Diabetic Atherosclerosis Management Can Be Personalized Using Coronary Artery Calcium Score

MedicalResearch.com Interview with:
Dr. MalikDr. Shaista Malik MD PhD MPH
Director of Samueli Center For Integrative Medicine
Assistant Professor, School of Medicine
University of California, Irvine

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

Response: Having diabetes has been considered to be a risk equivalent to already had a myocardial infarction for predicting future cardiovascular events.  We were interested in testing whether further risk stratification in those with diabetes and metabolic syndrome, using coronary artery calcium (CAC), would result in improved prediction of cardiovascular events.

We found that CAC score was associated with incident coronary heart disease and cardiovascular disease more than a decade after the scoring was performed.  We also found that even after we controlled for the duration of diabetes (of 10 years or more), insulin use, or hemoglobin A1c level, coronary artery calcium remained a predictor of cardiovascular events.

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People Who Regularly Eat Nuts Have Lower Risk of Heart Disease

MedicalResearch.com Interview with:
“Nuts” by fdecomite is licensed under CC BY 2.0
Marta Guasch-Ferre, PhD
Research Fellow
Department of Nutrition. Harvard TH Chan School of Public Health
655 Huntington Ave, Building 2
Boston, Ma, 02115 

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

Response: Although previous evidence has shown that frequent nut consumption is associated with reduced cardiovascular risk factors including dyslipidaemia, type 2 diabetes and metabolic syndrome; as well as with lower risk of coronary heart disease (CHD); most of the previous prospective studies have focused on total nut consumption in relation to the risk of CVD. However, the associations between peanut butter and specific types of nuts, such as peanuts and walnuts, with major cardiovascular events, and specifically the relation with stroke were unclear. Of note, because the nutritional composition of peanuts and walnuts differs from other nuts, it was of particular interest to evaluate the health effects of specific types of nuts. Therefore, our main aim was to look at several types of nuts including total nut consumption, peanuts, walnuts, and tree nuts.

Briefly, in three large prospective cohorts with up to 32 years of follow-up, people who regularly eat nuts, including peanuts, walnuts and tree nuts, have a lower risk of developing cardiovascular disease or coronary heart disease compared to people who never or almost never eat nuts. We found a consistent inverse association between total nut consumption and total cardiovascular disease (14% lower risk for those consuming nuts five or more times per week) and coronary heart disease (20% lower risk).

Also, after looking at individual nut consumption, eating walnuts one or more times per week was associated with a 19 percent lower risk of cardiovascular disease and 21 percent lower risk of coronary heart disease. Participants who ate peanuts or tree nuts two or more times per week had a 15 percent and 23 percent, respectively, lower risk of coronary heart disease compared to those who never consumed nuts.

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Bariatric Surgery Can Reduce Number Of Medications Needed To Control Blood Pressure

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Dr.
Carlos Aurelio Schiavon
Research Institute, Heart Hospital
São Paulo, Brazil 

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

Response: Obesity and hypertension are highly prevalent diseases and when they are associated,  cardiovascular risk is almost double over patients with obesity alone. 60-70% of hypertension in adults may be attributable to adiposity.

To address both problems, we designed the GATEWAY TRIAL to evaluate the efficacy of Gastric Bypass in the reduction of antihypertensive medications in obese patients using at least 2 medications at maximum doses.

After 1 year, results were very consistent. 83.7 % of the patients submitted to Gastric Bypass reduced at least 30% of the total number of medications maintaining a controlled blood pressure (<140/90 mm Hg) and 51% remitted from hypertension, defined by controlled blood pressure without medications. When we evaluated the reduction of the medication maintaining the Systolic blood pressure below 120 mmHg (SPRINT TARGET), 22.4% of the patients showed remission of hypertension.

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Children and Young Adults With Diabetes Have Increased Risk of Sudden Cardiac Death

MedicalResearch.com Interview with:
“Diabetes Test” by Victor is licensed under CC BY 2.0Jesper Svane

Medical student
The Heart Center, University Hospital Rigshospitalet
Copenhagen 

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

Response: At the beginning of this research project, we were aware that persons with diabetes have an increased risk of death, which is partly explained by an increased risk of sudden cardiac death. However, previous studies on causes of death and mortality among young persons with diabetes, particularly type 2 diabetes, are sparse. Furthermore the incidence of sudden cardiac death among young persons with diabetes in a nationwide setting is unknown.

The main purpose of the study was to illuminate the risk of death and especially the risk of cardiac death among children/young adults with diabetes.

On a personal note, a friend of mine, who was healthy and fit, died suddenly a few years ago at the age of 19. This tragic death raised a lot of feelings as well as questions in me. When I got the chance to work with Dr. Lynge and Dr. Tfelt, I saw this as an opportunity to expand my knowledge of sudden cardiac death among the young. Furthermore, the opportunity of contributing to research in order to prevent these devastating events in the future was personally appealing to me.

I initiated the project together with Thomas Hadberg Lynge, MD, last year, with Jacob Tfelt-Hansen, MD, DMSc as supervisor. Both are experienced researchers within the field of sudden cardiac death. Dr. Tfelt-Hansen leads a very productive research group at Rigshospitalet, Copenhagen, whose main focus is arrhythmias and sudden cardiac death.

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AI Study Supports Association of Increased Coffee Consumption With Decreased CVD Risk

MedicalResearch.com Interview with:
Coffee being poured Coffee pot pouring cup of coffee.  copyright American Heart Association
Laura Stevens
University of Colorado
Aurora, CO

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

Response:
We started with asking ourselves how we could better predict cardiovascular and stroke outcomes.  In an ideal world, we would be able to predict cardiovascular disease (CVD) and stroke with 100% accuracy long before the occurrence of the event.  The challenge here is there are so many potential risk factors, and testing each one using traditional methods would be extremely time consuming, and possibly infeasible.

Therefore, we used artificial intelligence to find potential risk factors that could be important for risk of CVD and stroke.  The results of this analysis pointed to consumption of coffee cups per day and the number of times red meat was consumed per week as being potentially important predictors of CVD.

We then looked into these findings further using traditional statistical analyses to determine that increased coffee consumption and red meat consumption appeared to be associated with decreased risk of CVD.  The study initially used data from the Framingham Heart Study (FHS) original cohort.

The findings from this data were then tested using data from 2 independent studies, the Cardiovascular Heart Study (CHS) and the Atherosclerosis Risk in Communities Study (ARIC), which both supported the association of increased coffee consumption with decreased CVD risk.

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Benefits of Hypertension Treatment Depends Somewhat on Starting Blood Pressure Level

MedicalResearch.com Interview with:

Blood pressure monitor reading 120/80 copyright American Heart Association

Blood pressure monitor reading 120/80
copyright American Heart Association

Dr. Mattias Brunström
Department of Public Health and Clinical Medicine
Umeå University,Sweden

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

Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering.

We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD.

While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg.

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High-Sensitivity Cardiac Troponin I Can Identify Low Risk Chest Pain Patients

MedicalResearch.com Interview with:

Dr Andrew R. Chapman BHF Clinical Research Fellow University of Edinburgh Chancellors Building Edinburgh 

Dr. Chapman

Dr Andrew R. Chapman
BHF Clinical Research Fellow
University of Edinburgh
Chancellors Building
Edinburgh 

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

Response: High-sensitivity cardiac troponin tests allow accurate measurement of cardiac troponin in the bloodstream. Currently, guidelines recommend we evaluate patients with suspected myocardial infarction using these tests, by looking for levels which are above the upper reference limit (99th centile). These troponin measurements are taken on arrival, and often repeated after admission to hospital up to six hours later. When levels are below this limit, the diagnosis of myocardial infarction is ruled out. However, using such a high limit in patients on arrival to hospital may not be safe, as lower risk stratification thresholds has been shown to reduce missed events,  and in these patients admission to hospital for repeat testing may not be necessary. However, there is no consensus as to the optimal threshold for use in practice.

In a worldwide study of 23,000 patients from 9 countries, we have shown when high-sensitivity cardiac troponin I concentrations are below a risk stratification threshold of 5 ng/L at presentation, patients are at extremely low risk of myocardial infarction or cardiac death at 30 days, with fewer than 1 in 200 patients missed. Importantly, this threshold identifies almost 50% of all patients as low risk after a single blood test. As admission or observation of these patients is estimated to cost as much as $11 billion per year in the United States, this strategy has major potential to improve the efficiency of our practice.

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Current Statin Guidelines May Miss Young Adults At Risk of Heart Attack

MedicalResearch.com Interview with:

Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA

Dr. Singh

Avinainder Singh, M.B.B.S.
Research Fellow
Cardiovascular Medicine
Brigham & Women’s Hospital
Harvard Medical School
Boston, MA 

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

Response: Overall, the incidence of myocardial infarction (MI) in the US has declined. However, it has remained stable in adults <50 years of age.

We evaluated the statin eligibility of a cohort of adults who had an MI at a young age using current guidelines – the 2013 ACC/AHA guidelines for cholesterol treatment and the 2016 USPSTF guidelines on use of statins for primary prevention.

In, our study we found that only 49% of these young adults would have been eligible for statin therapy prior to their MI according the 2013 ACC/AHA guidelines, and only 29% would have been eligible according to the USPSTF guidelines, despite a high prevalence of cardiovascular risk factors. These numbers were even more striking for women where only 18% were eligible for statin therapy according to the USPSTF guidelines.

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Children Can Save Lives By Learning CPR in School

MedicalResearch.com Interview with:
Young girl learning Hands-Only CPR at the American Heart Association Hands-Only CPR training kiosk at Cincinnati-Northern Kentucky International Airport. copyright American Heart Association 2017 Photos by Tommy Campbell Photography
Mimi Biswas M.D., MHSc
University of California Riverside School of Medicine and
Riverside Community Hospital 

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

Response: This started as  My son’s science project. He wanted to make a video game to teach CPR based on a science fair website. It grew to teaching the whole 6th grade using the AHA CPR training kit alone vs adding the video game or music, staying alive, to help with compression rate.  We found that a 12 year can easily learn the basic concepts of calling for help and starting hands only CPR and they can physically perform effective CPR at this age.

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Chronic Valvular Heart Disease Linked To White Matter Brain Changes

MedicalResearch.com Interview with:
Dr. Keun-Hwa Jung MD PhD

Program in Neuroscience, Neuroscience Research Institute of SNUMRC
College of Medicine
Seoul National University
First author: Dr. Woo-Jin Lee MD
Department of Neurology
Seoul National University Hospital
Seoul, South Korea 

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

Response: Cerebral white matter hyperintensity is a prevalent consequence of brain aging process and associated with various complications. One of the main mechanisms underlying the progression of white matter hyperintensity is chronic dysfunction of the glymphatic system which maintains metabolic homeostasis in brain. Glymphatic system is the route where the cerebrospinal fluid enters into the brain parenchyma and is cleared out with soluble wastes to the perivascular space of the cerebral small veins, peri-meningeal lymphatic vessels, deep cervical lymph nodes, and finally to the right atrium.

Although the integrity of the glymphatic system is dependent on the adequate drainage of cerebral veins and lymphatics to the downstream chamber, the right atrium, the impact of hemodynamic changes in right-sided cardiac chambers on the development of white matter hyperintensity have not been elucidated.

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Dual Antiplatelet Therapy Found Beneficial Over Aspirin Alone Following CABG Surgery

MedicalResearch.com Interview with:

Nayan Agarwal MD Intervention Cardiology Fellow, University of Florida, Gainesville, FL

Dr. Agarwal

Nayan Agarwal MD
Intervention Cardiology Fellow
University of Florida,
Gainesville, FL

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

Response: Optimal antiplatelet strategy post CABG remains controversial with guidelines still evolving. Though aspirin monotherapy is the therapy of choice, but some studies have suggested a benefit of dual antiplatelet (DAPT). Question also remains if choice of antiplatelet therapy strategy is influenced by clinical presentation (acute coronary syndrome [ACS] versus non ACS) or CABG technique ( off pump versus on pump).

The current meta-analysis of 8 randomized control trials and 9 observational studies with a total of 11,135 patients demonstrated that at a mean follow up of 23 months, major adverse cardiac events (MACE) (10.3% versus 12.1%, RR 0.84, confidence interval (CI) 0.71-0.99); all-cause mortality (5.7% versus 7.0%, RR 0.67, CI 0.48-0.94) and graft occlusion (11.3% versus 14.2%, RR- 0.79, CI- 0.63- 0.98) were less with DAPT compared with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. Subgroup analysis demonstrated that benefit of DAPT was independent of clinical presentation (ACS versus non ACS) or CABG technique (off pump versus on pump).

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Anti-Fibrotic Drug May Block Cardiac Scarring That Leads To Heart Failure

MedicalResearch.com Interview with:

Bruno Péault PhD Professor and Chair, Vascular Regeneration Center For Cardiovascular Science MRC Centre for Regenerative Medicine Scientific Director, BHF Laboratories The University of Edinburgh and Professor, David Geffen School of Medicine at UCLA Orthopaedic Hospital Research Center University of California at Los Angeles Los Angeles, CA 90095-7358

Dr. Péault

Bruno Péault PhD
Professor and Chair, Vascular Regeneration
Center For Cardiovascular Science
MRC Centre for Regenerative Medicine
Scientific Director, BHF Laboratories
The University of Edinburgh and
Professor, David Geffen School of Medicine at UCLA
Orthopaedic Hospital Research Center
University of California at Los Angeles
Los Angeles, CA 90095-7358

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

Response: Kidney, lung, liver, muscle, heart are among the many organs which can be severely affected by fibrosis, a natural scarring process whereby healthy tissues are replaced by a fibrous non-functional substitute. For instance, the billions of cardiac muscle cells that die after a heart infarct, consequently to blood supply interruption, are replaced by a fibrotic scar that cannot contract, reducing the capacity of the heart to pump blood, and leading often to heart failure. There is currently no efficient treatment of fibrotic scars, the basic cellular component of which is the myofibroblast, a cell of unremarkable appearance and unclear origin. The transforming growth factor β (TGFβ) molecule triggers fibrosis development after being activated, via the extra-cellular matrix, by αv integrins, which are adhesion molecules present at the surface of the target cells.

To gain further insight into the cells that drive fibrosis in the heart and skeletal muscle, and explore ways to control this deleterious process, mice were used in which cells expressing the β receptor for PDGF (platelet derived growth factor) have been genetically tagged with a green fluorescent protein, a system previously used by Prof. Neil Henderson to trace fibrosis in the diseased liver (cells naturally expressing PDGFRβ are, in their vast majority, perivascular cells surrounding small blood vessels, as well as some interstitial fibroblasts). Skeletal muscle was injured by a small incision or with a targeted injection of cardiotoxin, a snake venom compound that locally kills myofibers, while the heart was damaged by prolonged infusion of angiotensin II. In both settings, progression of fibrosis was followed over time and contribution of green fluorescent cells – i.e. those expressing PDGFRβ – was assessed.

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Any Detectable High-Sensitivity Cardiac Troponin T Level Associated With Adverse Outcomes

MedicalResearch.com Interview with:
Martin Holzmann PhD

Department of Medicine
Functional Area of Emergency Medicine,
Karolinska University Hospital, Huddinge
Stockholm, Sweden

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

Response: There has been a few studies in the general population that indicate that subjects with detectable and elevated high-sensitivity troponin T (hs-cTnT) levels have an increased risk of death and cardiovascular disease. However, in clinical practice troponins are not used for anything else than to rule in or rule out myocardial infarction in the emergency department. In addition, in a previous publication we have shown that patients with persistently elevated troponin levels are rarely investigated or followed-up to exclude heart disease. Therefore, we wanted to investigate how the association between different levels of hs-cTnT are associated with outcomes in patients with chest pain but no MI or other acute reasons for having an acutely elevated troponin level.

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Life Simple 7 Score Closely Link To Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

Parveen K. Garg, MD, MPH Assistant Professor of Clinical Medicine Keck Hospital of USC 

Dr. Garg

Parveen K. Garg, MD, MPH
Assistant Professor of Clinical Medicine
Keck Hospital of USC 

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

Response: Atrial fibrillation is the most commonly presenting cardiac arrhythmia in clinical practice, affecting over 2 million people in the United States. This arrhythmia accounts for up to 15% of all strokes and annual costs for AF treatment are estimated at over 6.5 billion dollars. Despite the growing public health challenge that AF poses, effective prevention strategies are lacking. In 2010, the American Heart Association identified metrics of ideal cardiovascular health known as Life’s Simple 7 to target for the primary prevention of cardiovascular disease. We wanted to determine whether adherence to these health metrics helps prevent atrial fibrillation as well.

Therefore, we examined the association between the Life’s Simple 7 (LS7) and incident atrial fibrillation in the REasons for Geographic And Ethnic Differences in Stroke (REGARDS) study. We found that individuals in this study with optimal cardiovascular health (high adherence to LS7 metrics) had an over 30% lower risk of developing atrial fibrillation compared to those with inadequate cardiovascular health (low adherence to LS7 metrics). We also observed that even minor improvements in adherence to the LS7 (increase in total score by 1-point) were associated with a 5% lower risk of atrial fibrillation.

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Very High Exercise Levels Linked To Increase in Coronary Artery Calcification

MedicalResearch.com Interview with:

Deepika Laddu PhD Assistant Professor Department of Physical Therapy College of Applied Health Sciences The University of Illinois at Chicago Chicago, IL 60612

Dr. Laddu

Deepika Laddu PhD
Assistant Professor
Department of Physical Therapy
College of Applied Health Sciences
The University of Illinois at Chicago
Chicago, IL 60612 

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

Response: Recent findings in population-based cohort studies on cumulative exercise dose have caused some controversy and debate showing U-shaped trends of association between physical activity and disease risk. Our objective was to better understand this association between physical activity and cardiovascular disease risk from young adulthood to middle age.

Given that engagement in physical activity is a continuously evolving behavior throughout life, this study looked at the physical activity trajectories of 3,175 black and white participants in the multicenter, community-based, longitudinal cohort CARDIA study who reported physical activity patterns over 25 years (from 1985 through 2011), and assessed the presence of coronary artery calcification, or CAC, among participants. Unique to this study is the evaluation of long-term exercise patterns from young adulthood into middle age in CARDIA participants. Based on the trajectories (or patterns of change) of physical activity over 25 years, participants were categorized into three distinct trajectory groups: trajectory group one was defined as exercising below the national guidelines (less than 150 minutes a week), group two as meeting the national guidelines for exercise (150 minutes a week), and group three as exercising three-times the national guidelines (more than 450 minutes a week).

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High Blood Pressure Is a Risk Factor For Mitral Regurgitation

MedicalResearch.com Interview with:

Professor Kazem Rahimi, FRCP MD DM MSc FES Deputy Director, The George Institute for Global Health UK Associate Professor of Cardiovascular Medicine, University of Oxford Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust

Dr. Rahimi

Professor Kazem Rahimi, FRCP MD DM MSc FES
Deputy Director, The George Institute for Global Health UK
Associate Professor of Cardiovascular Medicine, University of Oxford
Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust 

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

Response: Mitral regurgitation, the most common heart valve disorder in high-income countries, has until now been considered a degenerative disorder, which results from damage over time due to ‘wear and tear’. As a result, the focus of medical practitioners has been on treating the disorder – by repairing or replacing the valve – rather than preventing it. This is partly because there has been a lack of large-scale, longitudinal studies investigating the effect of risk factors on the condition.

We set out to analyse data on 5.5 million patients in the UK over 10 years. Our findings show, for the first time, that elevated blood pressure is an important risk factor for mitral regurgitation. Consistent with prior evidence on blood pressure associations with other cardiovascular disease – such as stroke and heart attacks – we found an association with mitral regurgitation that is continuous across the whole spectrum of blood pressure. More specifically, every 20 mmHg higher baseline systolic blood pressure is associated with a 26% increased risk of mitral regurgitation, with no threshold below or above which this relationship is not true.

The association we found was only partially mediated by conditions that are established causes of secondary mitral regurgitation, which suggests that high blood pressure has a direct and independent effect on valve degeneration.

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Gestational Diabetes Associated With Greater Risk Of Heart Attack and Stroke

MedicalResearch.com Interview with:

Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Bethesda, MD 20817 

Dr. Zhang

Cuilin Zhang MD, PhD
Senior Investigator
Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health.
Bethesda, MD 20817

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

Response: Gestational diabetes (GDM) is a common pregnancy complication. The American Heart Association identifies gestational diabetes as a risk factor for cardiovascular disease (CVD) in women, based on consistent evidence for the relationships between gestational diabetes and subsequent hypertension, dyslipidemia, type 2 diabetes, vascular dysfunction and atherosclerosis. Also, previous studies identify GDM as a risk factor for intermediate markers of CVD risk; however, few are prospective, evaluate hard cardiovascular disease end points, or account for shared risk factors including body weight and lifestyle.

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Does Gender Bias Play A Role in Cardiovascular Surgery in Women?

MedicalResearch.com Interview with:

Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa

Dr.  Jabagi

Habib Jabagi B.Sc., M.Sc., M.D.
Department of Surgery
University of Ottawa , Ottawa

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

Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes.

The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG).

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Women Tend To Manage Their Cardiac Risk Factors Less Well Than Men

MedicalResearch.com Interview with:
Min Zhao PhD student

Julius Center for Health Sciences and Primary Care, Clinical Epidemiology
University Medical Center Utrech

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

Response: Heart disease is still one of leading causes of deaths and disability worldwide. Management of modifiable risk factors, including both medical treatment target and healthy lifestyle, reduce the chance of new heart attack among those who survived a previous heart attack (so-called secondary prevention). Previous studies have demonstrated that the secondary prevention of heart disease is poorer among women than men. However, most studies were performed in Western populations.

We aimed to assess whether sex differences exist on risk factor management and to investigate geographic variations of any such sex differences. Our study is a large-scale international clinical audit performed during routine clinic visit. We recruited over 10,000 patients who had survived a previous heart attack from 11 countries in Europe, Asia, and the Middle East.

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Hip and Knee Replacements More Common In Patients With Transthryretin Cardiac Amyloidosis

MedicalResearch.com Interview with:

Dr. Mathew Maurer, Medical Director The Hypertrophic Cardiomyopathy Center NewYork-Presbyterian/Columbia University Medical Center.

Dr. Maurer

Dr. Mathew Maurer, Medical Director
The Hypertrophic Cardiomyopathy Center
NewYork-Presbyterian/Columbia University Medical Center.

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

Response: Transthryretin cardiac amyloidosis (TTR-CA) is an underdiagnosed type of cardiomyopathy in which TTR (transthyretin, also known as prealbumin), a protein that forms amyloid fibrils, deposits in the heart. The deposits cause thickening of the ventricular wall and diastolic as well as systolic dysfunction. It is usually discovered around age 75 and presents more commonly in men than in women. With advances in non-invasive diagnostic modalities and growing awareness, TTR-CA is being diagnosed increasingly more frequently. Additionally, there are several emerging treatments that are under active investigation. Most of these therapies prevent disease progression and don’t address the amyloid already deposited in the heart. Accordingly, it is imperative that we diagnose TTR-CA before patients develop significant amyloid heart disease. However, this presents a great challenge since there are few known clinical predictors that might alert even the most astute physician that a patient is at such risk. With identification of predictors that may appropriately raise the index of clinical suspicion, clinicians may begin to pick up more subtle (and perhaps not yet clinically significant) forms of TTR-CA and initiate treatment before significant damage occurs.

The few known clinical predictors of TTR-CA include bilateral carpal tunnel syndrome and lumbar spinal stenosis, and numerous studies found TTR on biopsies and autopsies of other musculoskeletal sites, particularly in hip and knee joints. (Just last week, and also discussed here on MedicalResearch.com, biceps tendon rupture was also shown to occur more frequently in TTR-CA!) We suspected that patients who ultimately develop TTR-CA may first develop clinically significant hip and knee disease, enough to even warrant a hip (THA) or knee (TKA) replacement.

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Ruptured Biceps Tendon and Wild-type Transthyretin Amyloidosis

MedicalResearch.com Interview with:

Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA

Dr. Singh

Avinainder Singh, M.B.B.S.
Research Fellow
Cardiovascular Medicine
Brigham & Women’s Hospital
Harvard Medical School
Boston, MA

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

Response: Amyloidosis due to aberrant folding of proteins. These misfolded proteins can deposit in various parts of the body and lead to organ dysfunction. The two most common types of amyloidosis affecting the heart include transthyretin and light chain amyloidosis. Transthyretin is a protein produced by the liver which supports the transport of thyroxine and retinol.

Wild-type transthyretin amyloidosis (ATTRwt, previously known as senile amyloidosis) occurs due to deposition of misfolded fibrils derived from transthyretin and primarily affects elderly men. Once considered a rare disease, it is now reported to be responsible for nearly 13% of heart failure with preserved ejected fraction and increased wall thickness.

Rupture of the biceps tendon is a rare occurrence in the general population (<1 per 1000). We noticed a ruptured biceps tendon in several patients with wild-type transthyretin amyloidosis and performed this study to further evaluate this finding in a group of patients with wild-type transthyretin amyloidosis and in a control group of age-matched patients with non-amyloid heart failure.

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Most Deaths During Triathlons Occur During The Swim

MedicalResearch.com Interview with:

Kevin M. Harris, MD Director, Fellowship Training; Director, Echocardiography Allina Health, Minnesota

Dr. Harris

Kevin M. Harris, MD
Director, Fellowship Training; Director, Echocardiography
Allina Health, Minnesota

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

Response: Triathlon is a popular endurance sport which combines swimming, bicycling and running. We investigated the death rate in the triathlon since its inception in the United States in 1985 through 2016. Specifically we were able to look at the rate of death in USAT races from 2006 to 2016.

We identified 135 deaths/cardiac arrests over the time period. 85% of victims were male and victims averaged 47 years. Most deaths and cardiac arrests occurred in the swim. 15 of the deaths were traumatic occurring during the bike portion. The rate of death was 1.74 per 100,000 participants. The death rate was significantly higher for males than females and increased significantly for men > 40 years. On autopsy, nearly half of those victims were found to have significant cardiovascular disease.

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Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation 

MedicalResearch.com Interview with:

Professor Christopher P. Cannon MD Executive Director, Cardiometabolic Trials, Baim Institute Cardiologist Brigham and Women's Hospital Baim Institute for Clinical Research Columbia University College of Physicians and Surgeons

Dr. Cannon

Professor Christopher P. Cannon MD
Executive Director, Cardiometabolic Trials, Baim Institute
Cardiologist Brigham and Women’s Hospital
Baim Institute for Clinical Research
Columbia University College of Physicians and Surgeons

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

Response: The trial explored whether a dual therapy approach of anticoagulation and P2Y12 antagonist – without aspirin – in non-valvular atrial fibrillation (AF) patients following percutaneous coronary intervention (PCI) and stent placement would be as safe, and still efficacious, as the current standard treatment – triple therapy. For more detailed background on the study, readers may want to review the first paragraph of the article in the New England Journal of Medicine.

Results showed significantly lower rates of major or clinically relevant non-major bleeding events for dual therapy with dabigatran, when compared to triple therapy with warfarin.

In the study, the risk for the primary safety endpoint (time to major or clinically relevant non-major bleeding event) was 48 percent lower for dabigatran 110 mg dual therapy and 28 percent lower for dabigatran 150 mg dual therapy (relative difference), with similar rates of overall thromboembolic events.

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Which Is Better? Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

MedicalResearch.com Interview with:

Prof. Jean-Louis MAS Université Paris Descartes INSERM UMR S 894 Service de Neurologie et Unité Neurovasculaire Hôpital Sainte-Anne Paris 

Prof. Jean Louis MAS

Prof. Jean-Louis MAS
Université Paris Descartes
INSERM UMR S 894
Service de Neurologie et Unité Neurovasculaire
Hôpital Sainte-Anne
Paris 

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

Response: Stroke is a major cause of death, disability and dementia affecting 17 million people each year worldwide. About 80% of strokes are ischemic strokes due to occlusion of a cerebral artery by a thrombus, itself the consequence of various arterial or heart diseases. In 30 to 40% of cases, no definite cause of ischemic stroke can be identified. Cryptogenic stroke is the term used to refer to these strokes of unknown etiology.

The patent foramen ovale (PFO) is a defect between the upper two heart chambers (called atria) though which a thrombus of venous origin may reach the systemic circulation and cause a stroke. This mechanism is called paradoxical embolism. Several case-control studies have shown an association between PFO and cryptogenic ischemic stroke, particularly in patients less than 60 years old, in those who have an atrial septal aneurysm (defined as an abnormal protrusion of the interatrial septum in the right or the left atrium or both) in addition to a PFO, and in those who have a PFO with a large right-to-left shunt. These findings suggested that a PFO might be responsible for stroke and that PFO closure with a device may decrease the risk of stroke recurrence. However, the causative relationship between PFO and stroke and the best strategy to prevent stroke recurrence have long been a hot topic of debate. Three previous randomized clinical trials failed to demonstrate any superiority of PFO closure over antithrombotic therapy.

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Adherence To Guidelines Reduces Mortality & Admissions For Patients With Severe Aortic Stenosis

MedicalResearch.com Interview with:

Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI Director, Research and Education, Center for Valve and Structural Heart Disease Director, LAAC/Watchman™ Program Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health

Dr. Goessl

Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI
Director, Research and Education, Center for Valve and Structural Heart Disease
Director, LAAC/Watchman™ Program
Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship
Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health

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

Response: We wanted to investigate if asymptomatic patients with severe aortic stenosis benefit clinically from adherence to current national guidelines that suggest close follow up within 6-12 months.

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Gender Gap in Myocardial Infarction Mortality Decreases Over Past 20 Years

MedicalResearch.com Interview with:
Dragana Radovanovic, MD 

Head of AMIS Plus Data Center
Hirschengraben Zürich

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

Response: What we know so far? When a woman suffers a heart attack she is older, has consequently more cardiovascular risk factors such as hypertension, has more comorbidities, is less likely to receive the same therapies and more likely to die in hospital. Furthermore, we know from many hospital statistics and administrative data bases that in-hospital mortality of acute myocardial infarction patients has been on the decrease from 1970 to the early 2000’s. We then wanted to know what the situation looks like in Switzerland and therefore analyzed in-hospital mortality over the last 20 years with regard to gender, age and therapies. For this study we used the data of the nationwide AMIS Plus registry (Acute Myocardial Infarction in Switzerland) which exists since 1997 and continuously prospectively collects clinical data of patients hospitalized with acute myocardial infarction. We have found that during the last 20 years (from 1997 to the end of 2016) in-hospital mortality of patients with acute myocardial infarction in Switzerland has halved. Although in-hospital mortality was consistently higher in women, overall age-adjusted mortality has decreased more prominently in women compared to men. Especially in patients aged below 60 years a significant decrease in in-hospital mortality was observed in women but not in men.

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Study Finds Ablation To Be Superior For Atrial Fibrillation In Patients With Heart Failure

MedicalResearch.com Interview with:

Nassir F. Marrouche, MD Professor, Internal Medicine Cardiology University of Utah

Dr. Marrouche

Nassir F. Marrouche, MD
Professor, Internal Medicine
Cardiology
University of Utah 

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

Response: Study the effectiveness of catheter ablation of Atrial Fibrillation in patients with heart failure in improving hard primary endpoints of mortality and heart failure progression when compared to conventional standard treatment

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COMPASS Study Finds Rivaroxaban -XARELTO® – Plus Aspirin Reduces Adverse Events in Patients With Heart Disease or PAD

MedicalResearch.com Interview with:

John Eikelboom MBBS Associate Professor, Division of Hematology & Thromboembolism Department of Medicine Canada Research Chair in Cardiovascular Medicine Canadian Institutes for Health Research McMaster University

Dr. Eikelboom

John Eikelboom MBBS
Associate Professor, Division of Hematology & Thromboembolism
Department of Medicine
Canada Research Chair in Cardiovascular Medicine
Canadian Institutes for Health Research
McMaster University

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

Response: Cardiovascular disease affects 1 in 25 persons around the world and a total of more than 300 million individuals. Thrombus formation at the site of a ruptured atherosclerotic plaque is the commonest mechanism of myocardial infarction and ischemic stroke in patients with cardiovascular disease. Aspirin is effective for the prevention of these complications but reduces the risk by only 19% during long term therapy.

Rivaroxaban has previously been tested in the ATLAS ACS-2 TIMI 51 trial at doses of 2.5 mg twice daily or 5 mg twice daily on top of background antiplatelet therapy and has been shown to reduce major adverse cardiovascular events as well as mortality. We tested these same doses of rivaroxaban for the prevention of cardiovascular death, stroke or myocardial infarction in patients with stable cardiovascular disease.

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High Carbohydrate Diet Associated With Increased Risk of Mortality

MedicalResearch.com Interview with:

Dr. Mahshid Dehghan, PhD Investigator- Nutrition Epidemiology Program Population Health Research Institute Senior Research Associate – Department of Medicine McMaster University

Dr. Dehghan

Dr. Mahshid Dehghan, PhD
Investigator- Nutrition Epidemiology Program
Population Health Research Institute
Senior Research Associate – Department of Medicine
McMaster University

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

Response: For decades, dietary guidelines have largely focused on reducing total fat and saturated fat intake based on the idea that reducing fat consumption should reduce the risk of CVD. But this did not take into account what nutrients replace saturated fats in the diet. Given that carbohydrates are relatively inexpensive, reducing fats (especially saturated fat) is often accompanied by increased carbohydrate consumption. This approach continues to influence health policy today. The guidelines were developed some 4 decades back mainly using data from some Western countries (such as Finland) where fat and saturated fat intakes were very high (eg total fat intake was >40% of caloric intake and saturated fats was >20% of caloric intake). It is not clear whether the harms seen at such high levels applies to current global intakes or countries outside North America and Europe where fat intakes are much lower.

The PURE (Prospective Urban Rural Epidemiology) study is a large international cohort study of more than 157,000 people aged 35 to 70 years from 18 low-income, middle-income, and high-income countries on 5 continents. In this study, 135,335 individuals with dietary information and without cardiovascular disease at baseline were included in the study. Standardized questionnaires were used to collect information about demographics, socio-economic factors, lifestyle behaviors, health history and medication use. Standardized case-report forms were used to record data on major cardiovascular events and mortality during follow-up, which were adjudicated centrally in each country by trained physicians using standard definitions. The participants were followed-up for 7.5 years, during which time 4784 major cardiovascular events and 5796 deaths were recorded.

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More Time in School Associated With Less Cardiovascular Disease

MedicalResearch.com Interview with:

Dr. Julien Vaucher  Physician and clinical research fellow (joint first author) Department of Internal Medicine Lausanne University Hospital Lausanne, Switzerland

Dr. Vaucher

Dr. Julien Vaucher 
Physician and clinical research fellow (joint first author)
Department of Internal Medicine
Lausanne University Hospital
Lausanne, Switzerland

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

Response: Since the sixties, traditional studies have found that people who stay longer in the educational system subsequently develop less coronary heart disease. However, whether this association is causal is not clear, partly because randomised controlled trials are practically infeasible in this area. In our study, we used a genetic approach, called Mendelian randomization, that represents the next best thing to do.Based on genetic variants randomized by nature, we were able to randomize individuals according to 162 genetic markers that associate with more or less education. In other words, we used genetic markers, free from condounding factors, as proxies of education to reproduce the conditions of a trial. Then, if the genetic markers also associate together with coronary heart disease, the association between education and coronary heart disease is likely to be causal.

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Victoza® Receives FDA Approval To Reduce Heart Attack and Stroke in Patients With Type 2 Diabetes and Heart Disease

MedicalResearch.com Interview with:

Todd Hobbs, MD Vice President and Chief Medical Officer Novo Nordisk North America

Dr. Hobbs

Todd Hobbs, MD
Vice President and Chief Medical Officer
Novo Nordisk North America 

MedicalResearch.com: Would you tell us a little about liraglutide? How does it work to control diabetes/blood sugar? 

Response: Victoza® (liraglutide) is a human glucagon-like peptide-1 (GLP-1) analog that was approved by the U.S. Food and Drug Administration (FDA) in 2010 to help lower blood sugar in adults with type 2 diabetes. Victoza® is the #1 prescribed (GLP-1) receptor agonist.

Victoza® is a non-insulin, once-a-day medication that helps lower blood sugar levels in adults with type 2 diabetes by increasing glucose-dependent insulin release, inhibiting glucagon secretion, and slowing gastric emptying.

On August 25, the FDA approved a new indication for Victoza®, making it the only type 2 diabetes treatment approved to reduce the risk of major adverse cardiovascular (CV) events, heart attack, stroke and CV death, in adults with type 2 diabetes and established CV disease.

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Cardiovascular Prediction Tool Underestimated Risk In Poor Socioeconomic Groups

MedicalResearch.com Interview with:

Jarrod Dalton PhD Department of Quantitative Health Sciences Cleveland Clinic , Cleveland 

Dr. Dalton

Jarrod Dalton PhD
Department of Quantitative Health Sciences
Cleveland Clinic , Cleveland

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

Response: Accurate risk assessment is critical for identifying patients who are at high risk of cardiovascular events such as heart attacks and strokes.

We evaluated the performance of a widely-used risk assessment tool against the socioeconomic position of patients’ neighborhoods of residence. This tool, called the Pooled Cohort Equations Risk Model, or PCERM, was developed in 2013 jointly by the American College of Cardiology and the American Heart Association (ACC/AHA).

We found that the PCERM model accurately characterized risk among patients from affluent communities, but performed more poorly among patients from disadvantaged communities. In particular, for these patients, major cardiovascular events occurred at rates that were as much as 2-3 times than predicted from the PCERM model.

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Familial Hypercholesterolemia: “Junk” RNA May Facilitate Gene Therapy

MedicalResearch.com Interview with:

Tamer Sallam, MD PhD Assistant Professor of Medicine Co-Director UCLA Center for Lipid Management Lauren B. Leichtman and Arthur E. Levine CDF Investigator Assistant Director, STAR Program Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles, California 90095-1679 

Dr. Sallam

Tamer Sallam, MD PhD
Assistant Professor of Medicine
Co-Director UCLA Center for Lipid Management
Lauren B. Leichtman and Arthur E. Levine CDF Investigator
Assistant Director, STAR Program
Division of Cardiology, Department of Medicine
David Geffen School of Medicine at UCLA
Los Angeles, California 90095-1679

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

Response: This study is extension of our previous work published in Nature showing that a gene we named LeXis (Liver expressed LXR induced sequence) plays an important role in controlling cholesterol levels. What is unique about  LeXis is that it belongs to a group of newly recognized mediators known as long noncoding RNAs. These fascinating factors were largely thought to be unimportant and in fact referred to as “junk DNA” prior the human genome project but multiple lines of evidence suggest that they can be critical players in health and in disease.

In this study we tested whether we can use  LeXis “gene therapy”  to lower cholesterol and  heart disease risk. This type of approach is currently approved or in testing for about 80 human diseases.

Our finding was that a single injection of LeXis compared with control significantly  reduced heart disease burden in mouse subjects. Although the effect size was moderate we specifically used a model that mimics a very challenging to treat human condition known as familial hypercholesterolemia..Familial hypercholesterolemia is one of the most common genetic disorders affecting up to 2 million Americans and characterized by 20 fold  fold increase risk of early heart attacks and often suboptimal response to currently available treatments.

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Insertable Cardiac Monitors Detect Previously Undiagnosed Atrial Fibrillation

MedicalResearch.com Interview with:
James A. Reiffel, M.D
Professor Emeritus of Medicine
Special Lecturer in Medicine
Dept of Medicine Cardiology
Columbia University Medical Center

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

Response: Atrial fibrillation is a common arrhythmia (multi-millions of Americans) and carries with it a risk of stroke and of heart failure (among others) if not treated preventively. In many people, atrial fibrillation comes to attention because of symptoms, but not in all. The chances of developing Atrial fibrillation are substantially increased in certain populations of patients, such as the ones we enrolled in our study.  Continuous monitoring of such patients, as we did, and as others have also done recently, though in smaller numbers of patients, can detect otherwise unsuspected atrial fibrillation, which can lead to treatment before complications arise.

We found that using such monitoring, when monitored for 18 months, almost 1 in 3 patients had atrial fibrillation detected, as did 40% by 30 months. Intermittent monitoring, including by cell phones, may detect some atrial fibrillation but it is not nearly as effective as the type of monitoring we did and so many patients will be missed by lesser monitoring methods.

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Smoking Cessation Meds Underprescribed To Hospitalized Cardiac Patients

MedicalResearch.com Interview with:

Dr Quinn Pack

Dr. Quinn Pack

Dr.  Quinn R Pack MD
Assistant Professor of Medicine at Tufts University School of Medicine
Baystate Northern Region Cardiology
Baystate Health
Springfield, MA  

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

Response: Smoking is the leading cause of preventable death and is very common among patients with heart disease.  Several smoking cessation medications are available and recommended in clinical guidelines to help smokers quite. However, it was unknown how often these were used and what factors make the use of pharmacotherapy more common.

The main finding is that, across of broad range of hospitals, smoking cessation medications are infrequently used and the hospital where the patient was treated was the most important factor in determining if the patient was treated.

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Cardiovascular Events Rise With Increased Duration of Psoriasis

MedicalResearch.com Interview with:

Alexander Egeberg, MD PhD Gentofte Hospital Department of Dermatology and Allergy Kildegårdsvej 28 2900 Hellerup Denmark 

Dr. Egeberg

Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Kildegårdsvej 28
2900 Hellerup
Denmark

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

Response: The majority cardiovascular events in psoriasis occur in patients at low risk by traditional cardiovascular risk calculators. It has been speculated that long-term exposure to systemic inflammation may increase the risk of adverse cardiovascular outcomes. Therefore, clinically available historical features such as disease duration may identify those at higher risk for cardiovascular disease.

Using a translational epidemiological approach, combining 18F-fluorodeoxyglucose positron emission tomography computed tomography scanning with nationwide epidemiological data of more than four million individuals, we provide the first convincing evidence to suggest a detrimental effect of psoriasis duration on cardiovascular disease beyond traditional cardiovascular risk factors, even in patients deemed “low-risk” by conventional risk scores. We found a 1% increase in future major adverse cardiovascular event risk per additional year of disease duration. This finding has an effect size similar to smoking, a well-established cardiovascular risk factor.

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NEJM: On-Pump CABG Should Continue To Be Standard Surgical Treatment

MedicalResearch.com Interview with:

A. Laurie Shroyer, Ph.D., M.S.H.A. WOC Health Science Officer Northport VAMC Research and Development Office (151) Northport, NY 11768 Professor and Vice Chair for Research, Department of Surgery Stony Brook University, School of Medicine Stony Brook, NY

Dr. Shroyer

A. Laurie Shroyer, Ph.D., M.S.H.A.
WOC Health Science Officer
Northport VAMC
Research and Development Office (151)
Northport, NY 11768
Professor and Vice Chair for Research, Department of Surgery
Stony Brook University, School of Medicine
Stony Brook, NY 

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

Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as  “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events.

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Children from Socially and Economically Disadvantaged Families Have Increased Cardiovascular Risks

MedicalResearch.com Interview with:
Lead author, Dr Richard Liu, MCRI Ph.D. student and
Senior author – Professor David Burgner PhD
The Child Health CheckPoint Investigator Group
Murdoch Children’s Research Institute
The Royal Children’s Hospital
Parkville, Victoria, Australia

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

Response: The socioeconomic gradient in cardiovascular disease is well recognised in adults. The more disadvantaged someone is, the higher their risk of heart attack and stroke. The mechanisms by which this occurs are not well understood, but we know the pathological process underlying this, thickening of the arteries, or atherosclerosis, begins very early in life. Our current understanding of the early development of atherosclerosis has previously been limited mainly to autopsy studies. Non-invasive imaging is increasingly being used to examine the early development of atherosclerosis.

We wanted to determine if there was an association between socioeconomic disadvantage and the thickness of the carotid artery wall in mid-childhood, which in adults is a proxy for atherosclerosis and indicates higher risk for heart attack and stroke in later life. We analysed both family and neighbourhood socioeconomic position data from 1477 Australian families, which included data on income, education and occupation of parents, as well as the relative socioeconomic status of the immediate neighbourhood.

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Racial Gap in Survival After In-Hospital Cardiac Arrest Nearly Closed

MedicalResearch.com Interview with:
Dr. Lee Joseph, MD, MS

Postdoctoral fellow at University of Iowa
Division of Cardiovascular Diseases
Department of Internal Medicine
University of Iowa Carver College of Medicine
Iowa City

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

Response: In-hospital cardiac arrest (IHCA) is common and affects more than 200,000 patients every year. Although survival for in-hospital cardiac arrest has improved in recent years, marked racial differences in survival are present. A previous study showed that black patients with in-hospital cardiac arrest have 27% lower chance of surviving an in-hospital cardiac arrest due to a shockable rhythm compared to white patients. Moreover, lower survival in black patients was largely attributable to the fact that black patients were predominantly treated in lower quality hospitals compared to white patients.  In other words, racial disparities in survival are closely intertwined with hospital quality, and this has been borne out in multiple other studies as well

In this study, we were interested in determining whether improvement in in-hospital cardiac arrest survival that has occurred in recent years benefited black and white patients equally or not? In other words, have racial differences in survival decreased as overall survival has improved. If so, what is the mechanism of that improvement? And finally, did hospitals that predominantly treat black patients make the greatest improvement in survival?

To address these questions, we used data from the Get With The Guidelines-Resuscitation, a large national quality improvement registry of in-hospital cardiac arrest that was established by the American Heart Association in the year 2000. Participating hospitals submit rich clinical data on patients who experience in-hospital cardiac arrest. Over the last 17 years, the registry has grown markedly and currently includes information on >200,000 patients from > 500 hospitals. The primary purpose is quality improvement. But it has also become an important resource to conduct research into the epidemiology and outcomes associated with in-hospital cardiac arrest.

Using data from the Get With the Guidelines-Resuscitation, we identified 112,139 patients at 289 hospitals between 2000-2014. Approximately 25% of the patients were of black race and the remainder were white patients. We constructed two-level hierarchical regression models to estimate yearly risk adjusted survival rates in black and white patients and examined how survival differences changed over time both on an absolute and a relative scale.

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Cardiovascular Fat in Women at Midlife Varies By Race and Body Shape

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 REl KhoudaryPhDMPH, BPharm, FAHA
Associate Professor, Epidemiology
PITT Public Health
Epidemiology Data Center
University of Pittsburgh
Pittsburgh, PA 15260  

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

Response: Heart fat is associated with greater coronary heart disease risk. Postmenopausal women have greater heart fat volumes than premenopausal women, and the association between specific heart fat depots and calcification in the coronary arteries is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact heart fat volumes.

We evaluated whether racial differences in heart fat volumes and in their associations with central (abdominal visceral fat) and general adiposity (as measured by body mass index [BMI]) exist in midlife women. Our study included 524 women from the Study of Women’s Health Across the Nation (SWAN) (mean age: 51 years; 62% White and 38% Black) who had data on heart fat volumes, abdominal visceral fat and BMI.

After accounting for the potential health effects of lifestyle and socioeconomic factors we found that midlife Black women had less heart fat volumes than white women and not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart. However, white women with higher BMI had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection. The results echo the findings we have reported previously in midlife men and published at the International Journal of Obesity (2015) 39, 488–494.
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USPSTF: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors

MedicalResearch.com Interview with:

Carol M. Mangione, MD, MSPH, FACP Barbara A. Levey, MD, and Gerald S. Levey, MD Endowed chair in medicine David Geffen School of Medicine University of California, Los Angeles Professor of public health at the UCLA Fielding School of Public Health

Dr. Mangione

Carol M. Mangione, MD, MSPH, FACP
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine
David Geffen School of Medicine
University of California, Los Angeles
Professor of public health at the UCLA Fielding School of Public Health

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

Response: Americans can experience several health benefits from consuming healthy foods and engaging in physical activity. The Task Force recommends that primary care professionals work together with their patients when making the decision to offer or refer adults who are not obese and do not have hypertension, high cholesterol, high blood sugar, or diabetes to behavior counseling to promote healthful diet and physical activity. Our focus was on the impact of a healthful diet and physical activity on cardiovascular risk because this condition is the leading cause of premature morbidity and mortality. The Task Force evaluates what the science tells us surrounding the potential benefits and harms of a particular preventive service. In this case, the Task Force found high quality evidence focusing on the impact a healthful diet and physical activity can have on a patient’s risk of cardiovascular disease. Relying on this evidence, the Task Force was able to conclude that there is a positive but small benefit of behavioral counseling to prevent cardiovascular disease.

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Duration of Dual Anti-Platelet Therapy After Cardiac Stenting Needs To Be Personalized

MedicalResearch.com Interview with:
Abhishek Sharma MD and

Division of Cardiovascular Medicine State University
New York Downstate Medical Center
Dr.Sahil Agarwal M.B.B.S., M.D.
Division of Cardiology
St. Luke’s University Health Network
Bethlehem, Pennsylvania

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

Response: Prior randomized control trials (RCTs) and meta-analysis of these trials which have attempted to compare differences in outcomes between strategies of short (S) (3-6 months) and longer (L) (12-30 months) durations of dual anti-platelet therapy (DAPT) after drug eluting stents (DES) implantation have reported conflicting results. In general, the events rates in these studies were small, affecting statistical power. To overcome this limitation, we conducted an updated meta-analysis to compare the efficacy and safety of strategies of S-DAPT versus L-DAPT strategy after DES implantation by restricting inclusion to randomized studies with follow-up durations of 24 months or longer.

The current meta-analysis is the first to compare outcomes between S-DAPT and L-DAPT in a meta-analysis restricted to trials with patient follow-up of 24 months or longer. We found no significant difference in the rates of mortality or of stent thrombosis with S-DAPT or L-DAPT. S-DAPT was associated with significantly lower risk of major bleeding but slightly higher risk of future myocardial infarctions.

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Lifestyle-Based Tool Estimates Premature Cardiovascular Events in Young Adults

MedicalResearch.com Interview with:

Holly Gooding, MD, MSc Assistant Professor of Medicine and Pediatrics, Harvard Medical School Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Division of General Internal Medicine, Brigham and Women's Hospital Boston, MA

Dr. Gooding

Holly Gooding, MD, MSc
Assistant Professor of Medicine and Pediatrics
Harvard Medical School
Division of Adolescent/Young Adult Medicine
Boston Children’s Hospital
Division of General Internal Medicine
Brigham and Women’s Hospital
Boston, MA

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

Response: Dr Stephanie Chiuve and colleagues at the Harvard TH Chan School of Public Health developed the Healthy Heart Score to predict the risk of heart disease in older adults based on lifestyle factors measured in middle age. We have known for some time that the precursor to heart disease – known as atherosclerosis – actually starts in childhood and adolescence. We calculated the Healthy Heart Score for young adults ages 18-30 years old and found it works in this age group as well.

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Does Spironolactone Work In Acute Heart Failure?

MedicalResearch.com Interview with:

Javed Butler, MD, PhD Chief of the Cardiology Division Dr. Vincent Yang, Simons Chair in Internal Medicine Stony Brook University

Dr. Butler

Javed Butler, MD, PhD
Chief of the Cardiology Division
Dr. Vincent Yang, Simons Chair in Internal Medicine
Stony Brook University

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

Response: Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. We therefore studies high dose spironolactone in patients with AHF. Unfortunately all of our primary and secondary endpoints were not different between spironolactone and placebo arms.

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TAVR Linked To Improved Quality of Life Even After Two Years

MedicalResearch.com Interview with:

Suzanne J. Baron, MD, MSc Saint Luke’s Mid America Heart Institute School of Medicine University of Missouri, Kansas City

Dr. Baron

Suzanne J. Baron, MD, MSc
Saint Luke’s Mid America Heart Institute
School of Medicine
University of Missouri, Kansas City

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

Response: Transcatheter Aortic Valve Replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis in patients at high and intermediate surgical risk.  Prior studies have demonstrated that both TAVR and surgical AVR (SAVR) results in substantial quality of life benefit in patients at high surgical risk.

Whether these results applied to an intermediate risk population was unknown and so we performed a prospective study alongside the PARTNER 2A trial to compare both short- and long-term health status outcomes in intermediate-risk patients with AS treated with either TAVR or SAVR.   The analysis included 1833 patients (950 TAVR, 833 SAVR), who were evaluated at 1 month, 1 year and 2 years post procedure.  By 1 month, quality of life had improved in both the TAVR and SAVR groups, although the gain was significantly greater in patients treated with TAVR via the transfemoral approach as opposed to patients treated with SAVR or with TAVR via the transthoracic approach (i.e. direct aortic access or transapical access).   At 1 and 2 years, both TAVR (via either approach) and SAVR were associated with similarly large, clinically meaningful improvements from baseline in both disease-specific and generic health status scales at 2 years.

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Cardiovascular Disease Not a Top Concern For Women or Their Physicians

MedicalResearch.com Interview with:

C. Noel Bairey Merz, MD, FACC  Director, Barbra Streisand Women's Heart Center Director, Linda Joy Pollin Women's Heart Health Program Director, Erika Glazer Family Foundation Women's Heart Disease Initiative Director, Preventive Cardiac Center  Professor of Medicine  Cedars-Sinai Medical Center

Dr. Merz

C. Noel Bairey Merz, MD, FACC 
Director, Barbra Streisand Women’s Heart Center
Director, Linda Joy Pollin Women’s Heart Health Program
Director, Erika Glazer Family Foundation Women’s Heart Disease Initiative
Director, Preventive Cardiac Center
Professor of Medicine
Cedars-Sinai Medical Center

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

Response: Cardiovascular disease (CVD) is the number 1 killer of women in the U.S.A., yet few younger women personalize awareness. CVD campaigns focus little attention on physicians and their role assessing risk.

MedicalResearch.com: What are the main findings?

Response: Overall, 45% of women were unaware that CVD is the #1 killer of women, only 11% knew a woman who has died from it.  Overall, 45% of women reported it is common to cancel or postpone a physician appointment until losing weight. Cardiovascular disease was a top concern for only 39% of PCPs, after weight and breast health. A minority of physicians (22% of PCPs and 42% of cardiologists) felt well prepared to assess women’s CVD risk, and infrequently use guidelines.

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Limited Benefit To Expedited Stress Testing of Chest Pain In ER Patients

MedicalResearch.com Interview with:
Alexander Sandhu, MD MS

Cardiology Fellow
Stanford University

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

Response: Millions of patients present to the emergency department with chest pain but most do not have lab or EKG findings that indicate the patient is having a heart attack. In patients without signs of a heart attack, stress testing is frequently used to determine the need for further workup and treatment. However, there is limited evidence regarding the benefit of stress testing in these patients.

We evaluated how cardiac testing – stress testing and coronary angiography – in these low-risk patients was associated with clinical outcomes. We used a statistical approach that took advantage of the fact that testing is more available on weekdays than weekends. We found that testing was associated with more angiography and revascularization (coronary stenting or coronary artery bypass surgery) but was not associated with a reduction in future heart attacks.

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Survival Benefit from Primary Prevention Implantable Cardioverter Defibrillators

MedicalResearch.com Interview with:

Daniel J. Friedman, MD Duke University Hospital Duke Clinical Research Institute Durham, NC

Dr. Friedman

Daniel J. Friedman, MD
Duke University Hospital
Duke Clinical Research Institute
Durham, NC

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

Response: Although primary prevention ICDs have saved countless lives among patients with heart failure and a reduced ejection fraction, the use of primary prevention ICDs in patients with more advanced heart failure [defined by New York Heart Association Class (NYHA)] is controversial.

Specifically, there are conflicting data from the pivotal primary prevention ICD trials regarding whether primary prevention ICDs reduce all-cause mortality among patients with a severely reduced ejection fraction (≤35%) and NYHA III heart failure.

We performed a patient level meta-analysis using data from 4 pivotal primary prevention ICD trials (MADIT-I, MADIT-II, SCD-HeFT, and DEFINITE) to assess whether primary prevention ICD efficacy varied by NYHA class (II vs. III). Overall, the ICD reduced all-cause mortality among the overall population of patients (NYHA II and III). We subsequently assessed ICD efficacy after stratification by NYHA class.

Among NYHA II patients, the ICD significantly reduced all-cause mortality by reducing sudden cardiac death. Although NYHA III patients randomized to an ICD experienced a significantly lower rate of sudden cardiac death, this did not translate into a reduction in all-cause mortality, due to competing causes of non-sudden death (which an ICD cannot treat). Based on relatively wide confidence intervals associated with the estimate for ICD effect in NYHA III patients, there appears to be substantial heterogeneity in outcomes among these patients. This suggests that many NYHA III patients can benefit from a primary prevention ICD, but further study is necessary to determine which NYHA III patients are poised to benefit.

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More Education Means Lowers Cardiovascular Risk, Regardless of Income

MedicalResearch.com Interview with:

Yasuhiko Kubota, MD, MPH Visiting Scholar Division of Epidemiology and Community Health School of Public Health University of Minnesota, Minneapolis, MN

Dr. Kubota

Yasuhiko Kubota, MD, MPH
Visiting Scholar
Division of Epidemiology and Community Health
School of Public Health
University of Minnesota, Minneapolis, MN

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

Response: Educational inequality is one of the most important socioeconomic factors contributing to cardiovascular disease. Since education is usually completed by young adulthood, educational inequality may affect risk of cardiovascular disease early in the life course. We thought it would be useful to calculate the lifetime risk of cardiovascular disease according to educational levels in order to increase public awareness of the importance of education.

Thus, our aim was to evaluate the association of educational attainment with cardiovascular disease risk by estimating the lifetime risks of cardiovascular disease using a US. biracial cohort. Furthermore, we also assessed how other important socioeconomic factors were related to the association of educational attainment with lifetime risk of cardiovascular disease.

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Income Disparities Persist In Cardiovascular Risk Factors in the US

MedicalResearch.com Interview with:

Dr. Ayodele Odutayo MD MSc DPhil(pending) Centre For Statistics in Medicine, University of Oxford Resident Physician (PGY1), Post-Doctoral Fellow, Applied Health Research Centre St. Michael’s Hospital, University of Toronto

Dr. Odutayo

Dr. Ayodele Odutayo
MD MSc DPhil(pending)
Centre For Statistics in Medicine,
University of Oxford
Resident Physician (PGY1), Post-Doctoral Fellow,
Applied Health Research Centre
St. Michael’s Hospital,
University of Toronto

 

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

Response: Previously published studies have reported increasing gaps in life expectancy among adults belonging to different socioeconomic strata and suggested that much of this gap was mediated through behavioural and metabolic risk factors.

In this study, we found that from 1999-2014, there was an increasing gap in the control of cardiovascular risk factors between high income adults compared to adults with incomes at or below the poverty line. The proportion of adults at high cardiovascular risk (predicted risk of a cardiovascular event ≥20%), the mean systolic blood pressure and the percentage of current smokers decreased for high income adults but did not change for adults with incomes at or below the poverty line. Notably, the income disparity in these cardiovascular risk factors was not wholly explained by access to health insurance or educational attainment. Trends in the percentage of adults with diabetes and the average total cholesterol level did not vary by income.

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