Biotricity: Deep Data and AI Bring Enhanced Value to Medical Wearables

MedicalResearch.com Interview with:

Waqaas Al-Siddiq

Waqaas Al-Siddiq

Waqaas Al-Siddiq
Founder and CEO of Biotricity Inc

MedicalResearch.com: In light of Apple’s announcement that it will incorporate an EKG monitoring device into Apple watches in the near future, would you discuss your vision of the growing medical wearables market? 

Response: First of all, the public is still largely confused as to what constitutes a medical wearable device. Apple’s new watch, with its EKG monitoring service, is not a medical wearable because it will not produce clinical-grade data needed for diagnosis or treatment. This is not to say that Apple’s watch isn’t helpful. Many people are not even aware that they have a heart problem, but if their Apple watch consistently tells them that they have an irregular heart rhythm, or arrhythmia, they could take that as a sign to go to a physician and get a professional diagnosis. A physician will then prescribe a medical wearable device, such as our Bioflux, to monitor the patient’s heart rhythm. Medical-grade wearable devices produce clinical-grade data that is accurate to within 90-95 percent or higher and are prescribed by physicians to make diagnoses and treatment plans.

That being said, I envision that the medical wearables market will expand considerably with the advent of consumer-based wearables that facilitate health tracking. One of the biggest problems we have today is a lack of awareness. Anywhere between 2.7 and 6.1 million people in the U.S. suffer from atrial fibrillation – a condition that makes the heart beat irregularly – and many aren’t aware that they have the condition. Consumer-based health trackers like the Fitbit and the Apple Watch can help raise awareness and alert consumers to possible health issues, which will encourage them to see a physician for a thorough and professional examination and diagnosis. This, in turn, gives the medical wearable market a boost as more people will be diagnosed with the aid of a medical wearable. Another factor that is playing into this adoption trend is that next-generation medical wearables are increasingly becoming smaller and easier to use for both patients and physicians. So, I think that the future of medical wearables will see them firmly entrenched in mainstream practice and eventually become tools within the home for individuals with chronic issues.  Continue reading

Gene Variants Can Alter Glucose Absorption and Cardiometabolic Risks

MedicalResearch.com Interview with:

Scott David Solomon, MD Director, Noninvasive Cardiology Professor, Harvard Medical School Brigham and Women's Hospital

Dr. Solomon

Scott David Solomon, MD
Director, Noninvasive Cardiology
Professor, Harvard Medical School
Brigham and Women’s Hospital 

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

Response: The sodium glucose transport proteins are known to be important in regulating uptake of glucose. SGLT-1 is predominantly located in the gut and is responsible for uptake of glucose and galactose in the small intestine. Individuals born with severe mutations of this gene have severe malabsorption syndrome.

We looked at genetic variants that lead to reduced function of the protein, but not complete loss of function, in a large cohort of individuals in the NIH funded Atherosclerosis Risk in Communities Study. We found that those with mutations in the gene had reduced glucose uptake, as measured by an oral glucose tolerance test, as well as less obesity, diabetes, heart failure and death.

Continue reading

Genetic Risk Score Improves Ability To Predict Diabetics at Risk of Coronary Disease

MedicalResearch.com Interview with:

Mario Luca Morieri

Dr. Morieri

Mario Luca Morieri MD
Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center
Department of Medicine, Harvard Medical School, Boston, MA

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

Response: Coronary artery disease (CAD) is one of the most important complications of diabetes.

Similarly to other complex disorders, CAD is influenced by both environmental and genetic factors. Over the last decade, our understanding of the genetic factors contributing to CAD has dramatically improved and hundreds of new genetic markers associated with increased cardiovascular risk have been identified.

In this study, we showed that combining these genetic markers into a single score (a so called genetic risk score) can improve our ability to the identify those patients with type 2 diabetes who are at higher risk of experiencing a coronary event. 

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

Response: One take-away message is that the genetic markers associated with CAD in persons without diabetes have a similar effect in people with diabetes. Another is that prediction of increased risk of CAD in people with diabetes can be improved with the combination of genetic markers with “classic” known markers of CAD such as high cholesterol and high blood pressure. Improving cardiovascular risk prediction will allow physicians to focus their effort on people at higher risk, making the allocation of health-care resources more efficient. 

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

Response: We were able to replicate our findings (from the ACCORD trial) in another study including diabetic patients with similar characteristics (the ORIGIN trial). However, to improve the generalizability of the genetic risk score, its performance should be tested in populations with different clinical characteristics. With the detailed information provided in the paper, other researchers should be able to do this. Also, the genetic score reported in our paper applies to Whites as it was derived from genetic markers discovered in that ethnic group. It would be important to build a similar genetic risk score for people of different ancestry using genetic markers specific to those populations.

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

Response: We showed in the paper that the identification of an increasing number of genetic markers of CAD risk over the last 8 years has resulted into a progressive improvement in the performance of genetic risk scores for prediction of CAD risk. Thus, if new genetic markers of CAD continue to be identified over the next few years, the usefulness of these genetic scores may continue to increase. 

Citation:

Genetic Tools for Coronary Risk Assessment in Type 2 Diabetes: A Cohort Study From the ACCORD Clinical Trial

Mario Luca Morieri, He Gao, Marie Pigeyre, Hetal S. Shah, Jennifer Sjaarda, Christine Mendonca,Timothy Hastings, Patinut Buranasupkajorn, Alison A. Motsinger-Reif, Daniel M. Rotroff, Ronald J. Sigal,Santica M. Marcovina, Peter Kraft, John B. Buse, Michael J. Wagner, Hertzel C. Gerstein, Josyf C. Mychaleckyj, Guillaume Parè and Alessandro Doria

Diabetes Care 2018 Sep; dc180709.https://doi.org/10.2337/dc18-0709

Sep 29, 2018 @ 6:39 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Big Survival Differences in Out-of-Hospital Cardiac Arrest Between EMS Agencies

MedicalResearch.com Interview with:

Masashi Okubo, MD. Clinical Instructor of Emergency Medicine Research Fellow Department of Emergency Medicine University of Pittsburgh

Dr. Okubo

Masashi OkuboMD.
Clinical Instructor of Emergency Medicine
Research Fellow
Department of Emergency Medicine
University of Pittsburgh

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

Response: Out-of-hospital cardiac arrest (OHCA) is a major public health problem, annually affecting over 350,000 individuals in the US with low survival rate, 11.4% among those who were treated by emergency medical services (EMS). Prior studies showed a 5-fold difference (3.0% to 16.3%)  in survival to hospital discharge between 10 study sites in North America (US and Canada) and 6.5-fold difference (3.4% to 22.0%) between 132 US counties after OHCA.

However, it was unclear how much patient outcome after OHCA differ between EMS agencies which play a critical role in OHCA care. Among 43,656 adults treated for Out-of-hospital cardiac arrest by 112 EMS agencies in North America, we found that survival to hospital discharge differed from 0% to 28.9% between EMS agencies. There was a median difference of 56% in the odds of survival to hospital discharge for patients with similar characteristics between any 2 randomly selected EMS agencies, after adjusting for known measured sources of variability.

Continue reading

Study Links Mitral Valve Prolapse with Risk of Sudden Death

MedicalResearch.com Interview with:

Professor Prash Sanders Director, Centre for Heart Rhythm Disorders NHMRC Practitioner Fellow, Knapman-NHF Chair of Cardiology Research, University of Adelaide | SAHMRI Director, Cardiac Electrophysiology & Pacing, Royal Adelaide Hospital

Prof. Sanders

Professor Prash Sanders
Director, Centre for Heart Rhythm Disorders
NHMRC Practitioner Fellow,
Knapman-NHF Chair of Cardiology Research,
University of Adelaide | SAHMRI
Director, Cardiac Electrophysiology & Pacing,
Royal Adelaide Hospital

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

Response: CLINICALLY WE HAVE HAD SOME PATIENTS WHO HAVE SURVIVED SUDDEN DEATH EPISODES AND HAVE NOTED THAT THEY HAD MITRAL VALVE PROLAPSE. THIS STIMULATED US TO UNDERTAKE A REVIEW OF THE LITERATURE.

Continue reading

Mothers of Infants Born With Major Birth Defect are at Increased Risk of Cardiovasular Disease

MedicalResearch.com Interview with:

Eyal Cohen, MD, MSc, FRCP(C) Associate Scientist and Program Head (interim), Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children Staff Physician, Division of Paediatric Medicine, The Hospital for Sick Children Professor, Paediatrics and Health Policy, Management & Evaluation The University of Toronto 

Dr. Cohen

Eyal Cohen, MD, MSc, FRCP(C)
Associate Scientist and Program Head (interim), Child Health Evaluative Sciences
Research Institute, The Hospital for Sick Children
Staff Physician, Division of Paediatric Medicine, The Hospital for Sick Children
Professor, Paediatrics and Health Policy
Management & Evaluation
The University of Toronto

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

Response: Having a child with a major birth defect can be a life-changing and stressful event for the child’s mother.  This stress may be associated with higher risk of premature cardiovascular disease.

We found that mothers of infants born with a major birth defect had a 15% higher risk of premature cardiovascular disease that a comparison group of mothers.  The risk was more pronounced, rising to 37% among mothers who gave birth to a more severely affected infant (and infant born with major birth defects affecting more than one organ system). The risk was apparent even within the first 10 years after the birth of the child.

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Lowering Triglycerides and Cholesterol Could Reduce Heart Disease and Diabetes Risk

MedicalResearch.com Interview with:

Luca A. Lotta, MD, PhD Senior Clinical Investigator MRC Epidemiology Unit University of Cambridge

Dr. Lotta

Luca A. Lotta, MD, PhD
Senior Clinical Investigator
MRC Epidemiology Unit
University of Cambridge

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

  • Drugs that enhance the breakdown of circulating triglycerides by activating lipoprotein lipase (LPL) are in pre-clinical or early-clinical development.
  • It is not known if these drugs will reduce heart attacks or diabetes risk when added to the current first line therapies (statins and other cholesterol-lowering agents).
  • Studying this would require large randomised controlled trials, which are expensive (millions of GBPs) and time-consuming (years).
  • Human genetic data can be used to provide supportive evidence of whether this therapy is likely to be effective by “simulating” a randomised controlled trial.
  • Our study used naturally occurring genetic variants in the general population (study of ~400,000 people) to address this.
  • Individuals with naturally-lower cholesterol due to their genetic makeup were used as model for cholesterol-lowering therapies (eg. Statins).
  • Individuals with naturally-lower triglycerides due to genetic variants in the LPL gene were used as model for these new triglyceride-lowering therapies.
  • We studied the risk of heart attacks and type 2 diabetes in people in different groups.

Continue reading

New Method of Intubation Offers Better Chance of Surviving Out-of-Hospital Cardiac Arrest

MedicalResearch.com Interview with:

Henry E. Wang, MD, MS Professor and Vice Chair for Research University of Texas Health Science Center at Houston  Department of Emergency Medicine Houston, Texas 

Dr. Wang

Henry E. Wang, MD, MS
Professor and Vice Chair for Research
University of Texas Health Science Center at Houston
Department of Emergency Medicine
Houston, Texas

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

Response: For over three decades, paramedics have performed endotracheal intubation (ETI) as the standard advanced airway management strategy in cardiac arrest. However, intubation is a difficult and error-prone intervention. Newer supraglottic airways such as the laryngeal tube (LT) offer easier insertion technique with comparable ventilation. However, intubation and laryngeal tubes have not been tested head-to-head in a randomized trial.

Our study – the Pragmatic Airway Resuscitation Trial (PART) – tested intubation vs laryngeal tube for airway management in adult out-of-hospital cardiac arrests. The trial included 27 EMS agencies from the Birmingham, Dallas-Fort Worth, Milwaukee, Portland and Pittsburgh communities. The trial randomized a total of 3,004 adult cardiac arrests to airway management with ETI or LT.

We found that compared with traditional ETI, LT was associated with almost 3% better survival. Out-of-hospital cardiac arrest survival in the US is less than 10%, so the observed difference is important.  Continue reading

Using a Pulmonary Valve To Replace Diseased Aortic Valve Improves QoL and Survival in Young and Middle-age Adults

MedicalResearch.com Interview with:

Amine Mazine, MD, MSc Associate Editor, BMC Surgery PGY-4 Cardiac Surgery PhD Candidate, Institute of Biomaterials and Biomedical Engineering McEwen Center for Regenerative Medicine Surgeon-Scientist Training Program  University of Toronto

Dr. Mazine

Amine Mazine, MD, MSc
Associate Editor, BMC Surgery
PGY-4 Cardiac Surgery
PhD Candidate, Institute of Biomaterials and Biomedical Engineering
McEwen Center for Regenerative Medicine
Surgeon-Scientist Training Program
University of Toronto

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

Response: We performed this study to compare two methods of replacing a diseased aortic valve in young and middle-aged adults: using an artificial mechanical valve (mechanical aortic valve replacement) versus using the patient’s own pulmonary valve (Ross procedure).

The study was a meta-analysis of existing literature that included more than 3,500 adult patients. It found that those who underwent the Ross procedure were 46 per cent less likely to experience death from any cause than patients who underwent mechanical aortic valve replacement. Patients in the Ross group were also less likely to suffer from a stroke or major bleeding, and had better quality of life. Patients who underwent the Ross procedure were more likely to need late reoperation, but this did not negatively impact their survival. Continue reading

Does Routine Oxygen After Heart Attack Reduce Risk of Dying?

MedicalResearch.com Interview with:

Robin Hofmann, MD PhD  Senior consultant cardiologist and researcher Department of clinical science and education Södersjukhuset, at Karolinska Institute

Dr. Hofmann

Robin Hofmann, MD PhD
Senior consultant cardiologist and researcher
Department of clinical science and education
Södersjukhuset, at Karolinska Institute

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

Response: Oxygen has been used to treat patients suffering a heart attack for more than a century, despite the fact that such treatment has not had any scientifically proven effect on patients who have normal oxygen levels in their blood. Since the turn of the millennium, researchers worldwide have started to question whether oxygen therapy for heart attacks is ineffective – or may even be harmful.

Continue reading

Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation?

MedicalResearch.com Interview with:
Jean François Obadia Adult Cardiovascular Surgery and Transplantation Louis Pradel HospitalJean François Obadia MD PhD
Adult Cardiovascular Surgery and Transplantation
Louis Pradel Hospital

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

-By definition a secondary MR concerns a normal valve or sub normal valve inside a dilated heart with poor LV function in a population of Heart failure patients. It is perfectly established today that secondary MR is a predictor of poor clinical outcomes of thissevere population.

-Therefore,it has been proposed to treat those regurgitation either by surgery (mainly the downsizing anuloplasty) or by percutaneous technique like the mitraclipwhich has been used more and more frequently recently.

-However, a beneficial effect on hardclinical outcomes has never been provedandwe still don’t know if those regurgitations need to be corrected or not, We still don’t Know if the regurgitation is the cause, the consequence or just a marker of poor prognosis.

-In this context according to the guidelines, there is a low level of evidence to support those treatments, and Europe and US Guidelines call for prospective randomized studies in this severe population.​

And this excatly what we have done with MITRA-FR

Continue reading

Coronary CT Angiography May Be Best Approach to Chest Pain

MedicalResearch.com Interview with:

Prof David Newby FRSE FMedSci Personal Chair - BHF John Wheatley Chair of Cardiology University of Edinburgh

Prof. Newby

Prof David Newby FRSE FMedSci
Personal Chair – BHF John Wheatley Chair of Cardiology
University of Edinburgh

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

Response: There are many tests that can try and determine whether a patient has heart disease. All are imperfect and do not directly see if the heart arteries are diseased.

This study used a CT heart scan to see if there was any heart disease in patients who presented to the outpatient clinic with chest pains that could be due to coronary heart disease. The doctor use the scan result to decide whether they had heart disease and how to manage the patient.

The study has found that if you use a CT heart scan then you are less likely to have a heart attack in the future. In the first year, you may require treatment with an angiogram and heart surgery (stent or heart bypass) but after the first year, you are less likely to need these treatments because the disease has already been treated promptly.

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Cardiovascular Risk Factors Also Linked to Dementia

MedicalResearch.com Interview with:

Cécilia Samieri, PhD Université de Bordeaux, INSERM Bordeaux Population Health Research Center Bordeaux, France

Dr. Samieri

Cécilia Samieri, PhD
Université de Bordeaux, INSERM
Bordeaux Population Health Research Center
Bordeaux, France

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

Response: Previous research has demonstrated that heart diseases and brain diseases share common risk factors. Favorable health factors (optimal levels of BMI, blood pressure, blood glucose and cholesterol) and behaviors (non smoking, physical activity and diet at optimal levels), which are known to protect the heart, have also been associated with a lower risk of age-related brain diseases (eg, dementia) and lower rate of cognitive decline in some epidemiological studies. However, studies have been controversial and importantly, very limited research has considered risk factors simultaneously. This may be an explanation for the lack of established consensus for recommendations aimed at dementia prevention.

This study adds to previous knowledge by evaluating cardiovascular health factors and behaviors simultaneously in relation to cognitive decline and the risk of dementia in older age. We used the American Heart Association 7-item tool to promote primordial prevention, which aims to prevent the developement of risk factors in a first place as a prevention strategy against cardiovascular diseases.

We found that each additional favorable health factor/behavior was associated with a 10% lower risk to develop dementia in the following decade.

These findings support the promotion if cardiovascular health to prevent the development of risk factors associated with dementia.  

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

Response: When considering cardiovascular health, each additional improvement of the level of one or several health factors/behaviors is associated with a lower risk opf dementia and less cognitive decline.

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

Response: Evaluate the change in risk factors over time as well was possible differential weighting of the factors in relation to dementia risk. 

Citation:

Samieri C, Perier M, Gaye B, et al. Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia. JAMA. 2018;320(7):657–664. doi:10.1001/jama.2018.11499

Aug 21, 2018 @ 5:49 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Clinical Chemistry Score Helps Rule Out Diagnosis of Heart Attack

MedicalResearch.com Interview with:

Peter Kavsak, PhD, FCACB, FAACC, FCCS Professor, Pathology and Molecular Medicine McMaster University 

Prof.. Kavsak

Peter Kavsak, PhD, FCACB, FAACC, FCCS
Professor, Pathology and Molecular Medicine
McMaster University 

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

Response: For patients who present to the hospital with symptoms suggestive of acute coronary syndrome (ACS) the preferred blood test to help physicians in making a diagnosis is cardiac troponin.

Recent studies have demonstrated that a very low or undetectable cardiac troponin level when measured with the newest generation of blood tests (i.e., the high-sensitivity cardiac troponin tests) in this population may rule-out myocardial infarction (MI or a heart attack) on the initial blood sample collected in the emergency department, thus enabling a faster decision and foregoing the need for subsequent serial measurements of cardiac troponin over several hours as recommended by the guidelines. The problem with this approach, however, is that using high-sensitivity cardiac troponin alone to do this has not reliably been demonstrated to achieve a sensitivity >99% for detecting MI, which is the estimate that most physicians in this setting consider as safe for discharge.

Our study goal was to compare the diagnostic performance of a simple laboratory algorithm using common blood tests (i.e., a clinical chemistry score (CCS) consisting of glucose, estimated glomerular filtration rate (eGFR), and either high-sensitivity cardiac troponin I or T) to high-sensitivity cardiac troponin alone for predicting MI or death within the first month following the initial blood work. Continue reading

Patients With Type II Diabetes Have Greatest Risk of Heart Failure

MedicalResearch.com Interview with:

Dr Araz Rawshani, PhD Department of Molecular and Clinical Medicine Institute of Medicine University of Gothenburg Gothenburg, Sweden

Dr. Rawshani

Dr Araz Rawshani, PhD
Department of Molecular and Clinical Medicine
Institute of Medicine
University of Gothenburg
Gothenburg, Sweden

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

 Response: Patients with type 2 diabetes have 2 to 4 times greater risk for death and cardiovascular events compared to the general population. There are several randomized trails that encourage a range of interventions that target traditional and modifiable risk factors, such as elevated levels for glycated hemoglobin, blood pressure and low-density lipoprotein cholesterol to reduce the risk for complications of type 2 diabetes. However, there are few randomized trails that have investigated the effects of multifactorial risk factor intervention in reducing the risk for death and cardiovascular events, as compared to patients that are treated with usual care.

We set out to investigate the extent to which the excess risk associated with type 2 diabetes may be mitigated or potentially eliminated by means of evidence-based treatment and multifactorial risk factor modification. In addition, we estimated the relative importance between various risk factors and the incremental risk of death and cardiovascular events associated with diabetes. Furthermore, we investigated the association between glycated hemoglobin, systolic blood pressure and low-density lipoprotein cholesterol (LDL-C) within evidence based target ranges and the abovementioned outcomes.

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New Biomarkers Predictive of Atrial Fibrillation Outcome

MedicalResearch.com Interview with:

John D Horowitz, MBBS, PhD. Director of Cardiology/Clinical Pharmacology Queen Elizabeth Hospital University of Adelaide Australia

Dr. Horowitz

John D Horowitz, MBBS, PhD.
Director of Cardiology/Clinical Pharmacology
Queen Elizabeth Hospital
University of Adelaide
Australia 

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

Response:  Atrial fibrillation (AF) describes intermittent or permanent episodes of irregular pulse, due to rapid electrical activity within the atria (filling chambers) of the heart. During AF, the atria quiver, rather than contract, and the response of the ventricles is often rapid, resulting in palpitations and an increased risk of development of heart failure. AF may occur at any age, but is most common in ageing patients (typically over 75 years). The primary importance of AF is that it markedly increases the risk of thrombus formation in the atrium, with the resultant problem that these thrombi may dislodge (embolise), and commonly block arteries in the brain, causing strokes. Hence patients with AF are usually treated with anticoagulants.

Although AF often occurs in patients with prior damage to their hearts and atrial distension, there has been evidence for about the past 8 years that AF also is caused, at least in part, by inflammatory changes: two components have been identified as possible causes for this inflammation: lack of nitric oxide (NO) effect[ NO is  an anti-inflammatory chemical formed by all tissues in the body],  and excess activity of the pro-inflammatory enzyme myeloperoxidase (MPO).  High concentrations of ADMA, which inhibits NO formation, may result from effects of MPO on tissues. SDMA, which is closely related to ADMA, also exerts pro-inflammatory effects and tends to suppress NO formation.

The currently reported study began with the design of the ARISTOTLE trial, an investigation of the (then) novel anticoagulant apixaban as an alternative to warfarin therapy, as a means of preventing strokes in patients with AF. It was elected to perform a substudy to investigate the potential role of ADMA and SDMA as modulators of risk in patients with atrial fibrillation.

This substudy, performed in just over 5000 patients from the ARISTOTLE trial, essentially asked two questions:

(1) There are several indices of stroke risk in patients with atrial fibrillation, such as the CHADS2 score. These all rely on patient characteristics (eg age, presence of diabetes) rather than chemical changes. We postulated that there would be a direct relationship between clinically based risk scores and ADMA/SDMA concentrations.

(2) More ambitiously, we postulated that ADMA and SDMA concentrations would represent INDEPENDENT risk markers for major adverse effects in atrial fibrillation patients on anticoagulant treatment, namely stroke, major bleeding and risk of mortality. 

ADMA/SDMA concentrations were determined in Adelaide, Australia, while statistical analyses were performed in Uppsala, Sweden.

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Type of Oral Contraceptive Can Influence Effect of Medications on EKG Change

MedicalResearch.com Interview with:

Joe-Elie SALEM, MD-PhD Chef de Clinique Assistant, Médecin délégué du Centre d'Investigation Clinique Paris-Est Institut CardioMétabolisme et Nutrition INSERM

Dr. Salem

Joe-Elie SALEM, MD-PhD
Chef de Clinique Assistant, Médecin délégué du Centre d’Investigation Clinique
Paris-Est
Institut CardioMétabolisme et Nutrition
INSERM

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

Response: The drug-induced long QT syndrome (diLQTS) is a problem for clinicians balancing risk and benefits across multiple therapeutic areas, and for pharmaceutical scientists and regulators evaluating new drug candidates. The prevalent view is that block of a specific ion current, the rapid component of the cardiac delayed rectifier (IKr), is the common mechanism predisposing to diLQTS across drug classes and that patients with mutations in ion channel genes are at especially increased risk. In the very extreme form of diLQTS, a specific form of ventricular arrhythmia potentially lethal, called Torsade de Pointes, can occur. All IKr blocking drugs do not confer the same Torsade de Pointes risk; the risk with antiarrhythmics such as sotalol or dofetilide can be 1-2%, while the risk with IKr-blocking antibiotics such as moxifloxacin is much lower, <1/20,000.

Women are at higher risk of diLQTS than men. Androgens are protective. Influence of hormonal contraception on diTdP and QT prolongation is controversial

MedicalResearch.com: Were you surprised by the study findings, why or why not? 

Response: We were not really surprised because the influence of testosterone (the main androgenic hormone) to shorten the duration of cardiac repolarization was already known. We wanted to see if this effect was also present with contraceptive pills with various androgenic-like activities.

MedicalResearch.com: Can you explain what exactly is “sotalol-induced QTc prolongation”? 

Response: After each heartbeat, the heart recovers to normal. This phenomenon is called ventricular repolarization and can be assessed on the electrocardiogram by measuring the duration of a parameter called QT interval. This QT interval is influenced by many factors one of them being heart rate. QT interval is therefore corrected for the heart rate observed at the time of its measurement (QTc). Sotalol is one of several drugs given to prolong ventricular repolarization, and hence QTc, as a mean to prevent the recurrence of some disturbances of heart beats. These disturbances are called arrhythmias. However, drugs which prolong QTc can also provoke a very rare arrhythmia which can cause cardiac arrest or the heart to stops. Only rare susceptible patients are at risk of having this drug-induced arrhythmia and most patients who receive sotalol and have prolonged QTc are doing well. 

MedicalResearch.com: What were the drug-induced alterations in “ventricular repolarization” seen among the women? 

Response: The alterations of ventricular repolarization were those expected with sotalol: prolongation of QTc interval and changes is the morphology of the T-wave which is part of the QT interval. What we found is that the extent of QTc prolongation and T-wave morphological changes caused by sotalol was greater in women who were receiving the anti-androgenic contraceptive pill drospirenone compared with levonorgestrel. This is in line with the known effect of androgens to shorten ventricular repolarization in men but it was not known to be influenced by the progestin androgenic activity of oral contraceptives in women. 

MedicalResearch.com: What new information does this study provide to the scientific literature on oral contraceptives? 

Response: We did not show that oral contraceptives influence ventricular repolarization. This was not the purpose of the study. Our study, with its limitations, suggests that the type of oral contraceptive can influence the effects of drugs such as sotalol which prolong QTc. Drospirenone, an oral contraceptive with antiandrogenic properties, was associated with greater drug-induced QTc prolongation than levonorgestrel, an oral contraceptive with androgenic activity. Whether this is associated with a greater risk of provoking arrhythmias with antiandrogenic pills is not proven although there are indirect indications from an analysis of the European pharmacovigilance database, that this might be the case. Additional studies need to be performed to better assess this risk.

MedicalResearch.com: What were some limitations of the study? 

Response: The type of oral contraceptive taken by women participating in the study was prescribed by their physician and women receiving different oral contraceptives may have differed in their response to sotalol for other reasons. In other words, oral contraceptives were not administered by chance to the women (the study was not randomized but observational) and this is not the most robust method to examine the influence drugs in general. Also, the level of the natural sex hormones in the blood of the study participants was not measured and it may have influenced QTc interval  

MedicalResearch.com: Why is this study important? 

Response: In spite of its limitations, our study prompts for a more thorough assessment of the influence of progestin androgenic activity of oral contraceptives on drug-induced QTc interval prolongation and the risk of associated arrhythmias. It also emphasizes the importance of androgens as a factor limiting the risk of QTc prolongation in patients receiving drugs which prolong ventricular repolarization.

Citation: 

Salem J, Dureau P, Bachelot A, et al. Association of Oral Contraceptives With Drug-Induced QT Interval Prolongation in Healthy Nonmenopausal Women. JAMA Cardiol. Published online August 01, 2018. doi:10.1001/jamacardio.2018.2251

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

When It Comes to LDL-C, “You Really Can’t Be Too Low”

MedicalResearch.com Interview with:

Marc S. Sabatine, MD, MPH  Chairman | TIMI Study Group  Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine Brigham and Women's Hospital  Professor of Medicine | Harvard Medical School

Dr. Marc Sabatine

Marc S. Sabatine, MD, MPH
Chairman | TIMI Study Group
Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine
Brigham and Women’s Hospital
Professor of Medicine | Harvard Medical School

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

Response: Low-density lipoprotein cholesterol (LDL-C) is a well-established risk factor for cardiovascular disease.

The initial statin trials studied patients with high levels of LDL-C, and showed a benefit by lowering LDL-C.

We and others did studies in patients with so-called “average” levels of LDL-C (120-130 mg/dL), and also showed clinical benefit with lowering.

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Heart Failure Medications Underutilized in Medical Practice

MedicalResearch.com Interview with:

Dr. Greene

Stephen J. Greene, MD
Fellow, Division of Cardiology
Duke University Medical Center
Durham, NC, USA

Stephen J. Greene, MD Fellow, Division of Cardiology Duke University Medical Center Durham, NC, USA

Dr. Fonarow

Gregg C. Fonarow, MD, FACC, FAHA, FHFSA
Eliot Corday Professor of Cardiovascular Medicine and Science
UCLA

 


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

Response: Heart failure is a very common medical condition impacting roughly 6 million men and women in the United States, and associated with impaired quality of life, frequent hospitalizations, and high rates of death.

There are over 300,000 deaths each year in the US among patients with heart failure. Half of heart failure patients have heart failure because of a weak heart muscle where the heart cannot eject a normal amount of blood with each heartbeat, a term called “reduced ejection fraction.” Fortunately, there are multiple medications proven in large clinical trials to make people with heart failure with reduced ejection fraction live longer and feel better.

We also have target doses for these medications, which are the doses used in the trials where the medication proved its benefit. These medications and the target doses are strongly recommended in professional guidelines to improve patient outcomes.

To make sure patients have the best outcomes possible, it is important that we work to get patients on these proven medications if at all possible. Unfortunately, prior research has suggested that many patients eligible for these medications in regular outpatient practice do not receive them.

Most of this research is several years old, and there have been a lot of efforts to improve the quality of heart failure care in the meantime. In our study, we wanted to see if there have been improvements in the use and dosing of proven heart failure medications in modern-day practice. We also wanted to determine which patient factors were associated with not receiving a medication, or receiving the medication at a below target dose.

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Who is Underrepresented in Cardiology Trials?

MedicalResearch.com Interview with:

Quoc Dinh Nguyen, MD MA MPH Interniste-gériatre – Service de gériatrie Centre hospitalier de l’Université de Montréal – CHUM

Dr. Nguyen

Quoc Dinh Nguyen, MD MA MPH
Interniste-gériatre – Service de gériatrie
Centre hospitalier de l’Université de Montréal – CHUM

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

Response: Randomized trials are the best evidence basis we have to treat patients. It is known for more than 20 years that older adults and women are disproportionately excluded from randomized trials in cardiology diseases. As the current US population is fast aging, we examined whether this underrepresentation improved or worsened in the last 20 years in the most influential studies published between 1996 and 2015.

The main finding is that the women and older adults continue to be underrepresented in cardiology trials. Overall, the mean age was 63 years and the percentage of women was 29%. For coronary heart disease, women comprise 54% of the US population in need of treatment, yet are only 27% of the trial population. For heart failure, the median age of older adults in the US population is 70 years whereas it is only 64 years in the trial population.

Our results indicate that the gap has very slowly narrowed in the last 2 decades. However, based on current trends, reaching proportionate enrollment would require between 3 and 9 decades. This persistent lack of representation has significant impacts on the ability of clinicians to provide evidenced based care for these segments of the population. Physicians and other health care professionals are forced to extrapolate study results from younger and male-predominant populations. This is problematic since we know that older adults and women may react differently to medications and to interventions.  Continue reading

Prehabilitation Seeks to Improve Outcomes in Frail Older Patients

MedicalResearch.com Interview with:

Rakesh Arora MD Department of Surgery, Max Rady College of Medicine University of Manitoba, Winnipeg, Canada Cardiac Sciences Program St Boniface Hospital Winnipeg, Manitoba, Canada

Dr. Rakesh Arora

Rakesh Arora MD PhD
Department of Surgery, Max Rady College of Medicine
University of Manitoba, Winnipeg, Canada
Cardiac Sciences Program
St Boniface Hospital
Winnipeg, Manitoba, Canada

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

Response: It is increasingly understood that patients with heart disease are getting older and sicker. In Canada, over 5.7 million people are estimated to be aged over 65 years and as a result a greater number of older adults often complex other health issues are now require cardiac procedures.  This places some patients, particular those who are more frail at a higher vulnerability to poorer postoperative outcomes and a complicated recovery process after cardiac surgery.  In addition, such patients experience a reduced quality of life as a result of loss of the ability to independently perform activities of daily living (i.e. as cooking, cleaning, bathing activities, toileting etc).

During the preoperative waiting period, the cardiac symptoms and anxiety induces inactivity that in turn compounds the physical and mental deconditioning. In order to improve the functional capacity and enhance postoperative recovery, prehabilitation (“prehab”), a component of the Enhanced Recovery Protocols (ERPs), may be of particular importance.

Prehabilitation (a.k.a. “prehab”) has been described as a preoperative cardiac rehabilitation intervention, a combination of exercise training, education, and social support, affecting patients’ physical and psychological readiness for surgery with the overarching goal to reduce postoperative complications and hospital length of stay as well as ideally improving the transition from the hospital to the community.   Continue reading

Algorithm Allows Patients To Calculate Their Risk of Stroke and Heart Disease

MedicalResearch.com Interview with:

Dr. Doug Manuel MD, MSc, FRCPC Professor and Senior Scientist Ottawa Hospital Research Institute | L’Institut de Recherche de l’Hôpital d’Ottawa Department of Family Medicine, University of Ottawa Départment de Médicine Familiale Université d’Ottawa 

Dr. Manuel

Dr. Doug Manuel MD, MSc, FRCPC
Professor and Senior Scientist
Ottawa Hospital Research Institute | L’Institut de Recherche de l’Hôpital d’Ottawa
Department of Family Medicine, University of Ottawa
Départment de Médicine Familiale
Université d’Ottawa 

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

Response: A lot of people are interested in healthy living, but often we don’t have that discussion in the doctor’s office,” says Dr. Manuel, who is also a professor at the University of Ottawa. “Doctors will check your blood pressure and cholesterol levels, but they don’t necessarily ask about lifestyle factors that could put you at risk of a heart attack and stroke. We hope this tool can help people — and their care team — with better information about healthy living and options for reducing their risk of heart attack and stroke.”

“What sets this cardiovascular risk calculator apart is that it looks at healthy living, and it is better calibrated to the Canadian population,” says Dr. Doug Manuel, lead author, senior scientist at The Ottawa Hospital and a senior core scientist at the Institute for Clinical Evaluative Sciences (ICES).”  Continue reading

Not All HDL Cholesterol is Good – Size Matters

MedicalResearch.com Interview with:

Samar R. El Khoudary, PhD, MPH, BPharm, FAHA Associate Professor, Epidemiology PITT Public Health Epidemiology Data Center University of Pittsburgh Pittsburgh, PA 15260 

Dr. El Khoudary

Samar R. El Khoudary, Ph.D., M.P.H. BPharm, FAHA
Associate Professor
Department of Epidemiology
University of Pittsburgh Graduate School of Public Health

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

Response: The background for this study is based on the current measurements used to determine cardiovascular disease risk in postmenopausal women. Higher levels of HDL “good cholesterol” as measured by the widely available clinical test, HDL-Cholesterol, may not always be indicative of a lower risk of cardiovascular disease in postmenopausal women.

HDL is a family of particles found in the blood that vary in sizes, cholesterol contents and function. HDL particles can become dysfunctional under certain conditions such as chronic inflammation. HDL has traditionally been measured as the total cholesterol carried by the HDL particles, known as HDL cholesterol. HDL cholesterol, however, does not necessarily reflect the overall concentration, the uneven distribution, or the content and function of HDL particles.

We looked at 1,138 women aged 45 through 84 enrolled across the U.S. in the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study sponsored by the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH). MESA began in 1999 and is still following participants today. We assessed two specific measurements of HDL: the number and size of the HDL particles and total cholesterol carried by HDL particles. Our study also looked at how age when women transitioned into post menopause, and the amount of time since transitioning, may impact the expected cardio-protective associations of HDL measures.

Our study points out that the traditional measure of the good cholesterol, HDL cholesterol, fails to portray an accurate depiction of heart disease risk for postmenopausal women. We reported a harmful association between higher HDL cholesterol and atherosclerosis risk that was most evident in women with older age at menopause and who were greater than, or equal to, 10 years into post menopause. In contrast to HDL cholesterol, a higher concentration of total HDL particles was associated with lower risk of atherosclerosis. Additionally, having a high number of small HDL particles was found beneficial for postmenopausal women. These findings persist irrespective of age and how long it has been since women became postmenopausal.

On the other hand, large HDL particles are linked to an increased risk of cardiovascular disease close to menopause. Women are subject to a variety of physiological changes in their sex hormones, lipids, body fat deposition and vascular health as they transition through menopause. We are hypothesizing that the decrease of estrogen, a cardio-protective sex hormone, along with other metabolic changes, can trigger chronic inflammation over time, which may alter the quality of HDL particles. Future studies should test this hypothesis.

The study findings indicate that measuring size and number of HDL particles can better reflect the well-known cardio-protective features of the good cholesterol in postmenopausal women. Continue reading

USPSTF and PAD: Uncertain if Nontraditional Risk Factors Can Predict Heart Disease or Stroke Risk

MedicalResearch.com Interview with:

Dr. Michael Barry MD Director of the Informed Medical Decisions Program Health Decision Sciences Center at Massachusetts General Hospital Physician at Massachusetts General Hospit Professor of Medicine,Harvard Medical School

Dr. Barry

Dr. Michael Barry MD
Director of the Informed Medical Decisions Program
Health Decision Sciences Center at Massachusetts General Hospital
Physician at Massachusetts General Hospit
Professor of Medicine,Harvard Medical School 

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

Response: Peripheral artery disease—which is known as PAD—is a disease that reduces blood flow to a person’s limbs, especially the legs. PAD can cause leg and foot pain when resting or walking, wounds to not heal properly, and loss of limbs. Additionally, people with PAD are more likely to experience a cardiovascular disease event, such as heart attack and stroke.

The U.S. Preventive Services Task Force looked at the latest research to see if screening people without signs or symptoms of PAD using the ankle brachial index (ABI) can prevent heart attack, stroke, or other adverse health effects. We found that more research is needed to determine if screening with ABI can help to identify PAD and/or prevent heart attack or stroke in people without signs or symptoms.

Additionally, in a separate recommendation statement, we looked into the effectiveness of what we call nontraditional risk factors for assessing a person’s risk of cardiovascular disease. Clinicians typically check someone’s risk for cardiovascular disease using traditional risk factors, such as age, race, and smoking status. The Task Force looked at the current evidence to see if three additional, nontraditional risk factors can help prevent heart disease or stroke. The nontraditional factors considered were ABI measurements, an elevated amount of high-sensitivity C-reactive protein (hsCRP) in the blood, and an elevated amount of calcium in the coronary arteries (CAC score).

In this recommendation, we also found that there is insufficient evidence to recommend for or against using nontraditional risk factors in addition to those normally used to assess cardiovascular disease risk in people without signs or symptoms.  Continue reading

Patients Who Discharge From Hospital Against Medical Advice Have Double Rate of Readmission

MedicalResearch.com Interview with:

Professor Mamas Mamas (BM BCh, MA, DPhil, MRCP) Professor of Cardiology at Keele University and an Honorary Professor of Cardiology at the University of Manchester

Prof. Mamas

Professor Mamas Mamas (BM BCh, MA, DPhil, MRCP)
Professor of Cardiology at Keele University and an
Honorary Professor of Cardiology at the University of Manchester

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

Response: Discharge against medical advice occurs in 1 to 2% of all medical admissions but little / no data around how frequently this occurs in the context of PCI or the outcomes associated with such a course of action. We undertook this study to understand both how commonly discharge against medical advice occurs, the types of patients it occurs in and outcomes in terms of both readmission rates and causes of readmisison.   Continue reading