Author Interviews, Biomarkers, BMJ, Heart Disease / 18.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47901" align="alignleft" width="158"]Prof. Nick Curzen  BM(Hons) PhD FRCPProfessor of Interventional Cardiology/Consultant CardiologistUniversity Hospital SouthamptonSouthampton Prof. Curzen[/caption] Prof. Nick Curzen  BM(Hons) PhD FRCP Professor of Interventional Cardiology/Consultant Cardiologist University Hospital Southampton Southampton MedicalResearch.com: What is the background for this study? Response: The commonest blood test now used to assess whether a patient has had a heart attack or not is called high sensitivity troponin (hs trop).  The test is supplied with an Upper Limit of Normal, which is based upon results from relatively healthy people.  When doctors take the hs trop, they then use this ULN to decide if the patient had has a heart attack. This study set out to see what the hs trop level is in a large number of patients attending the hospital for any reason, either inpatient or outpatient, in most of whom there was no clinical suspicion of heart attack at all.  We therefore took hs trop measurements on 20,000 consecutive patients attending our hospital and having a blood sample for any reason. 
Author Interviews, Genetic Research, Heart Disease, Lipids, NEJM, Statins / 13.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47926" align="alignleft" width="133"]Brian A Ference, MD, MPhil, MSc, FACC, FESCProfessor and Director of Research in Translational TherapeuticsExecutive Director, Centre for Naturally Randomized TrialsStrangeways Research LaboratoryUniversity of CambridgeCambridge, UK Dr. Ference[/caption] Brian A Ference, MD, MPhil, MSc, FACC, FESC Professor and Director of Research in Translational Therapeutics Executive Director, Centre for Naturally Randomized Trials Strangeways Research Laboratory University of Cambridge Cambridge, UK MedicalResearch.com: What is the background for this study? Response: Bempedoic acid is a novel therapy currently in development that lowers LDL-C by inhibiting ATP-citrate lyase, an enzyme in the same cholesterol biosynthesis pathway as HMG-CoA reductase (the target of stains).  However, whether lowering LDL-C by inhibiting ATP-citrate lyase will reduce the risk of cardiovascular events to the same extent as lowering LDL-C by inhibiting HMG-CoA reductase with a statin is unknown. We conducted a “naturally randomized trial” using Mendelian randomization in more than 650,000 participants who experienced more than 100,000 cardiovascular events to evaluate the potential clinical benefit of lowering LDL-C by inhibiting ATP-citrate lyase as compared to lowering LDL-C by inhibiting HMG-CoA reductase.
Author Interviews, Heart Disease, Imperial College, Lipids, NEJM, Statins / 13.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47863" align="alignleft" width="187"]Prof. Kosh Ray, MB ChB, MD, MPhil Faculty of Medicine, School of Public HealthChair in Public Health (Clinical)Imperial College London Dr. Ray[/caption] Prof. Kosh Ray, MB ChB, MD, MPhil Faculty of Medicine, School of Public Health Chair in Public Health (Clinical) Imperial College London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Bempedoic acid is the first in class of a new therapy for lowering LDL cholesterol. This is the largest and longest study to date with this therapy and involved about 2200 pts with patients with either established cardiovascular disease or familial hypercholestrolaemia and in whom LDL was > 70mg/dl or 1.8 mmol/L despite maximally tolerated statins. %0% were on high intensity statins and the majority of the rest on moderate intensity. The aim was to show long term safety 1 year and efficacy at 24 weeks and at 1 year. 
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Sleep Disorders / 07.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47830" align="alignleft" width="200"]Dr Manolis S Kallistratos MD, PhD, FESC,EHSAsklepeion General HospitalGreece Dr. Kallistratos[/caption] Dr Manolis S Kallistratos MD, PhD, FESC,EHS Asklepeion General Hospital Greece  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Lifestyle changes represent the cornerstone of treatment of arterial hypertension. Alcohol and salt reduction may decrease blood pressure levels by 2 to 8 mmHg. In our study 60 minutes of midday sleep decrease 24 hours systolic blood pressure levels by up to 3 mmHg in well controlled hypertensives. That is an effect as potent as other well-established life style changes. The magnitude of blood pressure decrease might seem small, but a drop in blood pressure as small as 2 mmHg can reduce the risk of cardiovascular events by up to 10 percent. 
Author Interviews, Dermatology, Heart Disease, JAMA, Race/Ethnic Diversity / 04.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47582" align="alignleft" width="150"]Francis Alenghat, MD, PhD Assistant Professor of Medicine Section of Cardiology University of Chicago Dr. Alenghat[/caption] Francis Alenghat, MD, PhD Assistant Professor of Medicine Section of Cardiology University of Chicago MedicalResearch.com: What is the background for this study? What are the main findings? Response: Psoriasis has been associated with higher rates of atherosclerotic cardiovascular disease (ASCVD), potentially due to higher-than-normal levels of systemic inflammation. Whether this association varies by race was unknown. Also, it was unclear whether patients with psoriasis have more frequent ASCVD because of higher rates of traditional cardiovascular risk factors (smoking, diabetes, hypertension, hyperlipidemia) or because of components intrinsic to psoriasis itself. We found that, amongst a large population of patients with psoriasis, patients of both sexes and most ages had elevated ASCVD rates compared to those without psoriasis. Overall, African American patients with psoriasis had a 15% ASCVD prevalence, whereas it was 10% in white patients with psoriasis. Increased ASCVD associated with psoriasis occurred at earlier ages in African American patients compared to white patients. Traditional cardiovascular risk factors were common in patients with psoriasis and appeared to play a large role in the driving the higher rates of ASCVD in these patients, but even in patients with psoriasis but without any documented traditional risk factors, ASCVD rates were elevated compared to patients without psoriasis. 
Annals Internal Medicine, Author Interviews, Clots - Coagulation, Heart Disease / 27.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47632" align="alignleft" width="200"]Dr Vanessa Selak, MBChB, MPH, PhD, FAFPHM, FNZCPHMSenior Lecturer, Section of Epidemiology & BiostatisticsSchool of Population Health, Faculty of Medical and Health SciencesUniversity of Auckland Dr. Selak[/caption] Dr Vanessa Selak, MBChB, MPH, PhD, FAFPHM, FNZCPHM Senior Lecturer, Section of Epidemiology & Biostatistics School of Population Health Faculty of Medical and Health Sciences University of Auckland MedicalResearch.com: What is the background for this study? Response: In order to determine the balance of benefits and harms of aspirin in primary prevention there’s a need to know an individual’s risk of CVD and their risk of a major bleed without aspirin. We have lots of equations that can be used to determine, among people considering aspirin for primary prevention, an individual’s risk of CVD, but few bleeding risk equations that can be used to determine their risk of a major bleed. We sought to develop a bleeding risk equation that can be used to determine the risk of a major bleed among people in whom aspirin is being considered for the primary prevention of CVD.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, Sleep Disorders / 16.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47525" align="alignleft" width="225"]Cameron S. McAlpine, Ph.D. Banting Postdoctoral Fellow Center for Systems Biology Massachusetts General Hospital Harvard Medical School Boston, MA, 02114 Dr. McAlpine[/caption] Cameron S. McAlpine, Ph.D. Banting Postdoctoral Fellow Center for Systems Biology Massachusetts General Hospital Harvard Medical School Boston, MA, 02114 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cardiovascular disease is caused by the build up of white blood cells and fat in arteries. We have known for a long time that poor sleep is associated with an increased risk of developing cardiovascular disease. A number of human observational studies have found this correlation. However, the reasons for this correlation have been largely unknown. Our study, performed in mice, provides one possible explanation. We found that when we disturbed the sleep of mice they produced more inflammatory white blood cells. These cells caused larger lesions in their arteries and more advanced cardiovascular disease. We found that his phenomenon is controlled by a hormone produced in the brain that normally suppresses the production of white blood cells. When mice have their sleep disturbed this pathway breakdown causing the increased production of white blood cells.
Author Interviews, Heart Disease, JACC / 13.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47482" align="alignleft" width="200"]Srikanth Yandrapalli, MD Chief Resident in Internal Medicine at New York Medical College at Westchester Medical Center Program  Dr. Yandrapalli[/caption] Srikanth Yandrapalli, MD Chief Resident in Internal Medicine at New York Medical College at Westchester Medical Center Program  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Risk factors play an important role in the development of and progression of coronary heart disease, thus necessitating strategies to address the leading modifiable risk factors to reduce the burden of coronary heart disease. Data are lacking regarding therecent temporal trends in the prevalence of these risk factors during a first AMI in US young adults. In our study, we report that among young adults in the US with a first acute myocardial infarction, the prevalence rates of major modifiable risk factors were very high with over 90% of patients having at least 1 such risk factor. Significant sex and racial disparities were observed. Sex differences in the rates of certain  risk factors were clearly evident with males having higher rates of smoking, dyslipidemia, and drug abuse, whereas females had higher rates metabolic risk factors like diabetes mellitus, hypertension, and obesity. Sex differences in the rates of certain risk factors narrowed with increasing age and over time. Blacks had higher rates of hypertension, obesity, and drug abuse, Whites had higher rates of smoking, Hispanics had higher rates of diabetes mellitus and patients of Asian/Pacific Islander race had higher rates of dyslipidemia. Prevalence rates progressively increased between 2005 and 2015 except for dyslipidemia for which a decreasing trend was noted more recently.
Author Interviews, Heart Disease, OBGYNE / 07.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47367" align="alignleft" width="135"]Professor Dino A. Giussani PhD ScD FRCOG Professor of Developmental Cardiovascular Physiology & Medicine Department of Physiology Development & Neuroscience University of Cambridge UK Director of Studies in Medicine College Lectureship in Medicine '1958' Gonville & Caius College Prof. Giussani[/caption] Professor Dino A. Giussani PhD ScD FRCOG Professor of Developmental Cardiovascular Physiology & Medicine Department of Physiology Development & Neuroscience University of Cambridge Director of Studies in Medicine College Lectureship in Medicine '1958' Gonville & Caius College UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Heart disease kills 1 in 3 people worldwide.  When we hear about heart disease, the first thing we think of is a gene-environent interaction.  That is to say, how our genes interact with traditional lifestyle factors, such as smoking, obesity and/or a sedentary lifestyle to promote an increased risk of cardiovascular disease.  However,  it has also become established that the gene-environment interaction early in life may be just as, if not more, important in ‘programming’ future heart health and heart disease. That is to say, how the quality of the intrauterine environment in which we develop may also shape our future heart risk.  Evidence from human sibling-pair studies suggests that these relationships are causal, that they occur independently of genotype and that they are significantly influenced by the quality of the intrauterine environment during pregnancy.  For instance, bariatric surgery to decrease the weight of obese women reduced the risk of obesity, insulin resistance and raised blood pressure in children born after surgery compared to those born before. Therefore, these studies highlight a disproportionate risk of disease in offspring born from the same mother but under different in utero conditions, providing strong evidence in humans that the environment experienced during this critical period of development directly influences long-term cardiovascular health. One of the most common outcomes of complicated pregnancy in humans is chronic fetal hypoxia, as can occur during placental insufficiency or preeclampsia. The main findings of our study show that prenatal hypoxia can programme future heart disease in the offspring and that maternal treatment with the antioxidant vitamin C can be protective (see paper attached).
Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Frailty, Heart Disease, Surgical Research / 05.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47274" align="alignleft" width="173"]Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center Dr. Dae Hyun Kim[/caption] Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The number of older adults undergoing aortic valve replacement is increasing.  Since these patients are at high risk for complications and functional decline due to preexisting multimorbidity and frailty, the latest guideline (Otto et al. J Am Coll Cardiol 2017;69:1313–46) emphasizes shared decision-making based on patient-centered outcomes.  Despite this recommendation, we witness many decision-making processes are cardio-centric—mainly informed by expected benefit in terms of cardiac-specific measures.  Many patients are not adequately informed about what their daily life would be like after the procedure. In this single-center prospective cohort study, we examined functional status trajectories via assessments of global functional status at 1, 3, 6, 9, and 12 months in 246 patients who underwent transcatheter and surgical aortic valve replacement.  We identified 5 clinically meaningful functional trajectories, ranging from high baseline function-early complete recovery to low baseline function-large and persistent decline.  We were able to predict most likely trajectory as well as best possible and worse possible trajectories using the preoperative frailty index.  Delirium and postoperative complications were also strongly associated with undesirable functional trajectories. 
Author Interviews, General Medicine, Heart Disease, Science, Weight Research / 04.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47294" align="alignleft" width="200"]Vitor Engrácia Valenti Professor São Paulo State University Marília Dr. Valenti[/caption] Vitor Engrácia Valenti, PhD Professor São Paulo State University Marília MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Autonomic modulation and cardiorespiratory variables are influenced by numerous factors. Abdominal fat tissue is a relevant variables related to metabolic and cardiovascular disorders, including diabetes mellitus, dyslipidemia and hypertension, which are associated to increased risk of morbidity and mortality. We evaluated cardiorespiratory variables and autonomic nervous system before and during recovery from exercise in healthy physically active men divided according to with waist-stature ratio (WSR): G1 – between 0.40 and 0.449 (N = 19), and G2 – between 0.45 and 0.49. This metholodigcal procedure is able to provide important information regarding the risk for developing cardiovascular disease in the future. Our main findings indicated that healthy physically active men with waist-stature ratio values close to the risk limit (between 0.449 and 0.5) presented slower return of autonomic and cardiorespiratory variables to baseline values after moderate exercise. It suggests that this group present an elevated probability of developing cardiovascular disease in the future compared to the groups with lower values of waist-stature ratio.
Author Interviews, Exercise - Fitness, Heart Disease, JAMA / 30.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47217" align="alignleft" width="132"]Laura DeFina, MD President and Chief Executive Officer Chief Science Officer The Cooper Institute  Dr. DeFina[/caption] Laura DeFina, MD President and Chief Executive Officer Chief Science Officer The Cooper Institute MedicalResearch.com: What is the background for this study? Response: Several studies suggest that endurance athletes may be at higher risk for asymptomatic hardening of the coronary arteries.  These studies, however, have been done on small numbers of endurance athletes (ie – marathon runners) and do not show whether this increase in hardening actually leads to increase in heart attacks or death of cardiovascular disease. In our population of 21,758 generally healthy individuals (average age 52 years) who presented for a preventive medicine examination, we were able to evaluate for the presence of hardening and cardiovascular events in individuals who exercised high volumes (≥3000 MET·minutes/week or comparable to running 6 miles/hour for an hour 5 days a week) versus those exercising less.
Author Interviews, Heart Disease, JAMA, Thyroid Disease, Vanderbilt / 27.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47159" align="alignleft" width="150"]Joe-Elie Salem, MD, PhD Associate Professor - MCU-PH, Sorbonne Université - INSERM - CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology Clinical Pharmacology, Nashville, TN Dr. Salem[/caption] Joe-Elie Salem, MD, PhD Associate Professor - MCU-PH, Sorbonne Université - INSERM - CIC, Clinical Pharmacology, Cardio-oncology, APHP, La Pitié-Salpêtrière, Paris, France Adjunct Associate Professor, Vanderbilt University Medical Center, Cardio-oncology Clinical Pharmacology, Nashville, TN MedicalResearch.com: What is the background for this study? What are the main findings? Response: A study by researchers at Vanderbilt University Medical Center has strengthened the link between thyroid function and atrial fibrillation (AF), an irregular heart rhythm that increases the risk of stroke and other heart-related complications. They phenome-wide association study scanned the medical records of more than 37,000 people for an association between genetically determined variation in thyroid stimulating hormone levels (a measure of thyroid function) and AF risk. Previous observational studies have found that subclinical hyperthyroidism, an overactive thyroid which does not meet the clinical threshold for diagnosis or treatment, nevertheless can increase the risk of atrial fibrillation.  But whether to treat subclinical hypo- or hyperthyroidism to reduce AF risk remains a matter of debate in the medical community. 
Author Interviews, Cost of Health Care, Heart Disease, Inflammation, JAMA, Stanford / 17.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46992" align="alignleft" width="150"]Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte Dr. Sehested[/caption] Thomas S. G. Sehested MD Department of Cardiology Copenhagen University Hospital Gentofte [caption id="attachment_46991" align="alignleft" width="150"]Jenny Bjerre, MD Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Copenhagen, Denmark Department of Health Research and Policy Stanford University School of Medicine Stanford, California Dr. Bjerre[/caption]   Jenny Bjerre, MD Department of Cardiology Copenhagen University Department of Health Research and Policy Stanford University School of Medicine Stanford, California   MedicalResearch.com: What is the background for this study? Response: n 2017, the results from the much-awaited Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial were published, confirming the inflammatory hypothesis, i.e. that targeting inflammation can reduce cardiovascular disease. The trial tested the monoclonal antibody canakinumab in a population of post-myocardial infarction patients with elevated inflammation markers (hs-CRP). Canakinumab is currently used for rare diseases and carries an orphan drug price: the 150mg dose used in CANTOS costs approximately $73,000 per year. Due to the high prevalence of cardiovascular disease, millions of patients could potentially be eligible for treatment with this high-priced anti-inflammatory drug. Therefore, we wanted to investigate the cost-effectiveness for canakinumab for secondary prevention of cardiovascular disease, using the reported results from CANTOS.
AHA Journals, Author Interviews, Heart Disease / 16.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46976" align="alignleft" width="200"]JAY H. Traverse, MD, FACC, FAHA Director of Research, Minneapolis Heart Institute Foundation Associate Professor of Medicine, Cardiovascular Division University of Minnesota School of Medicine Dr. Traverse[/caption] JAY H. Traverse, MD, FACC, FAHA Director of Research Minneapolis Heart Institute Foundation Associate Professor of Medicine Cardiovascular Division University of Minnesota School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reperfusion injury may contribute a significant amount to final infarct size in setting of ST-elevation myocardial infarction (STEMI). Several studies from Europe and Asia have suggested that modifying reperfusion with an angioplasty balloon of an occluded artery called postconditioning can reduce infarct size. However, not all studies show a benefit. We hypothesized that patient selection of STEMI patients could contribute to these inconsistent findings so we performed the first postconditioning study in the US sponsored by the NIH using the strictest enrollment criteria of any study to minimize factors that influence infarct size (ischemic time, collaterals, pre-infarction angina, TIMI 0 flow) designed to maximize the benefit of postconditioning to see if it can actually reduce infarct size.
Author Interviews, Heart Disease, JACC, Sleep Disorders / 14.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46941" align="alignleft" width="133"]José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics            JM-USDA-HNRCA at Tufts University Boston, MA 02111 Dr. Ordovás[/caption] José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics JM-USDA-HNRCA at Tufts University Boston, MA 02111 MedicalResearch.com: What is the background for this study? Response: The current knowledge supports the notion that poor sleep is associated with cardiovascular risk factors such as obesity, hypertension, and diabetes. Besides, there is some proof that poor sleep might be related to the development of atherosclerosis; however, this evidence has been provided by studies including few participants and, in general, with sleep disorders, such as sleep apnea. Our research has used state-of-the-art imaging technology to measure plaque buildup in the arteries, and objective measures of sleep quantity and quality in about 4000 participants of the PESA CNIC- Santander Study. Moreover, this is the first study to look at the multiterritory development of plaques versus other studies that looked exclusively at the coronary arteries. Therefore, this combination provides stronger evidence than previous studies about the risk of poor sleep on the development of atherosclerosis.
Annals Internal Medicine, Author Interviews, Beth Israel Deaconess, Cost of Health Care, Heart Disease, Lipids / 02.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46753" align="alignleft" width="150"]Dhruv S. Kazi, MD, MSc, MS Associate Directo Richard A. and Susan F. Smith Center for Outcomes Research Boston MA 02215 Associate Director Cardiac Critical Care Unit Beth Israel Deaconess Medical Center Dr. Kazi[/caption] Dhruv S. Kazi, MD, MSc, MS Associate Director Richard A. and Susan F. Smith Center for Outcomes Research Boston MA 02215 Associate Director Cardiac Critical Care Unit Beth Israel Deaconess Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The ODYSSEY Outcomes trial found that addition of alirocumab to statin therapy reduces the incidence of a composite of cardiovascular death, myocardial infarction, and stroke among patients with a recent history of a myocardial infarction and elevated low-density lipoprotein cholesterol. We modeled the cost-effectiveness of alirocumab and found that, at the March 2018 price of the drug, it would not be cost-effective (either relative to statin alone or statin + ezetimibe) for this indication. We found that a large price-reduction would be required to meet the cost-effectiveness threshold of $100,000 per quality-adjusted life year. Shortly after the preliminary findings of this study were released, both manufacturers of PCSK9 inhibitors announced large price reductions in order to improve access to these drugs.
Alcohol, Author Interviews, Heart Disease, JAMA / 29.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46714" align="alignleft" width="145"]David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110 Dr. Brown[/caption] David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The genesis of this study was a patient asking me if he could continue to have a nightly cocktail or two after he was hospitalized with the new diagnosis of heart failure. The main findings are that moderate drinking after the diagnosis of heart failure in older adults is probably safe and is associated with longer survival. These types of studies can not prove a causal relationship between alcohol consumption and survival. 
Author Interviews, Heart Disease, Women's Heart Health / 19.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46639" align="alignleft" width="200"]Dr. Sarah Perman MD, M.S.C.E. Assistant professor of Emergency Medicine University of Colorado School of Medicine in Denver  Dr. Perman[/caption] Dr. Sarah Perman MD, M.S.C.E. Assistant professor of Emergency Medicine University of Colorado School of Medicine Denver  MedicalResearch.com: What is the background for this study? Response: Women who suffer an out-of-hospital cardiac arrest have been observed to receive less bystander cardiopulmonary resuscitation (B-CPR) than men, and the potential reasons were largely unknown. We asked 54 people online to explain – with no word limit – why women might be less likely to get CPR when they collapse in public.
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Mediterranean Diet, Women's Heart Health / 10.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46414" align="alignleft" width="117"]Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA Dr. Mora[/caption] Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit. Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors. Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites. 
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 29.11.2018

MedicalResearch.com Interview with: Pratyaksh K. Srivastava, MD Division of General Internal Medicine, UCLA Gregg C. Fonarow, MD Ahmanson-UCLA Cardiomyopathy Center UCLA  Medical Center, Los Angeles Associate Editor, JAMA Cardiology MedicalResearch.com: What is the background for this study?  Response: Angiotensin Receptor-Neprilysin Inhibitors represent a novel class of heart failure therapeutics that have been shown to significantly improve mortality among patients with heart failure with reduced ejection fraction (HFrEF). In the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with Angiotensin Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, sacubitril-valsartan was associated with a 20% relative risk reduction in the primary outcome of death from cardiovascular causes or first hospitalization for worsening heart failure over a median follow up of 27 months. In our current study, we present long term (5-year) absolute risk reductions associated with the addition of angiotensin receptor-neprilysin inhibition to standard HFrEF background therapy using data from PARADIGM-HF. We utilize the number needed to treat (NNT) to quantify absolute risk reduction, and ultimately compare 5-year NNT values for sacubitril-valsartan to those of well-established HFrEF therapeutics for the outcome of all-cause mortality.
Author Interviews, Heart Disease, JAMA, Lifestyle & Health, Nutrition / 26.11.2018

MedicalResearch.com Interview with: [caption id="attachment_46168" align="alignleft" width="120"]Ravi B. Patel, MD Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois Dr. Patel[/caption] Ravi B. Patel, MD Division of Cardiology, Department of Medicine Northwestern University Feinberg School of Medicine Chicago, Illinois MedicalResearch.com: What is the background for this study? What are the main findings? Response: The digital attention of scientific articles can be readily quantified using the Altmetric score. The Altmetric score is a weighted measure, incorporating a variety of media platforms. We aimed to characterize the Top 10% of articles by Altmetric score among 4 major cardiovascular journals (Circulation, European Heart Journal, Journal of the American College of Cardiology, and JAMA Cardiology) in 2017. Our primary findings were: 1) nearly half of the most disseminated articles were not original research investigations, 2) the most common article topic was nutrition/lifestyle, and 3) there was a weak but significant correlation between Altmetric scores and citation number. 
Author Interviews, Cleveland Clinic, Heart Disease, JACC, Surgical Research / 22.11.2018

MedicalResearch.com Interview with: Peter Hu MD Cleveland ClinicPeter T. Hu MD Department of Cardiology Cleveland Clinic MedicalResearch.com: What is the background for this study? What are the main findings? Response: Among patients with blockages in multiple coronary vessels, we studied predictors and outcomes of having a staged versus one-time multivessel percutaneous coronary intervention. By "staged" we mean performing coronary intervention only on one vessel, letting the patient recover, and fixing the other blockages at a later date. We know that multivessel coronary artery disease is very common - present in up to 2/3 of patients who require coronary interventions. Previous studies in patients with STEMI (ST-elevation myocardial infarction) suggested that staged multivessel PCI was associated with lower risk of death compared with one-time multivessel revascularization. Outside of STEMI patients, very little data exist in a broader group of patients who undergo coronary interventions to multiple vessels. In our study, we found an association between doing a staged PCI and lower long-term mortality benefit compared with fixing multiple blockages at once. What was surprising was there seemed to be a correlation with the degree of benefit from staged PCI based on the symptoms and signs the patient presented with. The association with improved outcomes was strongest in patients with STEMI, followed by those with NSTEMI, unstable angina, and stable angina, respectively. We also found that the decision to perform staged PCI was driven by patient and procedural characteristics, as well as other unmeasured site variation. 
Author Interviews, Diabetes, Heart Disease, JAMA, Weight Research / 19.11.2018

MedicalResearch.com Interview with: "Obesity runs rampant in Indiana." by Steve Baker is licensed under CC BY-ND 2.0Haris Riaz MD (Cardiology Fellow Haitham Ahmed MD, MPH , Preventive Cardiologist, Cleveland Clinic, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elevated cholesterol (specially low density lipoprotein) has been causally linked to the development of coronary artery disease whereas the causal relationship between obesity and cardiovascular disease has remained controversial. This is important because of increasing epidemic of obesity and metabolic syndrome. Mendelian randomization studies provide one way of determining a causal association where we can look at the outcomes of individuals stratified by the presence or absence of a particular allele. Since these alleles are randomly distributed in the population of interest, this is "nature's randomized trial" in that the particular allele is naturally distributed and hence minimal risk of bias. In other words, lets say that I hypothesize that a particular gene "A" is linked with coronary artery disease. If the given gene is indeed causally linked with coronary artery disease, patients with activation of that gene should have significantly greater risk of developing coronary artery disease. Based on these principles, we conducted a systematic review and meta-analysis of the available evidence and found that the risk of developing coronary artery disease and diabetes is significantly increased with obesity. Although hypothesis generating, we think that these findings may suggest a causal association between obesity and cardiovascular disease. 
AHA Journals, Author Interviews, Heart Disease, Surgical Research / 13.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45845" align="alignleft" width="125"]MedicalResearch.com Interview with: Dr. Srikanth Yandrapalli New York Medical College NYMC · Cardiology Dr. Yandrapalli[/caption] Dr. Srikanth Yandrapalli New York Medical College NYMC · Cardiology MedicalResearch.com: What is the background for this study? What are the main findings? Response: Selection of coronary artery bypass grafting over percutaneous coronary intervention during an acute myocardial infarction is influenced by the extent of coronary artery disease and patient comorbidities. Prior studies have shown sex and racial differences in coronary artery diseaseburden. We sought to identify if there are any sex and racial differences in the utilization of  coronary artery bypass grafting over percutaneous coronary intervention during a revascularized first  acute myocardial infarction in the US. We found that males had a higher coronary artery bypass grafting rate than women, and compared to Whites, Blacks had lower coronary artery bypass grafting rate and Asians had higher coronary artery bypass grafting at the time of a first myocardial infarction.
Annals Internal Medicine, Author Interviews, Heart Disease, Race/Ethnic Diversity, Stanford / 13.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45897" align="alignleft" width="150"]Katie Hastings MPH Stanford Medicine  Kate Hastings[/caption] Katie Hastings MPH Stanford University School of Medicine Stanford, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Heart disease has been the leading cause of death since the early 1900s, but recent data has suggested cancer will surpass heart disease in the upcoming decades. To date, this is the first study to examine the transition from heart disease to cancer mortality as the leading cause of death by U.S. county and sociodemographic characteristics using national mortality records from 2003 to 2015. Our main findings are:
  • Epidemiologic transition is occurring earlier in high compared to low income U.S. counties, and occurs earlier for Asian Americans, Hispanics, and NHWs compared to blacks and American Indians/Alaska Natives.
  • Data may suggest that this shift arises from larger reductions in heart disease than cancer mortality over the study period, particularly in the highest income counties.
  • Continued disparities in heart disease and cancer mortality between blacks and other racial/ethnic groups, even in the highest income quintiles. While blacks continue to have the highest overall mortality than any other group, we do show this population experienced the greatest overall improvements in mortality (i.e. mortality rate reductions over time) for all-cause, heart disease, and cancer compared to all other racial/ethnic groups (except for heart disease in Hispanics). 
Author Interviews, Heart Disease, Lifestyle & Health, Yale / 11.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45884" align="alignleft" width="133"]Nikolaos Papoutsidakis, M.D., Ph.D. Associate Research Scientist, Yale University School of Medicine New Haven, CT  Dr. Papoutsidakis[/caption] Nikolaos Papoutsidakis, M.D., Ph.D. Associate Research Scientist, Yale University School of Medicine New Haven, CT  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Lifestyle education is a significant part of Hypertrophic Cardiomyopathy management. HCM patients, who frequently have to abstain from intense athletics, often ask if such restrictions extend to thrill-seeking activities they previously enjoyed, such as rollercoaster rides. Werealized there is very little data on this topic, which prompted us to set up this study. We found that for Hypertrophic Cardiomyopathy patients who elected to participate in thrill-seeking activities, adverse events (defined as losing consciousness or experiencing a shock from an implantable cardioverter-defibrillator) were rare. We also asked patients (participating and non participating) about advice received from their physician on this topic. We found that, probably due to the lack of data, physicians often avoid providing advice or provide conflicting advice regarding participation in thrill seeking activities. 
Author Interviews, Heart Disease, JAMA / 07.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45677" align="alignleft" width="128"]Dr. JeanPhilippe Empana, MD, PhD Research Director, INSERM U970 Paris Cardiovascular Research Center (PARCC) Team 4 Cardiovascular Epidemiology & Sudden Death Paris Descartes University Dr. Empana[/caption] Dr. Jean Philippe Empana, MD, PhD Research Director, INSERM U970 Paris Cardiovascular Research Center (PARCC) Team 4 Cardiovascular Epidemiology & Sudden Death Paris Descartes University MedicalResearch.com: What is the background for this study?  Response: In 2010, the American Heart Association (AHA) has emphasized the primary importance of the Primordial prevention concept, i.e. preventing the development of risk factors before they emerge, as a complementary prevention strategy for cardiovascular disease (CVD). Accordingly, the AHA has developed a simple 7-item tool, including 4 behavioral (nonsmoking, and ideal levels of body weight, physical activity and diet) and 3 biological metrics (ideal levels of untreated blood pressure, fasting blood glucose and total cholesterol) for promoting an optimal cardiovascular health (CVH). The relevance of the concept and of the tool has been several times reported by individual studies and meta-analyses (combining the results of several studies) showing substantial and graded benefit for cardiovascular disease but also mortality, quality of life and even cancer risk with higher level of CVH. However, most studies relied on one measure of  cardiovascular health. In the present work, using serial examinations from the well-known Whitehall Study II, we described change in CVH over time and then quantified the association of change in cardiovascular health over 10 years with subsequent incident cardiovascular disease and mortality. This analysis is based on 9256 UK men and women aged 30 to 55 in 1985-88, and thereafter examined every 5 years on average during 30 years.
Author Interviews, Dental Research, Heart Disease, Infections / 05.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45675" align="alignleft" width="169"]Martin H. Thornhill MBBS, BDS, PhD, MSc, FDSRCS(Edin), FDSRCSI, FDSRCS(Eng) Professor of Translational Research in Dentistry Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry  Prof. Thornhill[/caption] Martin H. Thornhill MBBS, BDS, PhD, MSc, FDSRCS(Edin), FDSRCSI, FDSRCS(Eng) Professor of Translational Research in Dentistry Academic Unit of Oral & Maxillofacial Medicine Surgery & Pathology, University of Sheffield School of Clinical Dentistry  MedicalResearch.com: What is the background for this study?   Response: Infective endocarditis is an infection of the heart valves that has a high death rate (around 30% in the first year). It requires intensive treatment often involving replacement of affected heart valves and frequently results in serious long-term illness and disability in those who survive as well as an increased risk of re-infection and high healthcare costs. In ~40% of cases, bacteria from the mouth are implicated as the causal organism. Because of this, guideline committees around the world recommended that all those at risk of infective endocarditis should receive antibiotic prophylaxis before undergoing invasive dental procedures. Due to a lack of evidence for efficacy, however, guideline committees started to limit the use of antibiotic prophylaxis. And in 2007, the American Heart Association (AHA) guideline committee recommended that antibiotic prophylaxis should continue for those at high-risk but should cease for those at moderate risk of endocarditis. Most guideline countries around the world followed suite. Except in the UK, where the National Institute for Health and Care Excellence (NICE) recommended that the use of antibiotic prophylaxis should completely stop in 2008.