) or fasting plasma glucose predicts worse left ventricular function after acute STEMI.

The present study demonstrated that HbA1c identified approximately another 20% of previously undiagnosed patients as diabetic. Furthermore, the present study was first to demonstrate that HbA1c, not fasting plasma glucose, was independently associated with more impaired LV diastolic function and elevated filling pressures after STEMI.
Continue reading

Heart Attack: Antiplatelet Use in Ambulance May Decrease Stent Thrombosis

Gilles Montalescot M.D., Ph.D. Professor of Cardiology University of Paris VI; Director, Cardiac Care Unit Institute of Cardiology, Pitié-Salpêtrière University Hospital Paris, FranceMedicalResearch.com Interview with:
Gilles Montalescot M.D., Ph.D.
Professor of Cardiology
University of Paris VI; Director, Cardiac Care Unit
Institute of Cardiology, Pitié-Salpêtrière University Hospital
Paris, France

Medical Research: What are the main findings of the study?

Dr. Montalescot : Among the 1862 patients with ongoing STEMI who were enrolled in the ATLANTIC study, we found no difference between those randomized to pre-hospital (in-ambulance) ticagrelor 180 mg and those randomized to in-hospital (in-catheterization laboratory) ticagrelor 180 mg in terms of either pre-PCI ST-segment elevation resolution (≥70%) or pre-PCI TIMI 3 flow in the culprit artery, which were the co-primary endpoints. There was also no difference between the groups in terms of major adverse cardiovascular events at 30 days, with the exception that rates of definite stent thrombosis were lower in the pre-hospital ticagrelor group than in the in-hospital group, both in the first 24 hours (0% versus 0.8%, p= 0.008) and at 30 days (0.2% versus 1.2%, p = 0.02). The safety of pre-hospital ticagrelor did not appear to be an issue, since the incidence of non-CABG-related major bleeding was low and similar in both treatment groups, whichever bleeding definition was used (PLATO, TIMI, STEEPLE, GUSTO, ISTH or BARC).
Continue reading

Patients Often Misinformed About Benefits of PCI for Heart Attack Prevention

Michael B. Rothberg, MD, MPH Department of Internal Medicine Medicine Institute, Vice Chair for Research Cleveland Clinic, Cleveland, OhioMedicalResearch Interview with:
Michael B. Rothberg, MD, MPH

Department of Internal Medicine
Medicine Institute, Vice Chair for Research
Cleveland Clinic, Cleveland, Ohio

Medical Research: What are the main findings of the study?

Dr. Rothberg: In this randomized study we found that when people are presented with no information about the benefits of elective PCI, most assumed that it would prevent a heart attack. Unfortunately, this is incorrect, so people may choose to have the procedure based on false information.  We also found that simply telling them that PCI would not prevent a heart attack successfully dispelled this belief for most,  but not all, participants.  Explaining why PCI does not prevent heart attacks in this circumstance was the most effective way to change people’s beliefs.  We also found that most people were willing to take medications, but when they were told that PCI does not prevent heart attacks, they were more likely to agree to medication.
Continue reading

Silent Heart Attack Common In Asymptomatic Resistant Hypertension

Dr. Rodrigo Modolo Department of Pharmacology Faculty of Medical Sciences University of Campinas–UNICAMP Campinas, SP, Brazil;MedicalResearch.com Interview with:
Dr. Rodrigo Modolo
Department of Pharmacology
Faculty of Medical Sciences University of Campinas–UNICAMP
Campinas, SP, Brazil;


Medical Research: What are the main findings of the study?

Dr. Modolo: The main findings of this study are the encounter of a high prevalence of silent myocardial ischemia (assessed by myocardial perfusion scintigraphy) in resistant hypertension and the identification of predictors of this alteration in this population.

Continue reading

After Heart Attack: High Dose Aspirin Still Commonly Prescribed

MedicalResearch.com Interview with:
Hurst M. Hall, MD and Sandeep Das, MD, MPH
Division of Cardiology
University of Texas Southwestern Medical Center
Dallas, TX

Medical Research: What are the main findings of the study?

Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day.  This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns.
Continue reading

Heart Attack Outcomes Vary By Ethnicity, Gender and Age

MedicalResearch.com Interview with:
Sahil Khera, MD and
Dhaval Kolte, MD, PhD
Department of Medicine, Division of Cardiology
New York Medical College, NY

Medical Research: What are the main findings of the study?

Answer: We used the publicly available Nationwide Inpatient Sample (NIS) databases for our study. We analyzed data on 6.5 million patients with heart attack (all types) from 2002 to 2011 in United States. Out of these 3.98 million were admitted with a diagnosis of non-ST elevation myocardial infarction (NSTEMI). Our objective was to describe how the care for patients with NSTEMI has changed over the past 10 years and whether this has resulted in better patient outcomes. We looked at the proportion of patients with NSTEMI who underwent cardiac catheterization each year. We also studied how many patients died in the hospital, how long was the hospital stay, and what was the total cost of hospitalization for this condition. Lastly, we determined if the changes in treatment and outcomes over the years were similar for different age- groups, men and women, and for different racial/ethnic groups.

In this analysis, we looked at cardiac catheterization trends after NSTEMI for both within 24 hours and within 48 hours. This is the first study of its kind to analyze two different time frames of early catheterization simultaneously. Although there was an increase in the proportion of patients with NSTEMI with increase in utilization of early cardiac catheterization and decrease in in-hospital death and length of stay, age-, sex-, and race/ethnicity-specific differences in the management and outcomes of NSTEMI were observed, and further studies are needed to develop strategies to ensure more equitable care for patients with this type of heart attack. Continue reading

Quitting Snuff/Chew/Dip After Heart Attack May Half Risk of Dying

Gabriel Arefalk Department of Medical Sciences Uppsala University Hospital Uppsala, SwedenMedicalResearch.com: Interview with:
Gabriel Arefalk
Department of Medical Sciences
Uppsala University Hospital
Uppsala, Sweden

Medical Research: What are the main findings of the study?

Answer: In this prospective cohort study, we investigated mortality risk in 2474 smokeless tobacco users who had been hospitalized for a myocardial infarction between the years of 2005-2009 in Sweden. We used a nationwide quality register and database called SWEDEHEART and found that those who stopped using snus (the Swedish type of snuff) after their MI had half the risk of dying during follow up relative to those who continued to use snus. This association, which was of the same magnitude as for smoking cessation, seemed to be independent of age, gender and smoking habits, as well as of many other relevant covariates.

Continue reading

Heart Attack: Young and Female Patients Have Worse Outcomes

Aakriti Gupta, MD, MBBS  Center for Outcomes Research and Evaluation Yale-New Haven Hospital, New Haven, ConnecticutMedicalResearch.com Interview with:
Aakriti Gupta, MD, MBBS
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital,
New Haven, Connecticut

Medical Research: What were the main findings?


Dr. Gupta:
Using a national database, we found that heart attack hospitalization rates for patients under the age of 55 have not declined in the past decade while their Medicare-age counterparts have seen a 20 percent drop.

We also found that among younger patients below 55 years of age, women fare worse because they have longer hospital stays, and are more likely to die in the hospital after a heart attack. Young women were also more likely to have higher prevalence of co-existing medical conditions including diabetes, high blood pressure and higher cholesterol levels. Overall, all patient groups in the study saw increases in these conditions including diabetes and high blood pressure in the past decade.

Continue reading

Is Testosterone Protective Against Heart Attack in Older Men?

Jacques Baillargeon, PhD Director, Epidemiology Division Associate Professor Department of Preventive Medicine and Community Health University of Texas Medical Branch MedicalResearch.com Interview with:
Jacques Baillargeon, PhD
Director, Epidemiology Division
Associate Professor
Department of Preventive Medicine and Community Health
University of Texas Medical Branch

MedicalResearch: What are the main findings of the study?

Dr. Baillargeon: The main findings of the study were that older men who were treated with testosterone did not appear to have an increased risk of Myocardial Infarction.  For men with high MI risk, testosterone use appeared to be modestly protective against MI.

Continue reading

Heart Attack Admissions In China Quadrupled Over 10 Years

Professor Lixin Jiang MD, PhD, F.A.C.C. National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital, National Center for Cardiovascular Diseases Beijing , ChinaMedicalResearch.com Interview with:
Professor Lixin Jiang MD, PhD, F.A.C.C.
National Clinical Research Center of Cardiovascular Diseases
State Key Laboratory of Cardiovascular Disease
Fuwai Hospital, National Center for Cardiovascular Diseases
Beijing , China

MedicalResearch: What are the main findings of the study?

Professor Jiang: In this first representative nationwide assessment of quality of care in China, we studied 13,815 hospital admissions for STEMI in 162 hospitals across China over the past decade. We found that the incidence of hospital admission for STEMI quadrupled from 3.7 per 100,000 in 2001 to 15.8 per 100,000 in 2011.

There were substantial changes in testing and treatment patterns. Over the study period, the rate of testing for troponin increased from 21.4% in 2001 to 66.5% in 2011. Additionally, based at the ideal patients’ analysis, the use of several highly effective treatments for STEMI, including aspirin, clopidogrel and statins, improved over the study period. However, other therapies known to reduce mortality in STEMI patients – such as β-blockers and ACE inhibitors – were underused with only 57.7% of patients receiving beta-blockers and 66.1% ACE inhibitors respectively in 2011.

While the proportion of patients receiving reperfusion therapy remained constant, there was a notable shift away from fibrinolysis, which was the primary means of reperfusion in 2001, towards primary PCI. However, in 2011, only 27.6% of patients admitted to Chinese hospitals for STEMI received primary PCI, the gold standard of treatment, while 27.4% received fibrinolytic therapy in the ideal patients.

Despite increasing overall intensity of treatment, procedure use, and testing, no significant change in the rate of in-hospital death from STEMI was seen over the study period. Continue reading

Heavy Episodic Alcohol Use Raises Risk of Heart Attack

Dr. Darryl P. Leong MBBS(Hons) MPH PhD FRACP FESC Hamilton General Hospital 237 Barton Street East CanadaMedicalResearch.com: Interview with:
Dr. Darryl P. Leong MBBS(Hons) MPH PhD FRACP FESC
Hamilton General Hospital
237 Barton Street East Canada

 

MedicalResearch: What are the main findings of the study?

Dr. Leong: The main findings of this study are that while low-moderate levels of alcohol use are associated with a reduced risk of myocardial infarction, this protective association was not seen in peoples of all ethnicities.

Secondly, heavy alcohol use (≥6 drinks) within a 24 hour period was associated with a significant increase in the immediate risk of myocardial infarction.
Continue reading

After Heart Attack: Encouraging Stem Cells To Regenerate Damaged Muscle

MedicalResearch.com Interview with
Dr. Takuji Toyama MD
Division of Cardiology
Gunma Prefectural Cardiovascular Center
Maebashi, Japan.

MedicalResearch: What are the main findings of the study?

Dr. Toyama: The early start of granulocyte colony-stimulating factor (G-CSF) therapy in acute myocardial infarction ( AMI) patients can improve myocardial perfusion, fatty acid metabolism and cardiac function in subacute and follow-up periods.
Continue reading

Post Heart Attack: Insulin Based Diabetes Control and Improved Longevity

MedicalResearch.com Interview with:
Viveca Ritsinger MD
Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm
Unit for Research and Development Kronoberg County Council, Växjö, Sweden

MedicalResearch: What are the main findings of the study?

Dr. Ritsinger: This is a long-term follow-up of the Swedish DIGAMI 1 study where patients with acute myocardial infarction and diabetes were randomized to either intensified insulin-based glycaemic control or to standard glucose lowering treatment. Patients and controls were followed for mortality for over 20 years and 90% of the patients died during follow up.

Survival improved during a period of about 8 years. Intensified insulin-based glycaemic control increased survival time by an average of 2.3 years.
Continue reading

Post MI: Increasing Dietary Fiber Decreased Mortality

Shanshan Li, Doctoral candidate Department of Epidemiology Harvard School of Public Health, 655 Huntington Avenue Boston, MA 02115, USAMedicalResearch.com Interview with:
Shanshan Li, Doctoral candidate
Department of Epidemiology
Harvard School of Public Health, 655 Huntington Avenue
Boston, MA 02115, USA


MedicalResearch.com: What are the main findings of the study?

Answer: This is the first study to show that greater intake of dietary fiber,
especially cereal fiber, was inversely associated with all-cause
mortality. Participants increased their average dietary fiber intake
after myocardial infarction (MI), and the greater the increase, the lower was the risk of
subsequent all-cause and cardiovascular mortality. Overall, the
benefits for increased fiber intake were strongest for fiber from
cereal and grain sources.

Continue reading

Heart Attack: Feminine Traits May Delay Cardiac Treatment

MedicalResearch.com Interview with:
Roxanne Pelletier, PhD Postdoctoral Fellow Division of Clinical Epidemiology  McGill University Health Centre (MUHC) 687 Pine Avenue West, V Building, Room V2.17 Montreal, QcRoxanne Pelletier, PhD
Postdoctoral Fellow
Division of Clinical Epidemiology
McGill University Health Centre (MUHC)
687 Pine Avenue West, V Building, Room V2.17
Montreal, Qc

MedicalResearch.com: What made you want to study this disparity between men and women and heart attacks? 

Dr. Pelletier:  Despite enhanced medical treatment and decrease in the incidence of heart diseases, important sex disparities persist in the risk of mortality following a cardiac event: the risk of mortality is higher in women compared to men, and this sex difference is even more important in younger adults. Therefore, we aimed to investigate potential mechanisms underlying this sex difference in mortality.
Continue reading

Gene Variant Influencing Cholesterol and Myocardial Risk Discovered

dr_cristen_j_willerMedicalResearch.com Interview with:
Cristen J. Willer, PhD
Assistant Professor
Division of Cardiovascular Medicine, Dept of Internal Medicine
Dept of Human GeneticsDept of Computational Medicine and Bioinformatics
University of Michigan Ann Arbor, MI 48109-5618

MedicalResearch.com: What are the main findings of the study?

Dr. Willer: We wanted to find new genes related to heart disease, so we examined the DNA of approximately 10,000 Norwegian individuals and found 10 genes that are important regulators of blood cholesterol levels. Nine of these were well known to be related to lipids, but one gene was new.  It turned out to be in a region we’d previously noticed to be related to cholesterol, but it was a big region and we hadn’t been able to pinpoint the gene yet.  Using this new approach, focusing on DNA differences that result in slightly different proteins in people, we zeroed in on the gene.  We then altered this gene in mice, and saw the predicted changes in cholesterol levels in mice.
Continue reading