Author Interviews, Heart Disease, JACC, Surgical Research / 23.11.2015

MedicalResearch.com Interview with: Chunsheng Wang, MD Department of Cardiovascular Surgery, Shanghai Cardiovascular Institution and Zhongshan Hospital Fudan University, Shanghai, China Medical Research: What is the background for this study? What are the main findings? Dr. Wang: Transcatheter aortic valve replacement (TAVR) has been widely used in high-risk patients for surgical aortic valve replacement. However, the majority of the TAVR devices were designed for aortic valve stenosis with significant valve calcification. For most of these devices, predominant aortic regurgitation remained to be a technological challenge because of questionable anchoring, which can result in a high incidence of valve migration and paravalvular leak. Consequently, the guidelines from the United States and the Europe suggest that candidates with predominant aortic regurgitation (>grade 3+) or noncalcified valve should not undergo TAVR. Patients with predominant aortic regurgitation who are at prohibitive risk for surgery need an alternative treatment. A new generation of transcatheter aortic valve devices with secure anchoring is needed. Six patients with native aortic regurgitation without significant valve calcification (age, 61 to 83 years; mean age, 75.50±8.14 years) underwent transapical implantation of the J-Valve prosthesis (JieCheng Medical Technology Co.,Ltd., Suzhou, China), a self-expandable porcine valve. Implantations were successful in all patients. During the follow-up period (from 31 days to 186 days, mean follow-up was 110.00±77.944 days), only 1 patient had trivial prosthetic valve regurgitation, and none of these patients had paravalvular leak of more than mild grade. There were no major postoperative complications or mortality during the follow-up. Our study demonstrated the feasibility of transapical implantation of the J-Valve system in high-risk patients with predominant aortic regurgitation. (more…)
Author Interviews, Heart Disease, Lipids / 20.11.2015

MedicalResearch.com Interview with: Dr. Héctor González-Pacheco MD Coronary Care Unit, National Institute of Cardiology Mexico City, Mexico Medical Research: What is the background for this study? Dr. González-Pacheco: Epidemiological studies have provided robust evidence for an inverse correlation between plasma levels of high-density lipoprotein cholesterol (HDL-C) and cardiovascular risk. At hospital admission, a high percentage of patients with an acute coronary syndrome (ACS) have low HDL-C levels. Currently, the association of very low levels of HDL-C with early mortality in patients with ACS is still a topic of considerable interest. However, the possible mechanisms are not clear. Since an acute coronary syndrome induces an inflammatory response, and several chronic systemic diseases and acute critical illnesses with clear pro-inflammatory components have been associated with significantly reduced HDL-C levels, and investigators have shown an inverse correlation between HDL-C levels and the levels of pro-inflammatory cytokines, we hypothesized that reduced HDL-C levels in acute coronary syndrome might be associated to inflammatory mediators. We therefore sought to evaluate the correlation between HDL-C levels and biomarkers of inflammation available in routine laboratory screenings (high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) count, and serum albumin) in a retrospective cross-sectional study of patients with ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTE-ACS). Medical Research: What are the main findings? Dr. González-Pacheco: We found that approximately one-fifth of patients had very low HDL-C levels (<30 mg/dL). Baseline levels of hs-CRP were significantly higher in these patients than in those with low (30–39.9 mg/dL) and normal (≥40 mg/dL) HDL-C levels. In contrast, serum albumin values were lower in patients with very low HDL-C levels. WBC count did not differ significantly. Accordingly, hs-CRP levels ≥ 10 mg/L and serum albumin levels ≤ 3.5 mg/dL, were two strong independent predictors of very low HDL-C levels. We observed that patients with STEMI had higher expression of biomarkers of inflammation and lower levels of HDL-C, compared with NSTE-ACS patients, as well as a lack of significant difference in the extent of coronary disease among the categories of HDL-C levels. These findings suggest that the fall in HDL-C levels is in accordance with the severity of the inflammatory response and the extent of the myocardial damage. Our findings are consistent with previous studies, in which patients with very low HDL levels had a higher rate of in-hospital mortality compared with those of other HDL-C levels. (more…)
AHA Journals, Author Interviews, Duke, Exercise - Fitness, Heart Disease, Social Issues / 18.11.2015

MedicalResearch.com Interview with: Lauren Cooper, MD Fellow in Cardiovascular Diseases Duke University Medical Center Duke Clinical Research Institute Medical Research: What is the background for this study? Dr. Cooper: The HF-ACTION study, published in 2009, showed that exercise training is associated with reduced risk of death or hospitalization, and is a safe and effective therapy for patients with heart failure and reduced ejection fraction. Subsequently, Medicare began to cover cardiac rehabilitation for patients with heart failure. However, many patients referred to an exercise training program are not fully adherent to the program. Our study looked at psychosocial reasons that may impact participation in an exercise program. Medical Research: What are the main findings? Dr. Cooper: We found that patients with higher levels of social support and fewer barriers to exercise exercised more than patients with lower levels of social support and more barriers to exercise. And patients who exercised less had a higher risk of cardiovascular death or heart failure hospitalization compared to patients who exercised more. (more…)
AHA Journals, Author Interviews, Heart Disease / 14.11.2015

MedicalResearch.com Interview with: Susan Marzolini, R.Kin, PhD Scientific Associate, TRI-REPS Supervisor Toronto Rehab/UHN Cardiovascular Prevention and Rehabilitation Program Medical Research: What is the background for this study? What are the main findings? Dr. Marzolini: Coronary artery bypass graft (CABG) surgery is a leading revascularization procedure for treating coronary artery disease. Despite effective revascularization, cardiovascular risk factor control through intensive lifestyle and pharmacological treatment is essential to prevent graft deterioration and progression of atherosclerosis following surgery. Outpatient cardiac rehabilitation (CR) programs offer structured exercise, education, interdisciplinary support, counselling, and risk reduction to promote secondary prevention. These programs have been shown to improve fitness, psychosocial well-being, and significantly reduce morbidity and mortality after CABG surgery. However, while Canadian and international guidelines endorse “early” referral to CR post-cardiac event, actual practice is variable and delays are common_ENREF_9_ENREF_9_ENREF_7. Delayed entry is of concern, as there is emerging evidence that later referral and initiation of cardiac rehabilitation is associated with negative consequences on cardiovascular fitness, however this has not been examined in the post-CABG population. Therefore, we conducted a retrospective analysis of 6497 consecutively enrolled post CABG participants in a single cardiac rehabilitation program in Toronto, Canada from January 1995 to October 2012. Our objective was to examine the effects of later entry on CR outcomes (i.e., CR use, anthropometrics, and functional capacity) while accounting for demographic, environmental, and physiological correlates of longer wait-time. We found that longer wait-time to start a cardiac rehabilitation program was associated with poorer outcomes including less improvement in cardiopulmonary fitness and lower program attendance, which have been shown to confer a mortality disadvantage. Longer wait time was also associated with less improvement in body fat percentage as well as poorer completion rates. We identified that bypass patients predisposed to longer wait times, and subsequently poorer participation and outcomes, are women, those who are older, from a lower socioeconomic neighborhood, people with a more complex medical history, who are employed, have a longer drive-time to cardiac rehabilitation, and people with less social support. (more…)
Author Interviews, Heart Disease, Lipids, Stanford / 13.11.2015

MedicalResearch.com Interview with: Liana Del Gobbo PhD Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and Life Sciences Research Organization, Bethesda, MD Medical Research: What is the background for this study? What are the main findings? Dr. Del Gobbo: Accumulating evidence suggests that nut intake lowers risk of cardiovascular disease. But the specific mechanisms by which nuts may exert beneficial effects (eg. through lowering blood cholesterol, blood pressure, inflammation, etc.) were not clear. Two prior reviews on this topic only evaluated one type of nuts, and only a few cardiovascular risk factors. To address these knowledge gaps, we performed a systematic review and meta-analysis of controlled trials to examine the effects of eating tree nuts (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, Brazil nuts) on major cardiovascular risk factors including blood lipids (total cholesterol, LDL, HDL, triglycerides [TG]), lipoproteins (ApoA1, ApoB, ApoB100), blood pressure (systolic, SBP; diastolic, DBP), and inflammation (C-reactive protein, CRP) in adults 18 years or older without cardiovascular disease. A daily serving of nuts (1oz serving, or 28g per day) significantly lowered total cholesterol, LDL, ApoB, and triglycerides, with no significant effects on other risk factors, such as HDL cholesterol, blood pressure or inflammation. To give you an idea of a 1oz serving size of nuts, it is about 23 almonds, 18 cashews, 21 hazelnuts, 6 Brazil nuts, 12 macadamia nuts, 14 walnut halves, 20 pecan halves, 49 pistachios. We did not see any differences in cholesterol-lowering effects by nut type. (more…)
Author Interviews / 12.11.2015

MedicalResearch.com Interview with: Aouatef Bellamine, Ph.D Lonza Inc Medical Research: What is the background for this study? What are the main findings? Dr. Bellamine: About two years ago, Robert Koeth and his colleagues (Nat Med. 2013 May;19(5):576-85) published a paper linking atherosclerosis and increased cardiac disease risks to Trimethylamine N-oxide (TMAO), a degradation product of dietary quaternary ammonium compounds such as L-Carnitine, Betaine and Choline. When these compounds are not completely absorbed into the intestine, bacterial gut metabolizes them to TMA (Trimethylamine) which is absorbed to the blood and further metabolized by the liver flavin-containing mono-oxygenases (FMOs) to TMAO. This is why some people use injectable l carnitine products. Koeth’s observation was based on
  • 1- clinical association between L-Carnitine levels increased incidence of major cardiac events,
  • 2- on increased lesion formation in ApoE-/- mouse, a disease model used to study atherosclerosis.The conclusion was that TMAO promotes atherosclerosis. Although the association is established, the cause to effect cannot be clarified given the lack of dose response in this mouse model (a single dose has been used) and the small number of animals in the treatment group making the difference between treatments (3 out of 11 animals). In addition, TMAO has been described to play the role of a molecular chaperone, preventing the protein unfolding. TMAO is also found in fish where it plays an important role in maintaining a normal osmolality. Fish is reported otherwise to be a healthy food source and its consumption is not linked to atherosclerosis occurrence.
Lonza decided to investigate the mechanism (s) behind these observations (Bellamine et al., Experimental Biology meeting, San Diego, 28 April 2014, Bellamine et al., Atherosclerosis in press). First, we showed that increasing TMAO levels up to 10-fold the Cmax as reported in humans, did not affect the foam cell formation in vitro, an obligatory step in the atherosclerosis disease progression. Second, we used an improved version of the ApoE-/- mouse model, expressing the cholesteryl ester transport protein (CETP) lacking normally in rodents. The CETP plays a major role in the cholesterol re-cycling in humans and its inhibition has been studied as a target for atherosclerosis treatment. Further, we used different doses of dietary L-Carnitine, leading to different levels of TMAO in an attempt to establish a dose-response curve. We found that TMAO levels inversely correlated with the lesion size. Significantly reduced aortic lesion size was observed at high levels of TMAO. These effects were independent from lipid changes. These observations suggest that TMAO may play a protective role in atherosclerosis disease development by reducing the lesion formation. When the lesions start developing, the TMAO levels would be up-regulated by a compensatory mechanism (possibly by increasing FMOs expression levels). (more…)
Annals Internal Medicine, Author Interviews, Heart Disease, Surgical Research / 11.11.2015

Dr. Giuseppe Andò University of Messina, Messina, ItalyMedicalResearch.com Interview with: Dr. Giuseppe Andò University of Messina, Messina, Italy Medical Research: What is the background for this study? Dr. Andò: Patients’ preference for radial access for coronary angiography and percutaneous intervention is paralleled by an almost complete abolition of access-site bleeding. Given the deleterious impact of any clinically relevant bleeding event on short- and long-term outcomes, the use of radial access should translate into a reduction in net adverse events, especially in patients with high risk of bleeding such as those with an acute coronary syndrome. Nonetheless, studies conducted over the past decade by pioneers of radial access were relatively small and not sufficiently compelling to affect guidelines and endorse a change in current practice. Medical Research: What are the main findings? Dr. Andò: We have pooled in the present study 4 well-conducted, large, multicenter studies with data from centers with different expertise in radial procedures across America, Europe, Asia and Oceania. We demonstrate that the use of radial access can reduce mortality in patients with acute coronary syndromes undergoing invasive management by a consistent reduction in major bleeding. (more…)
AHA Journals, Author Interviews, Duke, Education, Gender Differences, Heart Disease / 10.11.2015

MedicalResearch.com Interview with: Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Douglas: The impetus for our study was the concern that cardiology as a profession might be enhanced by greater diversity. By not attracting women in larger numbers (9% of FACCs are female), our fellowships have incomplete access to the talent pool of outstanding residents, and we do not have a diverse group of clinicians to care for our increasingly diverse patient population, or of researchers to explore potentially important health care disparities. Our findings were twofold: first, job descriptions for men and women cardiologists are dramatically different. Men are much more likely to do invasive procedures while women are more likely to see patients and perform imaging/noninvasive tests.  While there were slightly more women working part time than men this was still rare, and the difference in number of days worked was just 6, across an entire year. The second finding was that there was a significant difference in compensation. Unadjusted, this was over $110, 000 per year; after very robust adjustment using over 100  personal, practice, job description and productivity measures, the difference was $37, 000 per year, or over a million dollars across a career. A separate independent economic analysis of wage differentials yield a similar difference of $32,000 per year. (more…)
Author Interviews, Heart Disease, Pharmacology / 10.11.2015

Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, CanadaMedicalResearch.com Interview with: Josep Rodés-Cabau, MD Director, Catheterization and Interventional Laboratories Quebec Heart and Lung Institute Professor, Faculty of Medicine, Laval University Quebec City, Quebec, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Rodés-Cabau: The occurrence of new-onset migraine attacks has been reported in about 15% of patients following transcatheter atrial septal defect (ASD) closure. Prior observational studies suggested a reduction of migraine headache post-ASD closure with the use of clopidogrel on top of aspirin. Our study (the prospective randomized CANOA trial) showed that the use of clopidogrel (in addition to aspirin) following transcatheter ASD closure was associated with a significant reduction in the occurrence and number of new-onset migraine attacks within the 3 months following the procedure. Also, among patients with migraine attacks, those receiving clopidogrel therapy experience less-severe migraine attacks. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Mental Health Research / 10.11.2015

MedicalResearch.com Interview with: Dr. Christina Mangurian MD Associate Professor of Clinical Psychiatry UCSF School of Medicine and the UCSF Department of Psychiatry's first Director of Diversity Medical Research: What is the background for this study? What are the main findings? Dr. Mangurian: People with severe mental illness (SMI, e.g., schizophrenia and bipolar disorder) die 25 years earlier than the general population, often from cardiovascular disease.  The ADA and APA guidelines recommend annual diabetes screening of this population when taking certain antipsychotic medications.  Despite these guidelines, nearly 70% of this population remain unscreened.  This has huge public health implications and likely costs our public health system a tremendous amount in undiagnosed disease. (more…)
Author Interviews, Heart Disease, JAMA, PAD / 09.11.2015

MedicalResearch.com Interview with: Farzin Fakhry, MD PhD Candidate Depts. of Epidemiology & Radiology Erasmus MC Rotterdam, the Netherlands and Myriam Hunink MD, PhD Professor Professor of Radiology and Clinical Epidemiology Erasmus University Medical Center Rotterdam Adjunct Professor of Health Decision Science Harvard T.H. Chan School of Public Health, Boston Medical Research: What is the background for this study? What are the main findings? Response: Intermittent claudication is the classical symptomatic form of peripheral arterial disease (PAD) and affects approximately 20-40 million people worldwide. These patients experience significant functional disability resulting in a sedentary lifestyle and reduced quality of life. In the Endovascular Revascularization And Supervised Exercise (ERASE) study we compared a combination therapy of endovascular revascularization plus supervised exercise versus the recommended care of supervised exercise only as first-line treatment for patients with intermittent claudication. Results from the ERASE study showed that after one year follow up patients in both groups showed significant improvements in their treadmill walking distance and disease specific quality of life. Yet, patients receiving the combination therapy had more rapid and significantly greater improvement in their walking performance and disease specific quality of life compared to the patients following a supervised exercise program only. (more…)
Author Interviews, Gender Differences, Heart Disease, JAMA / 09.11.2015

MedicalResearch.com Interview with: Dr. David Bluemke MD, PhD, MsB Director of Radiology and Imaging Sciences NIH Clinical Center Bethesda, MD  Medical Research: What is the background for this study? What are the main findings? Dr. Bluemke: Heart disease is the most common reason for death and disability of adults in the United States and worldwide. This study evaluated 1,840 adults in six communities throughout the United States, ages 45-84. In normal adults, the heart is a muscle, but various injuries to the heart (the most severe being a myocardial infarction/ heart attack) occur over an individual’s lifetime. These injuries result in heart muscle being replaced by a scar composed of fibrous tissue. The main finding is that even in healthy, middle and older adults, about 1 in 12 adults in the U.S. have developed scars in the heart. Most of these (80%) are not detected by their doctor, or by other tests such as ECG. (more…)
Author Interviews, Heart Disease, Kidney Disease, Pharmacology / 08.11.2015

MedicalResearch.com Interview with: Frederic T. (Josh) Billings IV, MD, Msc Assistant Professor of Anesthesiology and Critical Care Medicine Vanderbilt University Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Billings: Acute kidney injury (AKI) following cardiac surgery is common (affects 20-30% of patients), and even mild forms of AKI are independently associated with a five-fold increase in death. Statins, commonly prescribed to reduce cholesterol concentrations and cardiovascular disease, affect several mechanisms underlying surgical AKI. Observational studies comparing rates of AKI between statin users and non-users have yielded inconsistent results and don’t assess the effect of statin use during the surgical period. In a double blind, placebo-controlled, randomized clinical trial of 653 cardiac surgery patients, we found that high-dose atorvastatin given prior to surgery, the day of surgery and daily postoperatively did not affect AKI. In fact, among statin-naïve patients with pre-existing kidney disease, rates of AKI were higher in those randomized to atorvastatin compared to those randomized to placebo. In patients who were using statins prior to the study, rates of AKI were similar between those randomized to atorvastatin and those randomized to placebo (short-term withdrawal), regardless of baseline kidney function. Safety markers of muscle and liver toxicity were not affected by statin treatment. (more…)
AHA Journals, Author Interviews, Electronic Records, Heart Disease / 30.10.2015

MedicalResearch.com Interview with: Jonathan R. Enriquez, MD Assistant Professor of Medicine Division of Cardiology University of Missouri- Kansas City Director, Coronary Care Unit Truman Medical Center  Medical Research: What is the background for this study? Dr. Enriquez:  
  • In 2009, U.S. legislation appropriated tens of billions of dollars to promote the use of electronic health records (EHRs).
  • Approximately 4 million hospitalizations for cardiovascular diagnoses occur annually in the U.S., which are more hospitalizations than for any other category of disease.  Therefore, evaluating the use of EHRs in these settings can help us understand how to best optimize the care and outcomes of a huge set of patients.
(more…)
AHA Journals, Author Interviews, Heart Disease, Nutrition, Pediatrics / 28.10.2015

MedicalResearch.com Interview with: Michael D. Miedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN Medical Research: What is the background for this study? Dr. Miedema: A healthy diet is an essential component in the prevention of cardiovascular disease. A dietary pattern high in fruits and vegetables has been associated with reduced rates of cardiovascular disease outcomes in multiple observation cohorts of middle-aged and older adults. However, the cardiovascular impact of fruit and vegetable intake in younger adults is less clear. Medical Research: What are the main findings? Dr. Miedema: To evaluate this relationship, we studied 2,506 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study to determine the association between fruit and vegetable intake during young adulthood and subsequent development of coronary artery calcium 20 years later. After adjusting for age, gender, and lifestyle variables, including smoking and physical activity, we found an inverse relationship between fruit and vegetable and subsequent coronary artery calcium across tertiles of fruit and vegetable intake (p-value <0.001). Individuals in the top third of fruit and vegetable intake at baseline had 26% lower odds of developing calcified plaque 20 years later. This inverse linear relationship remained significant after adjusting for fruit and vegetable intake at year 20 as well as after adjustment for other dietary variables such as dairy, nuts, fish, salt, and refined grains. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pediatrics / 18.10.2015

MedicalResearch.com Interview with: Ashley Winning, ScD, MPH Postdoctoral Research Fellow Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Medical Research: What is the background for this study?  Dr. Winning: Several studies have found associations between psychological distress and heart disease and diabetes; however, much of the research has measured distress and disease risk in adulthood and we can’t tell how long people have been distressed or how far-reaching the effects of distress are. Some work has shown that childhood distress is associated with adult health, indicating that distress may start to affect health even earlier in life than we thought. However most of the research has measured distress at a single point in time so we have not been able to answer questions regarding effects of persistent distress or if effects on health are less bad if people become less distressed over time. Medical Research: What are the main findings? Dr. Winning: Distress at any period in the life course was associated with increased cardiovascular and metabolic disease risk in adulthood (age 45). Not surprisingly, those with high levels of distress in both childhood and adulthood had the greatest cardiometabolic risk. The most striking finding is that high levels of childhood distress (measured in childhood) predicted heightened adult disease risk, even when there was no evidence that these high levels of distress persisted into adulthood. (more…)
Author Interviews, Heart Disease, Radiology / 17.10.2015

MedicalResearch.com Interview with: Dr. Andre R. M. Paixao MD Division of Cardiology Arkansas Heart Hospital Little Rock, AR. Medical Research: What is the background for this study? Dr. Paixao: Coronary artery calcium (CAC) measured by computed tomography has emerged as a powerful predictor of coronary heart disease (CHD) but most of the evidence behind it comes from cohorts comprised of older individuals (mean age 62 years).Coronary artery calcium has a very strong association with age and young individuals tend to have a higher proportion of noncalcified plaque so validating the predictive value of CAC in a younger cohort is of extreme importance.   Medical Research: What are the main findings? Dr. Paixao: Using data from the Dallas Heart Study, a multi-ethnic cohort comprised of younger individuals (mean age 44 years), the addition of Coronary artery calcium to a traditional risk factor model significantly improved discrimination and risk classification (change in c-statistic = 0.03; NRI = 0.216, p = 0.012). We also performed a meta-analysis of prior studies and observed that our findings are of similar magnitude to those reported in older individuals (NRI = 0.200). (more…)
AHA Journals, Author Interviews, Women's Heart Health / 16.10.2015

MedicalResearch.com Interview with: Kate Smolina, PhD Banting Postdoctoral Fellow Centre for Health Services and Policy Research School of Population and Public Health The University of British Columbia Vancouver, BC  Canada  Medical Research: What is the background for this study? What are the main findings? Dr. Smolina: Women take fewer cardiovascular medications than men in an outpatient setting and there is limited information in the literature as to why. There are two possible explanations: this is either a consequence of prescribing behaviour by physicians or adherence behaviour by patients – or a combination of the two. This study showed that younger women are less likely to be prescribed or to fill their first prescription after a heart attack compared to younger men. But once the therapy is actually started, we found no sex differences in adherence. This is very helpful because it identifies the point on the continuum of care at which the disparity occurs and where we need to focus interventions. (more…)
Author Interviews, Baylor College of Medicine Houston, Health Care Systems, Heart Disease, JACC / 14.10.2015

MedicalResearch.com Interview with: Salim S. Virani, M.D., Ph.D Investigator, Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Staff Cardiologist, Michael E. DeBakey VA Medical Center Associate Director for Research, Cardiology Fellowship Training Program Associate Professor (tenured), Section of Cardiovascular Research Baylor College of Medicine  Houston Medical Research: What is the background for this study? What are the main findings? Dr. Virani: The increase in Americans securing health care coverage under the Affordable Care Act, in combination with a projected shortage of specialty and non-specialty physicians, has led to a growing pressure on the existing physician workforce in America.  One proposed solution is to increase the scope of practice for advanced practice providers (APPs) (nurse practitioners [NPs] and physician assistants [PAs].  An important aspect of this discussion is whether the quality of care provided by APPs is comparable to that provided by physicians. The study utilized data from the American College of Cardiology’s (ACC) National Cardiovascular Data Registry PINNACLE Registry® to examine whether there were clinically meaningful differences in the quality of coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) care delivered by advanced practice providers  versus physicians in a national sample of cardiology practices. The primary analyses included 883 providers (716 physicians and 167 APPs) in 41 practices who cared for 459,669 patients. The mean number of patients seen by APPs (260.7) was lower compared to that seen by physicians (581.2). Compliance with most CAD, HF, and AF measures was comparable, except for a higher rate of smoking cessation screening and intervention (adjusted rate ratio [RR] 1.14, 95% CI 1.03-1.26) and cardiac rehabilitation referral (RR 1.40, 95% CI 1.16-1.70) among CAD patients receiving care from APPs. Compliance with all eligible CAD measures was low for both (12.1% and 12.2% for APPs and physicians, respectively) with no significant difference. Results were consistent when comparing practices with both physicians and APPs (n = 41) and physician-only practices (n = 49). (more…)
Annals Internal Medicine, Author Interviews, Diabetes, Heart Disease, Nutrition / 13.10.2015

Iris Shai MD PhD Professor of Nutrition and Epidemiology of Chronic Diseases Dep. of Public Health Faculty of Health SciencesMedicalResearch.com Interview with: Iris Shai MD PhD Professor of Nutrition and Epidemiology of Chronic Diseases Dep. of Public Health Faculty of Health Sciences Medical Research: What is the background for this study? What are the main findings? Dr. Shai: Despite enormous contribution of observational studies, clinical recommendations for moderate alcohol consumption remain controversial, particularly for people with diabetes, due to lack of long-term, randomized controlled trials, which are needed for evidence-based medicine. People with diabetes are more susceptible to developing cardiovascular diseases than the general population and have lower levels of HDL-c. Also, it is uncertain if red wine confers any advantage over white wine or whether the ethanol is the primary mediator of alcoholic beverages related beneficial associations.  The two-year CArdiovaSCulAr Diabetes and Ethanol (CASCADE) RCT was performed among 224 controlled diabetes patients (aged 45 to 75), who generally abstained from alcohol. Red wine was found to be superior in improving overall metabolic profiles, mainly by modestly improving the lipid profile. As for glycemic control and blood pressure, the effect of both, red or white wine, was dependent on ADH enzyme polymorphism, suggesting personalized approach. Overall, wine of either type did not effect change in liver function tests, adiposity, or adverse events/symptoms. However, sleep quality was significantly improved in both wine groups, compared with the water control group. All comparisons were adjusted for changes in clinical, medical and drug therapy parameters occurring among patients during the years of the study. The trial completed with adherence rate of 87 percent after 2 years. (more…)
AHA Journals, Author Interviews, Dermatology, Heart Disease, NIH / 12.10.2015

Nehal Mehta, M.D., M.S.C.E., F.A.H.A. Lasker Clinical Research Scholar Section of Inflammation and Cardiometabolic Diseases NIHMedicalResearch.com Interview with: Nehal Mehta, M.D., M.S.C.E., F.A.H.A. Lasker Clinical Research Scholar Section of Inflammation and Cardiometabolic Diseases NIH Medical Research: What is the background for this study? What are the main findings? Dr. Mehta: Psoriasis increases cardiovascular disease (CVD), and this study shows for the first time that the amount of psoriasis on the skin is mirrored in the blood vessels by increasing blood vessel inflammation. Medical Research: What should clinicians and patients take away from your report? Dr. Mehta: Even one plaque may be too many if we are seeing a relationship between skin disease severity and vascular inflammation. (more…)
Author Interviews, Biomarkers, Cleveland Clinic, Heart Disease, JACC, Kidney Disease / 12.10.2015

Dr. Wilson Tang MD Professor of Medicine Cleveland Clinic Lerner College of Medicine Case Western Reserve University Director of the Center for Clinical Genomics Cleveland ClinicMedicalResearch.com Interview with: Dr. Wilson Tang MD Professor of Medicine Cleveland Clinic Lerner College of Medicine Case Western Reserve University Director of the Center for Clinical Genomics Cleveland Clinic  Medical Research: What is the background for this study? What are the main findings? Dr. Tang: Renal impairment has long been associated with worse outcomes in acute heart failure. Administration of diuretic therapy often obscures accurate assessment of renal function by urine output.  Despite extensive literature suggesting the poor outcomes in those with a rise in creatinine following treatment, recent data has suggested that in the presence of effective diuresis, this phenomenon likely represents hemoconcentration and azotemia rather than acute kidney injury.  We observed that using a novel and sensitive biomarker that identified acute kidney injury, specific to tubular injury, we can identify those at higher risk of adverse outcomes in patents admitted for acute heart failure.   However, after adjusting for standard risk factors, the prognostic value was clearly attenuated. (more…)
AHA Journals, Author Interviews, Exercise - Fitness, Heart Disease, JACC, University Texas, UT Southwestern / 07.10.2015

Ambarish Pandey, MD Cardiology Fellow, PGY5 University of Texas Southwestern Medical Center, Dallas, Texas 75390MedicalResearch.com Interview with: Ambarish Pandey, MD Cardiology Fellow, PGY5 University of Texas Southwestern Medical Center, Dallas, Texas 75390 Medical Research: What is the background for this study? What are the main findings? Dr. Berry: Physical inactivity is considered a major modifiable risk factor for coronary artery disease and the current guidelines recommend atleast 150 min/week (~ 500 MET-min/week) of moderate intensity physical activity to reduce the burden of coronary artery disease. In contrast, the role of physical activity in reducing risk of heart failure is not emphasized in the current guidelines. This is particularly relevant considering the increasing burden of heart failure in the community. Against this background, we performed this study to the dose-response relationship between physical activity levels and risk of heart failure. We observed a dose dependent inverse association between physical activity levels and heart failure risk. Furthermore, we observed that the current guideline recommended physical activity levels (500 MET-min/week) are associated with only modest reduction in HF risk (< 10%). In contrast, a substantial reduction in heart failure risk was observed at twice and four times the recommended physical activity levels (19% and 35% risk reduction respectively) (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, Surgical Research / 05.10.2015

Mads Emil Jørgensen Copenhagen University Hospital..., MedicalResearch.com Interview with: Mads E. Jørgensen, MB Cardiovascular Research Center Gentofte Hospital University of Copenhagen, Denmark Medical Research: What is the background for this study? What are the main findings? Response: For many years there has been a wide use of beta blockers in the non-cardiac surgery setting with the intent to protect the heart. Within recent years, this field of research has opened up to new studies evaluating in detail which patient subgroups do benefit from this therapy and which may actually be at increased risk. The current study evaluated chronic beta blocker use and risks of perioperative complications in a rather low risk population of patients with hypertension, but without cardiac, kidney or liver disease. Among 55,000 patients receiving at least two antihypertensive drugs, we found that patients treated with a beta blocker were at increased risks of complications during surgery and 30-day after surgery, compared to patients treated with other antihypertensive drugs only. In various subgroup analyses (by age, gender, diabetes, surgery risk etc.) the findings were consistent although challenged in power. (more…)
Author Interviews, Depression, Heart Disease, JAMA / 28.09.2015

MedicalResearch.com Interview with:Dr-Ken-Freedland Kenneth E. Freedland, PhD Professor of Psychiatry and Psychology Washington University School of Medicine St. Louis, Missouri Medical Research: What is the background for this study? What are the main findings? Dr. Freedland: Major depression is a common problem in patients with heart failure, and it makes heart failure self-care tasks such as daily weight checks and compliance with dietary restrictions more difficult for these them.  Unfortunately, recent clinical trials have shown that both depression and inadequate self-care can be hard to treat in patients with heart failure. Cognitive behavior therapy (CBT) is often used to treat depression in otherwise healthy individuals, but it hasn’t been tested in patients with heart failure. We added a self-care component to the standard CBT treatment protocol and conducted a clinical trial to determine whether it is effective both for depression and for self-care.  We randomized 158 heart failure patients to  cognitive behavior therapy or to usual care, and both groups received heart failure education.  About 1/3 of the patients in both groups were also taking antidepressant medications. The intervention was effective for depression, with remission rates of 51% in the cognitive behavior therapy group compared to only 20% in the usual care group.  However, it was not effective for heart failure self-care. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Prostate Cancer, Testosterone / 27.09.2015

Anthony V. D'Amico, MD, PhD Chief, Division of Genitourinary Radiation Oncology Professor of Radiation Oncology, Harvard Medical SchoolMedicalResearch.com Interview with: Anthony V. D'Amico, MD, PhD Chief, Division of Genitourinary Radiation Oncology Professor of Radiation Oncology, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. D'Amico: Controversy exists as to whether androgen deprivation therapy (ADT) used to treat prostate cancer can cause fatal cardiac events. We found that in men with moderate to severe comorbidity based most often on a history of a heart attack that the use of 6 months of androgen deprivation therapy to treat non metastatic but clinically significant prostate cancer was associated with both an increased risk of a fatal heart attack and shortened survival. (more…)
Author Interviews, Heart Disease, Karolinski Institute, Nutrition, Stroke / 27.09.2015

Susanna C. Larsson | PhD, Associate Professor Associate professor, Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm, SwedenMedicalResearch.com Interview with: Susanna C. Larsson  PhD, Associate Professor Associate professor, Nutritional Epidemiology Institute of Environmental Medicine Karolinska Institutet Stockholm, Sweden Medical Research: What are the main findings? Dr. Larsson: A high dietary cholesterol intake has been postulated to increase the risk of cardiovascular disease. Egg is a rich source of dietary cholesterol and has been positively associated with risk of heart failure in previous prospective studies. High consumption of eggs has also been associated with a higher risk of myocardial infarction in diabetic patients. Medical Research: What is the background for this study? Dr. Larsson:  We investigated the association between egg consumption and risk of cardiovascular diseases in two population-based prospective cohort studies of approximately 38,000 Swedish men and 33,000 Swedish women. Findings from our study indicate that egg consumption does not increase the risk of myocardial infarction, ischemic stroke, or hemorrhagic stroke. High egg consumption (one or more times per day) was associated with an elevated risk of heart failure in men but not in women. Egg consumption was not associated with an increased risk of heart failure, myocardial infarction, or stroke in individuals with diabetes. (more…)
Author Interviews, Heart Disease, Lipids / 25.09.2015

MedicalResearch.com Interview with: Dr Marcus Kleber PhD Post-doctoral researcher at the Vth Department of Medicine of the Medical Faculty Mannheim Heidelberg University Medical Research: What is the background for this study? What are the main findings? Dr. Kleber: Most trans fatty acids in our diet are industrially produced.  High concentrations of trans fatty acids are hazardous to human health but whether low concentrations are also harmful has not been studied in detail. We measured trans fatty acids in the erythrocyte membranes of our study participants  and found relatively low levels that were not associated with increased mortality. To the contrary, we found an association with a reduced risk for sudden cardiac death for higher concentrations of the naturally occurring trans fatty acid trans-palmitoleic acid that is ingested with milk and milk products. (more…)