Patients With Highest LDL Levels Benefit Most From Lipid-Lowering Drugs

MedicalResearch.com Interview with:

Dr. Jennifer Robinson, MD MPH professor of epidemiology, University of Iowa College of Public Health. CREDIT Tom Langdon

Dr. Robinson

Dr. Jennifer Robinson, MD MPH
Professor, Departments of Epidemiology & Medicine
Director, Prevention Intervention Center
Department of Epidemiology
University of Iowa

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

Response: Compared to previous placebo-controlled statin trials, the FOURIER trial where all patients were on high or moderate intensity statin, had no reduction in cardiovascular or total mortality and the reduction in cardiovascular events was less than expected.  However, other PCSK9 inhibitor trials performed in populations with higher baseline low density lipoprotein cholesterol (LDL-C) had cardiovascular risk reductions similar to that in the statin trails.

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Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes

MedicalResearch.com Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan

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

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion.  Continue reading

Sacubitril/Valsartan Reduces Physical and Social Limitations in Heart Failure Patients

MedicalResearch.com Interview with:
Dr. Alvin Chandra  MD first author  and
Dr. Scott David Solomon M.D.
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, Massachusetts

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

Response: In general, the quality of life of heart failure with reduced ejection fraction patients is quite impaired, and  similar to that of patients on dialysis.

PARADIGM-HF was the largest trial of heart failure patients and showed that sacubitril/valsartan was superior to the gold-standard enalapril in reducing cardiovascular death, heart failure hospitalization and all-cause mortality. In addition, patients on sacubitril/valsartan, when compared to enalapril, showed significant improvement in overall quality of life.

In this study we looked in more detail at the individual components of “quality of life” and found that in virtually all domains and activities, patients who were randomized to sacubitril/valsartan reported improvement in their limitations  compared to those who were randomized to enalapril. These activities included jogging, doing hobbies, and household chores, with the largest improvement seen in  sexual activities limitations.

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Epigenetic DNA Variants Predictive of Coronary Artery Disease

MedicalResearch.com Interview with:

Stella Aslibekyan, PhD Associate Professor PhD Program Director Department of Epidemiology University of Alabama at Birmingham

Dr. Aslibekyan

Stella Aslibekyan, PhD
Associate Professor
PhD Program Director
Department of Epidemiology
University of Alabama at Birmingham

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

Response: When the human genome was sequenced in 2003, there were somewhat unrestrained expectations of unraveling all etiologic mysteries and discovering breakthrough treatments. Needless to say, that did not happen, in part because individual genetic variants can only account for a small fraction of trait variability. Since then, epigenetics– the study of mitotically heritable changes in gene expression– has emerged as another promising avenue for understanding disease risk. The best studied epigenetic process in humans is DNA methylation, and earlier studies (including some from our group) have shown interesting associations between changes in methylation in specific genomic regions and cardiovascular disease traits, e.g. plasma cholesterol levels.

In this project, we have combined DNA methylation data on thousands of individuals from multiple international cohorts and interrogated epigenetic contributions to circulating tumor necrosis factor alpha (TNFa), a marker of systemic inflammation. We identified and replicated several epigenomic markers of TNFa, linked them to variation in gene expression, and showed that these methylation changes (which were located in interferon pathway genes) were predictive of coronary heart disease later in life. Interestingly, the variants we discovered were not sequence-dependent (in other words, they were not associated with any genetic mutations), highlighting the role of the environment.

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Migraine Linked To Increased Risk of Heart Disease and Stroke

MedicalResearch.com Interview with:

Islam Elgendy MD Division of Cardiovascular Medicine University of Florida  

Dr. Elgendy

Islam Elgendy MD
Division of Cardiovascular Medicine
University of Florida  

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

Response: Migraine headache is a prevalent medical condition, often being chronic and debilitating to many. Previous studies have shown that migraine, particularly migraine with aura, is associated with an increased risk of cardiovascular events. Recently, a number of these studies have reported long-term follow up data. To better understand the long-term morbidity that is associated with migraines, we performed a systematic evaluation to study the link between migraine and risk of cardiovascular and cerebrovascular events.

This study demonstrated that migraine is associated with an increased risk of major adverse cardiovascular and cerebrovascular events, which was driven by an increased long-term risk of myocardial infarction and stroke. This effect was predominantly observed in migraineurs who have aura.  Continue reading

Smartphone App Bests Clinical Assessment of Blood Flow

MedicalResearch.com Interview with:

Benjamin Hibbert MD PhD FRCPCz Interventional Cardiologist Clinician Scientist and Assistant Professor CAPITAL Research Group Vascular Biology and Experimental Medicine Laboratory University of Ottawa Heart Institute

Dr. Benjamin Hibbert

Benjamin Hibbert MD PhD FRCPCz
Interventional Cardiologist
Clinician Scientist and Assistant Professor
CAPITAL Research Group
Vascular Biology and Experimental Medicine Laboratory
University of Ottawa Heart Institute

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

Response: When we designed the study in 2014 we were routinely using the modified allen’s test (MAT) to screen patients for transradial access for coronary angiography and PCI. We all had iPhones and we started using the HeartRate monitoring application as a photoplethysmograph. Quite quickly we found that using the application was simple, worked well and because we always had our iPhone with us we tended to use it more often. That being said – we wanted to test it in a scientifically rigorous method and thus we elected to perform an RCT to evaluate it’s diagnostic accuracy.

smart app measures blood flowThe current study is the first to use the photoplethysmographic capabilities of smartphones to assess blood flow – in this case in the hand to assess for blockages in arteries before accessing them for a procedure. The hand is supplied by two arteries – the radial artery and the ulnar artery. In many cases in medicine we use the radial artery, whether it be placing a catheter to monitor blood pressure, as a method of getting to the heart for angioplasty and in coronary artery bypass grafting it is removed and used as a bypass to restore blood flow to the heart. In many instances doctors assess the patency of the ulnar artery to decided if they are going to use the radial artery for a procedure – the concept being that if the ulnar is compromised and we use the radial then the hand can develop complications from not enough blood flow. To determine if a patient is eligible doctors would use a bedside physical exam test called the modified Allen’s test in which they occlude both arteries to cause the hand to turn white. They then release pressure on the ulnar letting blood only pass through this vessel to see if the hand turns pink. However, there is a lot of variability in what doctors consider to be abnormal and determining if the test is positive can depend on numerous factors including skin tone, the amount of pressure applied and the size of the vessels. Continue reading

More Heart Attacks In Younger Men Following Canadian Hockey Games

MedicalResearch.com Interview with:
“Wings Hawks Game 2-11” by Michael Kumm is licensed under CC BY 2.0

Hung Q. Ly, M.D., S.M., FRCPC

President, Canadian Association of Interventional Cardiology
Program Director, Adult Cardiology Postgraduate Training Program
Associate Professor of Clinical Medicine
Interventional Cardiology Division,
Dept. of Medicine, Montreal Heart Institute, Montréal, Québec, Canada

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

Response: Prior scientific reports have discussed the association between major sporting events and cardiovascular events, irrespective of the sport.

Ours is the first to report an increase in hospital admission rates for heart attacks in men younger than 55yo in the day following a hockey game.

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

Response:  Emotional stress and lifestyle habits/behavioural patterns surrounding the spectatorship of hockey (i.e. drinking, unhealthy eating patterns, etc.) might make some Hockey (sports) fans more susceptible to heart attacks. We report a statistically significant increase in the incidence of heart attacks in young men watching the sport. This was an association that we manage to document but not an actual causal relationship. 

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

Response:  (1) Ascertain causality: Document that the “watching/attending a hockey game” was indeed an activity that the patient presenting with a heart attack did indeed do; (2) randomize sports fan to lifestyle changes and/or stress management strategies to explore if there is a decrease in cardiovascular events around the time of a sporting event. 

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

Response:  (1) I am a hardcore, diehard (no pun intended) Montreal Canadiens fan, which motivated me to perform this analysis; (2) We accounted for the effect of harsh winter conditions as a potential confounder of the increase in hospital rate admission for heart attacks; (3) we were quite surprised that victory, instead of defeat, lead to an increase in events; (4)  I have to conflict of interest to declare.

Citations:

Caroline E. Gebhard, Catherine Gebhard, Foued Maafi, Marie-Jeanne Bertrand, Barbara E. Stähli, Karin Wildi, Zurine Galvan, Aurel Toma, Zheng W. Zhang, David Smith, Hung Q. Ly. Hockey Games and the Incidence of ST-Elevation Myocardial Infarction. Canadian Journal of Cardiology, 2018; DOI: 10.1016/j.cjca.2017.12.028

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Every Minute Counts! Short Bursts of Physical Activity Reduces Mortality

MedicalResearch.com Interview with:

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

Dr. Saint-Maurice

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

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

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

Urgent/Emergent TAVR Feasible But Mortality Higher Than When Performed Electively

MedicalResearch.com Interview with:

Dawn Abbott, MD, FACC, FSCAI Associate Chief, Faculty Development and Academic Advancement Director, Interventional Cardiology and Structural Fellowship Programs Associate Professor of Medicine Warren Alpert Medical School, Brown Providence, RI 02903

Dr. Abbott

Dawn Abbott, MD, FACC, FSCAI
Associate Chief, Faculty Development and Academic Advancement
Director, Interventional Cardiology and Structural Fellowship Programs
Associate Professor of Medicine
Warren Alpert Medical School, Brown
Providence, RI 02903 

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

Response: Approximately 35,000 transcatheter aortic valve replacement (TAVR) procedures are now performed annually in the United States (US). TAVR is usually performed as an elective procedure in hemodynamically stable patients. Approximately 1 in 5 hospitalizations for severe aortic stenosis (AS) are emergent with acute decompensation. Balloon aortic valvuloplasty (BAV) is a therapeutic option in patients with acute decompensated AS; however, long-term survival after BAV remains poor with a high incidence of valvular re-stenosis. Data on the outcomes of urgent/emergent TAVR as a rescue therapy in patients with acute decompensated severe AS are extremely limited.

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Women Who Walk Briskly At Least Twice Per Week Have Lower Risk of Heart Failure

MedicalResearch.com Interview with:
Dr. Somwail Rasla, MD

Primary Care Center
Brown University, Pawtucket, RI

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

Response: Heart failure (HF) is a major global epidemic. The risk of heart failure rises with age, It triples for women above age 60.
Studies have found an inverse relationship between the risk of heart failure hospitalization and midlife fitness.Walking is the most common form of physical activity reported in women
and older adults. T
his study aims at exploring the association of walking pace (speed), walking frequency and duration with the risk of incident acute hospitalized HF (HHF).

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