Author Interviews, Heart Disease, JAMA / 18.03.2016

MedicalResearch.com Interview with: Ruut Laitio, MD, PhD Department of Anaesthesiology and Intensive Care Division of Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, Turku, Finland MedicalResearch.com: What is the background for this study? Dr. Laitio: Numerous animal studies with different types of brain injury (hypoxic, toxic,stroke, traumatic brain injury) have established the neuroprotective effect of xenon during the last 15 years. We designed a proof-of-concept study to find out whether xenon has neuroprotective effect in humans. An important finding from animal studies was that xenon has at least additive or even synergistic neuroprotective interaction with hypothermia and the results were based on histopathological and functional outcomes. These putative neuroprotective properties had not been reported in humans until now.
AHA Journals, Author Interviews, Genetic Research, Heart Disease, Lipids / 18.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22561" align="alignleft" width="140"]Dr. Sarah de Ferranti MD MPH Boston Children’s Hospital Director, Preventive Cardiology Program Assistant Professor of Pediatrics Harvard Medical School Dr. Sarah de Ferranti[/caption] Dr. Sarah de Ferranti MD MPH Boston Children’s Hospital Director, Preventive Cardiology Program Assistant Professor of Pediatrics Harvard Medical School MedicalResearch.com:  What are the main findings? Dr. de Ferranti: Familial hypercholesterolemia, or FH, is a genetic condition that causes severely elevated cholesterol levels from birth and is a leading cause of early heart attack. It is generally slowly progressive without symptoms until there is serious heart disease in the 3rd and 4th decade of life, making it important to look for it at a young age. Prior to this analysis it was thought that FH affected about 1 in 500 adults. The current study used data from 36,949 adults who took part in the 1999-2012 National Health and Nutrition Examination Survey (NHANES) and extrapolated to the 210 million U.S. adults aged 20 years and older. We identified cases of probably or definite Familial hypercholesterolemia in our analysis by using a combination of high levels of low-density-lipoprotein cholesterol (considered “bad” because it contributes to plaque buildup in arteries) and early heart disease in a person or close relative.
AHA Journals, Author Interviews, Cognitive Issues, Heart Disease / 18.03.2016

MedicalResearch.com Interview with: Hannah Gardener, ScD Department of Neurology, Miller School of Medicine University of Miami Miami, FL MedicalResearch.com: What is the background for this study? Response: At the beginning of the study, 1,033 participants in the Northern Manhattan Study (average age 72; 65 percent Hispanic, 19 percent black and 16 percent white), were categorized using the American Heart Association’s “Life’s Simple Seven®” definition of cardiovascular health, which includes tobacco avoidance, ideal levels of weight, physical activity, healthy diet, blood pressure, cholesterol and glucose. The participants were tested for memory, thinking and brain processing speed. Brain processing speed measures how quickly a person is able to perform tasks that require focused attention. Approximately six years later, 722 participants repeated the cognitive testing, which allowed us to measure performance over time. The cardiovascular health factors, which have been shown to predict risk of stroke and myocardial infarction, were then examined in relation to cognitive performance and impairment over time.
Author Interviews, Heart Disease / 15.03.2016

MedicalResearch.com Interview with: [caption id="attachment_18607" align="alignleft" width="150"]Michael D. Miedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN Dr. Michael Miedema[/caption] Michael D. Miedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN MedicalResearch.com: What is the background for this study? Dr. Miedema: Heart disease is the leading cause of death in the United States. With increasing risk factors like obesity and diabetes more population level prevention efforts are needed. Heart of New Um Project (HONU) was created as a demonstration project to test prevention of cardiovascular disease by reducing modifiable risk factors across the entire community. HONU interventions focus on improving health by reaching individuals in health care, worksites, and the community settings but also creating healthier environment and a social movement around being healthy to enable individuals to make healthier choices. Example interventions in health care, worksite, and the broader community include:
  • Health care: Comprehensive free heart health screening held every few years to identify risks (results shared with providers and follow up was done in clinics to address medication needs). We also used the electronic health record to apply some algorithms to calculate risk of heart disease and were able to offer health coaching to people who did not yet have heart disease or diabetes but who were at high risk.
  • Worksites:  we developed and partnered with over 40 worksites in the community to conduct health screenings of employees, to identify ways companies could improve their wellness policies, and offering onsite behavior change programs.
  • Community: work with restaurants to improve healthy options, increasing farmers market participation by farmers and by consumers, creating run/walk events, community wide health challenges, and creating a social movement through social marketing and community organizing.
AHA Journals, Author Interviews, Heart Disease, McGill / 14.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22622" align="alignleft" width="153"]Dr George Thanassoulis MD MSc FRCPC McGill University Health Center and Research Institute Montreal, Quebec, Canada Dr. George Thanassoulis[/caption] Dr George Thanassoulis MD MSc FRCPC McGill University Health Center and Research Institute Montreal, Quebec, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Thanassoulis: Currently statins are recommended in most countries worldwide based on 10-yr risk of heart disease but because age is the best predictor of future heart disease this leads to many more older patients being eligible for statins at the expense of younger people.  This means that even young patients with higher levels of low-density cholesterol, a known cause of heart disease, are not eligible for statins until they are much older.  However, waiting for these individuals to become "old enough for treatment" permits their higher LDL  to continue to damage their arteries leading, in some cases, to advanced coronary disease at the time when statins are finally stated.  So we are missing an opportunity to effectively prevent heart disease. What our analysis shows is that we need to consider not just someone's risk of having a heart attack but also whether they would be expected to benefit from statins.  By integrating information from randomized trials we were able to show that there were over 9.5 million Americans who were at low risk (and not eligible for statin therapy) that would have the same absolute benefit as higher risk people who we currently treat.  These patients, as expected, were younger but had higher levels of LDL cholesterol.  We also showed that statin therapy in these individuals would avoid more than 250,000 cardiac events over 10 years. 
Author Interviews, Heart Disease / 14.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22034" align="alignleft" width="165"]Prof. Dr. Thomas Pilgrim Inselspital Berne Switzerland Dr. Thomas Pilgrim[/caption] Prof. Dr. Thomas Pilgrim Inselspital Berne Switzerland  Medical Research: What is the background for this study? Dr. Pilgrim: Long-term prognostic implications of different clinical manifestations of coronary artery disease are insufficiently understood at this time. A time variable pattern of recurrent events following PCI for STEMI, Non-STE-ACS or stable ischemic heart disease may have important implications for medical management and secondary prevention. Medical Research:? What are the main findings? Dr. Pilgrim: In our analysis, we found a differential in timing of ischemic events after PCI according to presentation with STEMI, NSTE-ACS, or stable ischemic heart disease, respectively. While patients with NSTE-ACS were at increased risk of death at any time after PCI as compared to patients with stable ischemic heart disease, patients with STEMI had an increased risk during the first 30 days after PCI but not thereafter compared to patients with stable ischemic heart disease.
AHA Journals, Author Interviews, Exercise - Fitness, Heart Disease / 14.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22504" align="alignleft" width="135"]Pei-JieChen, Ph.D. Professor of Exercise Science, President of Shanghai University of Sport Dr. Pei JieChen[/caption] Pei-JieChen, Ph.D. Professor of Exercise Science, President of Shanghai University of Sport MedicalResearch: What is the background for this study? Dr. Pei-JieChen: Traditional Chinese exercises (such as Tai Chi, Qigong, Baduanjin) have been used for 2000 years with great contributions to human health, which are increasingly popular around the world. And traditional Chinese exercise is a low-risk, promising intervention that could be helpful for improving quality of life and depression in patients with cardiovascular diseases (CVDs).However, there appears to be no consensus agreement that traditional Chinese exercises (TCEs) could be effective for CVDs. Therefore, we performed a systematic review and meta-analysis to estimate the effectiveness of Traditional Chinese exercise for patients with CVDs. MedicalResearch: What are the main findings? Dr. Pei-JieChen: The pooling revealed that TCEs could decrease systolic blood pressure by 9.12 mmHg and diastolic blood pressure by 5.12 mmHg. Patients performing traditional Chinese exercises were also found superior compared with those in the control group in terms of triglyceride, six-minute walk test, Minnesota Living with Heart Failure Questionnaire results, SF-36 physical function, and Profile of Mood States depression.
Author Interviews, Heart Disease / 11.03.2016

MedicalResearch.com Interview with: Malin Inghammar, MD, PhD Department of Infectious Diseases Skåne University Hospital, Lund Sweden  MedicalResearch.com: What is the background for this study? Dr. Inghammar: Fluoroquinolones are a class of antibiotics with a widespread use in the treatment of common infections. Agents of this drug are generally well tolerated and have few side effects but in some people fluoroquinolones can prolong the QT-interval. QT-prolongation is a sort of electrical disturbance in the heart that can, in rare instances, lead to potentially life-threatening arrhythmia. Some drugs are well known to cause QT-prolongation and to be able to trigger arrhythmia. Fluoroquinolones however, have only weak effect on the QT-time. There have been a few previous studies published reporting an increased risk. Some of these, compared fluoroquinolone treated patients with people who were not treated with antibiotics at all. In these studies, it can’t be ruled out that the infection itself, rather than the antibiotic treatment could have influenced the risk of arrhythmia. In some other previous studies, there have been indications that the patients receiving fluoroquinolones were of poorer general health than the comparison group, which could also have affected the results. Therefore it is not clear if oral fluoroquinolone treatment leads to an increased risk of serious cardiac arrhythmia in an everyday clinical situation.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Radiology / 10.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22547" align="alignleft" width="139"]Guillermo J. Tearney, MD PhD Mike and Sue Hazard Family MGH Research Scholar Professor of Pathology, Harvard Medical School Wellman Center for Photomedicine Massachusetts General Hospital Dr. Gary Tearney[/caption] Guillermo J. Tearney, MD PhD Mike and Sue Hazard Family MGH Research Scholar Professor of Pathology, Harvard Medical School Wellman Center for Photomedicine Massachusetts General Hospital MedicalResearch.com: What is the background for this study? Dr. Tearney: In this study, we investigated a new, advanced catheter-based imaging technology for identifying the coronary plaques that may potentially precipitate heart attack. The new technique combines intracoronary OCT, that provides images of tissue emicrostructure with near-infrared autofluorescence (NIRAF) that informs on the molecular/biological characteristics of plaque. MedicalResearch.com: What are the main findings? Dr. Tearney: Our main findings were that: 1) Intracoronary OCT-NIRAF is safe and feasible in patients 2) NIRAF was elevated focally in portions of the coronary artery that contained high risk OCT features, and 3) The findings are suggestive that NIRAF may be a new imaging feature that is indicative of inflammation in human coronary lesions in vivo.
Author Interviews, Heart Disease, JACC / 10.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22469" align="alignleft" width="200"]Cathy Handy, MD MPH Fellow, Department of Oncology Johns Hopkins Hospital Dr. Cathy Handy[/caption] Cathy Handy, MD MPH  Fellow, Department of Oncology Johns Hopkins Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Handy: We explored the relationship between coronary artery calcium and age related diseases.  Coronary artery calcium refers to calcium deposits in the blood vessels of the heart.  It can be seen with a non invasive imaging test and is thought to be a biologic measure of aging.  Previous research has shown coronary artery calcium to be highly correlated with cardiovascular disease and mortality. We found that it is also associated with an increased risk of cancer, pneumonia, chronic kidney disease, chronic obstructive pulmonary disease and hip fractures.
Author Interviews, Heart Disease / 09.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22520" align="alignleft" width="187"]Anna Gundlund, MB Gentofte Hospital, Kildegårdsvej Hellerup, Denmark Anna Gundlund[/caption] Anna Gundlund, MB Gentofte Hospital, Kildegårdsvej Hellerup, Denmark MedicalResearch.com: What is the background for this study? Response: Atrial fibrillation seems to accumulate in families and several studies have indicated that a family history of atrial fibrillation may be an important risk factor for developing atrial fibrillation. In addition, three genomic regions associated with atrial fibrillation have been identified in Genome Wide Association Studies. In this study we compared atrial fibrillation patients with or without a family history of atrial fibrillation. MedicalResearch.com: What are the main findings? Response: We found that patients with a family history are diagnosed with atrial fibrillation at a younger age and with more disabling symptoms than those without a family history of atrial fibrillation. When looking at the longitudinal course of the disease, we found no differences in risk of progression of atrial fibrillation (e.g. from paroxysmal to persistent), risk of thromboembolic complications, all-cause hospitalization, or all-cause death when comparing those with a family history of atrial fibrillation with those without a family history.
Author Interviews, Heart Disease, JACC, Surgical Research / 06.03.2016

MedicalResearch.com Interview with: Seung-Whan Lee, MD, PHD Associate professor, Asan Medical Center University of Ulsan College of Medicine on behalf of our investigators.  Medical Research: What is the background for this study? Response: Survival benefit of successful coronary Chronic Total Occlusion  (CTO) recanalization has been a rationale behind PCI for CTOs. However, this knowledge is based on many observational studies that predate the widespread use of dedicated devices or techniques, drug-eluting stents (DESs), and current standards of medical management, making them low-quality evidence from the current perspective. Medical Research: What are the main findings? Response: Our study showed that successful PCI using DES was not associated with a lower risk for mortality compared with failed CTO-PCI. The revascularization strategy for non-CTO vessels, high frequency of subsequent CABG in patients with failed PCI, and high procedural success with low life-threatening complication rate may all have contributed to our study finding.
Author Interviews, Global Health, Heart Disease, Infections, JAMA / 04.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22249" align="alignleft" width="165"]Thomas Pilgrim, Prof. Dr. med. Oberarzt, Invasive Kardiologie Universitätsspital Bern Bern Switzerland Dr. Thomas Pilgrim[/caption] Thomas Pilgrim, Prof. Dr. med. Oberarzt, Invasive Kardiologie Universitätsspital Bern Bern Switzerland MedicalResearch.com: What is the background for this study? Dr. Pilgrim: Three quarters of all children worldwide grow up in regions endemic for rheumatic heart disease. Clinically manifest rheumatic heart disease represents only the tip of the iceberg: only one in in 5 to 8 children with valvular lesions consistent with rheumatic heart disease have a heart murmur or clinical symptoms; the remaining children have clinically silent disease that goes undetected unless echocardiography is performed. An understanding of incidence, prevalence, and progression of disease is an important prerequisite to guide active surveillance and secondary prevention. We therefore performed a school-based cross-sectional study among more than 5000 children from 26 schools in Nepal. The objective of the study was to assess prevalence of clinically silent and manifest rheumatic heart disease as a function of age, gender and socioeconomic status and to estimate the age-specific incidence from available prevalence data. MedicalResearch.com: What are the main findings? Dr. Pilgrim: In our population-based observational cross-sectional study, the prevalence of borderline or definite rheumatic heart disease among schoolchildren in Eastern Nepal amounted to 10.2 (95% CI 7.5-13.0) per 1000 children between the ages of 5 and 15 years, and was more common in girls as compared to boys. The prevalence increased across age categories in a nearly linear fashion from 5.5 (95% CI 3.5-7.5) per 1000 in children 5 years of age to 16.0 (95% CI 14.9-17.0) in children 15 years of age, while the average incidence remained stable at 1.1 per 1000 children per year. The prevalence of clinically silent rheumatic heart disease was 5 times higher compared to manifest disease and the ratio of manifest to subclinical disease increased with increasing age.
Author Interviews, Genetic Research, Heart Disease, JACC / 04.03.2016

MedicalResearch.com Interview with: Silvia G Priori ,MD, PhD and Andrea Mazzanti, MD Medical Research: What is the background for this study? What are the main findings? Response: The study investigates a novel therapeutic approach for Long QT Syndrome type 3: a malignant varian of long QT Syndrome a disease in which the risk of arrhythmias is proportional to the prolongation of QT interval. LAQT3 is caused by gain of function mutations in the gene SCN5A that encode for the alpha subunit of the cardiac sodium channel. These mutations increase the late sodium current (INa late) that prolongs the QT interval and predisposes the heart to develop life-threatening ventricular arrhythmias. In 1996 we demonstrated in an animal model of Long QT Syndrome type 3 that administration of mexiletine was able to shorten QT interval and the same results were obtained in LQT3 patients treated with mexiletine : these data provided rational for the adoption in clinical practice guidelines to recommend the use of mexiletine to shorten QT interval in LQT3 patients with the expectation that shortening QT interval would reduce the risk of arrhythmic death. In this setting, our study is the first to provide data in support of the view that mexiletine shortens QT interval and reduces the probability to experience arrhythmic events.
Author Interviews, Heart Disease, NEJM, Pharmacology / 25.02.2016

MedicalResearch.com Interview with: [caption id="attachment_22006" align="alignleft" width="120"]Professor Paul Myles MBBS, MPH, MD, FCARCSI, FANZCA, FRCA Director, Dept of Anaesthesia and Perioperative Medicine Alfred Hospital and Monash University, Melbourne, Australia Prof. Paul Myles[/caption] Professor Paul Myles MBBS, MPH, MD, FCARCSI, FANZCA, FRCA Director, Dept of Anaesthesia and Perioperative Medicine Alfred Hospital and Monash University, Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Dr. Myles: When we set up this study 10 years ago there was marked variation in practice for  people taking aspirin waiting for coronary artery bypass surgery.  About half were being told that they must stop their aspirin 5-7 days before surgery, and the other half were told that they should stay on their aspirin. This variation existed across different countries, different cities, and even within a single hospital. Doctors had varied opinions because reliable medical research was sparse; the evidence was contradictory. We thus designed a definitive clinical trial in which half the patients were randomly assigned to receive aspirin and the other half received a placebo. Our study has shown that aspirin is safe (i.e. it does not increase the bleeding risk). We also found that there does not appear to be a benefit during and after surgery, but in view of the clear benefits that exist in daily life, including the preoperative waiting period, we recommend that people should stay on their aspirin if they are having coronary artery surgery.
Author Interviews, Heart Disease, JAMA, Kidney Disease, Pharmacology / 24.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21970" align="alignleft" width="158"]Frederic T. Billings Dr. Frederic T.Billings[/caption] Frederic T. Billings IV, MD, MSc Assistant Professor of Anesthesiology and Medicine Additional Specialty: Cardiothoracic Anesthesiology Vanderbilt University Medical Research: What is the background for this study? What are the main findings? Dr. Billings: Acute kidney injury (AKI) affects up to 30% of patients following cardiac surgery and is associated with long-term kidney function decline as well as a 5-fold increase in death during hospitalization following surgery. Statins affect several mechanisms of AKI following cardiac surgery including improvement of endothelial function and attenuation of oxidative stress, so we performed a clinical trial to test the hypothesis that high-dose atorvastatin (brand name Lipitor) use prior to and following surgery reduces AKI following cardiac surgery. In 615 patients who completed the study high-dose atorvastatin treatment, compared to placebo administration, did not reduce the risk of AKI overall, among patients naïve to statins, or patients already using a statin. In fact, among patients naïve to statins with baseline chronic kidney disease we found some evidence that atorvastatin may increase risk for kidney injury, although the number of patients was small in this subgroup.
Author Interviews, Biomarkers, Heart Disease, Lipids / 19.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21786" align="alignleft" width="120"]Lorenz Räber, MD, PhD Director Division CAD and MI INSELSPITAL, Bern University Hospital Bern, Switzerland Dr. Lorenz Räber[/caption] Lorenz Räber, MD, PhD Director Division CAD and MI INSELSPITAL, Bern University Hospital Bern, Switzerland Medical Research: What is the background for this study? Response: Inflammation is a key player in the pathobiology of atheorsclerosis. Inflammatory markers and specifically C-reactive protein (CRP) associate with statin-mediated clinical event reduction and plaque burden reduction in patients with stable CAD. Whether CRP correlates with changes in plaque composition, ie. an important presumed substrate of plaque vulnerability, remains unknown. We thought to assess compositional atheroma changes by means of virtual histology IVUS in relation to levels of hs-CRP in STEMI patients. For this purpose, we performed intracoronary imaging using virtual histology IVUS in the proximal part of the two non-infarct related coronary arteries of STEMI patients at baseline and 13 months follow-up (IBIS-4 study). A total of 44 patients with 80 vessels had serial imaging and hsCRP measurements available. Medical Research: What are the main findings? Response: This is the first study to show that serial changes and on-treatment levels of hs-CRP correlate with virtual histology IVUS-defined necrotic core content in patients with STEMI receiving high-intensity statin therapy. Patients with a low inflammatory activity are more likely to achieve a reduction in necrotic core, which represents a presumed substrate of plaque vulnerability. These findings may provide the basis for assessing inflammation at follow-up to monitor disease activity in STEMI patients.
Author Interviews, Gender Differences, Heart Disease, JACC, McGill / 13.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21585" align="alignleft" width="112"]Dr. Roxanne Pelletier Dr. Roxanne Pelletier[/caption] Roxanne Pelletier, PhD Divisions of General Internal Medicine and of Clinical Epidemiology Department of Medicine The Research Institute of the McGill University Health Centre Montreal, Quebec, Canada Medical Research: What is the background for this study? Dr. Pelletier: The increased risk of mortality in young females compared with males after acute coronary syndrome (ACS) remain difficult to understand. As gender-related characteristics has evolved considerably in the last decades (e.g. hours of paid work have increased significantly among women), we hypothesized that these sex differences in adverse outcomes following  acute coronary syndrome are partly explained by gender, rather than by biological sex itself. As explained in our paper, "Gender reflects social norms and expectations ascribed to women and men, in contrast to biological characteristics that are captured by sex. Gender can be referred to as the nonbiological aspects of being male or female (e.g., social roles, personality traits).Our team had previously shown that sex differences in access to care for ACS were partly explained by these gender-related characteristics, such that both men and women presenting with acute coronary syndrome and with personality traits and social roles traditionally ascribed to women (e.g. sensitive to the needs of others, shy, household  responsibility, child care) were waiting longer before diagnostic tests and were less likely to receive invasive treatment procedures such as percutaneous coronary intervention, when compared to men and women with masculine gender-related characteristics. We then aimed to assess whether gender was also playing a role in sex differences in adverse outcomes following acute coronary syndrome.
Author Interviews, Exercise - Fitness, Heart Disease, JACC / 13.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21575" align="alignleft" width="157"]Daniel Kim-Shapiro, PhD Professor and Associate Chair of Physics Harbert Family Distinguished Chair Director, Translational Science Center Wake Forest University Dr. Daniel Kim-Shapiro[/caption] Daniel Kim-Shapiro, PhD Professor and Associate Chair of Physics Harbert Family Distinguished Chair Director, Translational Science Center Wake Forest University Medical Research: What is the background for this study? What are the main findings? Dr. Kim-Shapiro: Heart failure with preserved ejection fraction (HDPEF) is the most common form of heart failure.  It is characterized by poor perfusion to active muscles which results in poor exercise capacity and a poor quality of life.  Currently, the only effective treatment for this condition is aerobic exercise. Several studies have shown that dietary nitrate, usually in the form of beet root juice, increases nitric oxide bioavaiability in a way that targets areas of low oxygen so that perfusion increases where it is needed.  This action relies on conversion of nitrate to nitrite by oral bacteria with subsequent conversion of nitrite to nitric oxide.  Nitrite from the blood is taken up by salivary glands so that dosing with dietary nitrate can be long-lasting. The main finding of this study was that daily intake of high nitrate containing beet root juice improved exercise endurance in patients with HFPEF.
Author Interviews, Heart Disease, Pharmacology / 12.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21364" align="alignleft" width="113"]Giuseppe Biondi-Zoccai MD Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome Corso della Repubblica Latina, Italy Dr. Biondi-Zoccai[/caption] Giuseppe Biondi-Zoccai MD Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome Corso della Repubblica Latina, Italy  Medical Research: What is the background for this study? Dr. Biondi-Zoccai: The main premise of our work is the historically established benefit of aspirin to reduce the risk of cardiovascular events in apparently healthy people, which is however substantially offset by the risk of bleeding. More recently, several pieces of evidence have highlighed the cancer benefits of aspirin, namely its capability of reducing the risk of cancer, in particular cancer in the colon and rectum, as well as deaths due to such cancer. Despite these potentially momentous benefits, there is uncertainty on which dose and preparation of aspirin is best suited to reduce cardiovascular and cancer events, while minimizing bleeding. Indeed, several dosages of aspirin have been tested and are commercially available (for instance from as little as 50 mg per day to more than 300 mg per day). In addition, aspirin is available in different pharmacologic preparations, for instance with specific gastro-protective coatings or controlled-release features, which may have impact on safety and efficacy.     Medical Research: What are the main findings? Dr. Biondi-Zoccai: Our results, building upon the recent research work of the US Government sanctioned Preventive Services Task Force (USPSTF), suggest that a dosage of aspirin of 100 mg per day, combined with enteric-coating, is most likely to be beneficial to reduce the risk of cancer and minimize stomach bleeding. The results, as often in biomedical research, are not however 100% certain, and thus this increased likelihood of benefit must be viewed in the context of our study design, as well as other procedural and patient factors.
Author Interviews, Cancer Research, Heart Disease, Journal Clinical Oncology / 07.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21310" align="alignleft" width="200"]Saro H. Armenian, DO, MPH Associate Professor Departments of Pediatrics and Population Sciences City of Hope Comprehensive Cancer Center Director of the Childhood Cancer Survivorship Clinic Duarte, CA Dr. Saro Armenian[/caption] Saro H. Armenian, DO, MPH Associate Professor Departments of Pediatrics and Population Sciences City of Hope Comprehensive Cancer Center Director of the Childhood Cancer Survivorship Clinic Duarte, CA     Medical Research: What is the background for this study? What are the main findings? Dr. Armenian: There are an estimated 14 million cancer survivors living in the U.S. today, and this number is expected to reach 19 million by 2024. Among these cancer survivors, nearly two-thirds will have survived more than five years beyond their cancer diagnosis, and two out of every five will be considered a ten-year survivor, contributing to a growing population of aging cancer survivors. Until now, very little was known about the cardiovascular health of adult long-term cancer survivors. For the current study, we relied on diagnosis/procedures routinely recorded in a large integrative healthcare system that includes racially/ethnically and socioeconomically diverse members who are broadly representative of the residents in Southern California. Cardiovascular outcomes were captured from a wide variety of healthcare delivery settings (inpatient and outpatient, primary and sub-specialty care). Importantly, cancer survivors included in the current study continued to receive their primary and subspecialty care within this system well-beyond their initial cancer diagnosis (5- and 10-year retention rate: 81% and 70%, respectively), providing us with reliable population-based estimates of long-term cardiovascular disease (CVD) risk. We found an up to 70% higher risk of CVD (ischemic heart disease, stroke, or cardiomyopathy/ heart failure) in patients diagnosed with breast, kidney, lung/bronchus, multiple myeloma, non-Hodgkin lymphoma, and ovarian cancer when compared with an age- sex- and zip-code matched non-cancer controls. Cancer survivors who had multiple modifiable risk factors such as hypertension, diabetes, dyslipidemia were at highest risk of developing cardiovascular disease  later in life, irrespective of cancer diagnosis. Importantly, cancer survivors who developed CVD were significantly more likely to die from all causes when compared to cancer survivors who did not develop CVD. While the reasons for these findings are not clear, it is possible that the presence of CVD can markedly diminish treatment options or planned duration of therapy at the time of cancer recurrence, thus compromising the optimal long-term management of a cancer patient.
Author Interviews, Cancer Research, Heart Disease, JAMA, Pharmacology / 06.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21344" align="alignleft" width="200"]Jonathan Douxfils Pharm.D. - Ph.D. Research assistant Faculty of Medicine - Department of Pharmacy NAmur Research Institute for LIfe Sciences (NARILIS) Namur Thrombosis and Hemostasis Center (NTHC) Dr. Jonathan Douxfils[/caption] Jonathan Douxfils Pharm.D. - Ph.D. Research assistant Faculty of Medicine - Department of Pharmacy NAmur Research Institute for LIfe Sciences (NARILIS) Namur Thrombosis and Hemostasis Center (NTHC) Medical Research: What is the background for this study? What are the main findings? Dr. Douxfils: We decided to perform this study based on the release of the FDA regarding the risk of arterial occlusive events associated with ponatinib. We then hypothesize that the risk was not only restricted to ponatinib but also to other TKIs. This study shows that dasatinib, nilotinib and ponatinib increase the risk of vascular occlusive events compared to imatinib. Medical Research: What should clinicians and patients take away from your report? Dr. Douxfils: We suggest that patients treated with these molecules should be more frequently monitored, i.e. by an intensive support of associated comorbidities. In addition, even if they appear to have a better efficacy in terms of molecular response, new generation TKIs does not improve the overall survival at one year. As we have not access to individual data, it was impossible to clearly identify categories of patients for whom the risk of cardiovascular occlusive events is predominant. Therefore, the intensive monitoring proposed should be applied to all patients treated with these molecules. Regarding the choice of the therapy, the physician should certainly consider the goals of the treatment. For elderly patients, improving survival is the main objective and in this context, imatinib remains an excellent choice. For patients with a life expectancy greater than 10 years in whom we aim to achieve a deep molecular response to potentially reach a point of treatment cessation, dasatinib and nilotinib could be preferred. However, the choice of dasatinib or nilotinib as first-line treatments should involve a screening for potential risk factors such as diabetes, prior vascular occlusive events or any risk that could increase these adverse events. For second- and third-line treatments, the choice of the treatment has to be based on mutational analysis, previous adverse events, and the medical condition of the patient. Thus, in case of intolerance or resistance, the switch to one of the other TKIs approved for first-line therapy is an option. If treatment failure still occurs, a more potent TKI, i.e. bosutinib, is preferred. Importantly, ponatinib is reserved to patients with the T315I mutation and must be avoided in patients with good prognosis.
Cancer Research / 03.02.2016

MedicalResearch.com [caption id="attachment_21268" align="alignleft" width="133"]Prof. Norbert Stefan, MD Department of Molecular Epidemiology German Institute of Human Nutrition Potsdam-Rehbruecke Nuthetal, Germany Prof. Norbert Stefan[/caption] Prof. Norbert Stefan, MD Department of Molecular Epidemiology German Institute of Human Nutrition Potsdam-Rehbruecke Nuthetal, Germany MedicalResearch: What is the background for this study? Prof. Stefan: Cardiovascular disease, type 2 diabetes, and cancer are among the most important causes of morbidity and mortality worldwide. Although the body mass index and waist circumference are established variables that help to predict the risk of these disease, adult height also predicts mortality independently of adiposity measures. However, compared to these risk factors, it has been somewhat neglected in clinical practice. Based on the finding that in recent decades the height of children and adults has steadily increased throughout the world, the question arises whether this secular trend in height might be a marker of a yet not well understood mechanism that affects not only stature, but also the development of cardiometabolic disease and cancer.  MedicalResearch: What are the main findings? Prof. Stefan: We summarized and interpreted data from different areas of research and also could provide some novel data to better understand the causes of the worldwide increase in height and its relationships with cardiometabolic disease and incidence of cancer. There is strong epidemiological evidence that tall people, in comparison to short people, have a lower risk of cardiovascular disease and type 2 diabetes but have a higher cancer risk. Per 6.5 cm in height the risk of cardiovascular mortality decreases by six percent, but cancer mortality, by contrast, increases by four percent. We suspect that the increase in body height is a marker of overnutrition of high-calorie food rich in animal protein during different stages of growth. Thus, already in utero, lifelong programming might take place that until now has mainly been established for the insulin-like growth factor 1 and 2 and the IGF-1/2 system. Among other consequences, activation of this system causes the body to become more sensitive to insulin action, thus positively influencing the lipid metabolism. Accordingly, our new data show that tall people are more sensitive to insulin and have lower fat content in the liver, which may explain their lower risk for cardiovascular disease and type 2 diabetes. However, this activation of the IGF-1/2 system and other signaling pathways may be related to an increased risk of certain cancers, especially breast cancer, colon cancer, and melanoma because cell growth is permanently activated.
Author Interviews, Exercise - Fitness, Heart Disease, Lifestyle & Health / 02.02.2016

MedicalResearch.com Interview with: Gabriel E. Shaya MS University of Miami Miller School of Medicine MD/MPH Candidate 2016 Medical Research: What is the background for this study? Response: High exercise capacity has been established as an important protective factor against a wide array of poor health indicators and outcomes including cardiovascular morbidity and mortality. Most of the studies assessing the association of exercise capacity and cardiovascular outcomes have done so over an extended period of followup, however, whether high exercise capacity may influence the risk of early mortality following a first myocardial infarction has not been investigated. This is the question that we sought to answer in our study. Medical Research: What are the main findings? Response: Our study found that high exercise capacity was associated with statistically significant and clinically meaningful risk reductions in mortality in the short-term following a first myocardial infarction. Achieving the highest category of fitness in our cohort was associated with as much as a 60% mortality risk reduction relative to those in the least fit category, and similar magnitudes of benefit were observed to persist up to 1 year after a myocardial infarction. Importantly, the greatest risk reductions were observed when comparing the least fit patients to those with moderate fitness, suggesting that those with relatively low fitness may stand to benefit most from even just modest fitness improvements.
Author Interviews, Biomarkers, Heart Disease, JACC / 29.01.2016

[caption id="attachment_21093" align="alignleft" width="117"]Joseph Yeboah MD, MS Heart and Vascular Center of Excellence Assistant Professor, Cardiology Maya Angelou Center for Health Equity Epidemiology & Prevention Wake Forest University School of Medicine Dr. Joseph Yeboah[/caption] MedicalResearch.com Interview with: Joseph Yeboah MD, MS Heart and Vascular Center of Excellence Assistant Professor, Cardiology Maya Angelou Center for Health Equity Epidemiology & Prevention Wake Forest University School of Medicine  Medical Research: What is the background for this study? What are the main findings? Dr. Yeboah: In 2013 the American College of Cardiology/American Heart Association introduced a new way of atherosclerotic cardiovascular disease (ASCVD) risk assessment. The document also recommended the use of additional risk markers including coronary artery calcium (CAC), ankle brachial index, high sensitivity C-reactive protein, family history of ASCVD, to refine ASCVD risk assessment for primary prevention. The goal of this study was to assess the utility of these recommended additional risk markers for primary ASCVD risk assessment in the most ethnically diverse prospective cohort in the USA. We found that among the additional risk markers considered in this analysis, only coronary artery calcium modestly improved primary ASCVD risk assessment.
Author Interviews, Heart Disease, Mental Health Research / 29.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21060" align="alignleft" width="148"]Dr Jodie Ingles GradDipGenCouns MPH PhD Heart Foundation Future Leader Fellow Conjoint Senior Lecturer, Sydney Medical School, University of Sydney National Coordinator, Australian Genetic Heart Disease Registry Research Officer, Molecular Cardiology Centenary Institute Newtown Australia Dr. Jodie Ingles[/caption] Dr Jodie Ingles GradDipGenCouns MPH PhD Heart Foundation Future Leader Fellow Conjoint Senior Lecturer, Sydney Medical School, University of Sydney National Coordinator, Australian Genetic Heart Disease Registry Research Officer, Molecular Cardiology Centenary Institute Newtown Australia Medical Research: What is the background for this study? What are the main findings? Dr. Ingles : Sudden cardiac death of a young relative is devastating for the family. Not only are they grieving, but must come to terms with the familial risk to other family members. The clinical and genetic aspects of family management are beginning to be better understood, but there has been a lack of research regarding the psychological impact to family members. We found 1 in 2 family members report significant symptoms of prolonged grief and posttraumatic stress warranting need for specialized intervention by a clinical psychologist. Furthermore, we found those family members who witnessed the death or discovered the decedents body were 3 to 4 times more likely to report these symptoms.
Annals Thoracic Surgery, Author Interviews, Heart Disease, Outcomes & Safety, Surgical Research / 27.01.2016

[caption id="attachment_21014" align="alignleft" width="174"]Dr. Christian McNeely, MD Resident Physician, Division of Cardiothoracic Surgery Barnes-Jewish Hospital/Washington University Medical Center St. Louis, Missosuri Dr. Christian McNeely[/caption] MedicalResearch.com Interview with: Dr. Christian McNeely, MD Resident Physician, Department of Medicine Barnes-Jewish Hospital/Washington University Medical Center St. Louis, Missosuri  MedicalResearch: What is the background for this study? What are the main findings? Dr. McNeely : Since year 2000, 30-day mortality of aortic valve replacement (AVR) in Medicare beneficiaries has improved. Additionally, mechanical valve use in the elderly, which are often avoided in older patients largely because the risk of bleeding complications outweighs the risk of valve deterioration over time, has fallen significantly. Prior research has demonstrated worse outcomes in cardiac surgery for lower volume centers. Therefore, we sought to investigate the longitudinal relationship between institutional volume and outcomes in AVR using the Medicare database, looking at patients only > 65 years over a 10-year period. We found that, in general, mechanical valve use in the elderly decreased with increasing hospital volume. Lower volume hospitals exhibited increased adjusted operative mortality. Importantly, the discrepancy in operative mortality between low and high-volume hospitals diverged during the course of the study such that higher volume centers demonstrated significantly greater improvement over time compared to lower volume centers.
Author Interviews, BMJ, Cancer Research, Heart Disease, Pharmacology / 24.01.2016

More on Heart Disease on MedicalResearch.com [caption id="attachment_20895" align="alignleft" width="104"]Prof. Ian Wong Prof. Ian Wong[/caption] MedicalResearch.com Interview with: Professor Ian C K Wong Fellow of Royal Pharmaceutical Society Fellow of Royal College of Paediatrics and Child Health (Honorary) Fellow of the Higher Education Academy Chair in Pharmacy Practice Head of Research Department of Practice and Policy UCL School of Pharmacy London  Medical Research: What is the background for this study? What are the main findings? Dr. Wong: Previous studies had showed an increased cardiovascular risk associated with clarithromycin (a widely used antibiotic) but the duration of effect remained unclear. Therefore, we conducted this study to investigate the duration of cardiovascular adverse effect provided that the risk exists after patients receiving clarithromycin in Hong Kong. We used three study designs to examine the  association (temporal relationship) between clarithromycin and cardiovascular adverse outcomes such as myocardial infarction, arrhythmia, stroke, cardiac mortality at different time points.

We found that there was an increased short-term risk of myocardial infarction, arrhythmia and cardiac mortality associated with clarithromycin in all study designs. However, no long-term risk was observed. In every 1000 patients, there was 1.90 extra myocardial infarction events in current use of CLARITHROMYCIN when compared with the use of amoxicillin.