Author Interviews, Diabetes, Heart Disease / 15.11.2017

MedicalResearch.com Interview with: “Diabetes Test” by Victor is licensed under CC BY 2.0Jesper Svane Medical student The Heart Center, University Hospital Rigshospitalet Copenhagen  MedicalResearch.com: What is the background for this study? Response: At the beginning of this research project, we were aware that persons with diabetes have an increased risk of death, which is partly explained by an increased risk of sudden cardiac death. However, previous studies on causes of death and mortality among young persons with diabetes, particularly type 2 diabetes, are sparse. Furthermore the incidence of sudden cardiac death among young persons with diabetes in a nationwide setting is unknown. The main purpose of the study was to illuminate the risk of death and especially the risk of cardiac death among children/young adults with diabetes. On a personal note, a friend of mine, who was healthy and fit, died suddenly a few years ago at the age of 19. This tragic death raised a lot of feelings as well as questions in me. When I got the chance to work with Dr. Lynge and Dr. Tfelt, I saw this as an opportunity to expand my knowledge of sudden cardiac death among the young. Furthermore, the opportunity of contributing to research in order to prevent these devastating events in the future was personally appealing to me. I initiated the project together with Thomas Hadberg Lynge, MD, last year, with Jacob Tfelt-Hansen, MD, DMSc as supervisor. Both are experienced researchers within the field of sudden cardiac death. Dr. Tfelt-Hansen leads a very productive research group at Rigshospitalet, Copenhagen, whose main focus is arrhythmias and sudden cardiac death. (more…)
Author Interviews, Coffee, Heart Disease, Red Meat, Stroke / 15.11.2017

MedicalResearch.com Interview with: Coffee being poured Coffee pot pouring cup of coffee. copyright American Heart AssociationLaura Stevens University of Colorado Aurora, CO MedicalResearch.com: What is the background for this study? What are the main findings? Response: We started with asking ourselves how we could better predict cardiovascular and stroke outcomes.  In an ideal world, we would be able to predict cardiovascular disease (CVD) and stroke with 100% accuracy long before the occurrence of the event.  The challenge here is there are so many potential risk factors, and testing each one using traditional methods would be extremely time consuming, and possibly infeasible. Therefore, we used artificial intelligence to find potential risk factors that could be important for risk of CVD and stroke.  The results of this analysis pointed to consumption of coffee cups per day and the number of times red meat was consumed per week as being potentially important predictors of CVD. We then looked into these findings further using traditional statistical analyses to determine that increased coffee consumption and red meat consumption appeared to be associated with decreased risk of CVD.  The study initially used data from the Framingham Heart Study (FHS) original cohort. The findings from this data were then tested using data from 2 independent studies, the Cardiovascular Heart Study (CHS) and the Atherosclerosis Risk in Communities Study (ARIC), which both supported the association of increased coffee consumption with decreased CVD risk. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA / 15.11.2017

MedicalResearch.com Interview with: Dr. Mattias Brunström Department of Public Health and Clinical Medicine Umeå University,Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering. We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD. While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 14.11.2017

MedicalResearch.com Interview with: Dr Andrew R. Chapman BHF Clinical Research Fellow University of Edinburgh Chancellors Building Edinburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: High-sensitivity cardiac troponin tests allow accurate measurement of cardiac troponin in the bloodstream. Currently, guidelines recommend we evaluate patients with suspected myocardial infarction using these tests, by looking for levels which are above the upper reference limit (99th centile). These troponin measurements are taken on arrival, and often repeated after admission to hospital up to six hours later. When levels are below this limit, the diagnosis of myocardial infarction is ruled out. However, using such a high limit in patients on arrival to hospital may not be safe, as lower risk stratification thresholds has been shown to reduce missed events,  and in these patients admission to hospital for repeat testing may not be necessary. However, there is no consensus as to the optimal threshold for use in practice. In a worldwide study of 23,000 patients from 9 countries, we have shown when high-sensitivity cardiac troponin I concentrations are below a risk stratification threshold of 5 ng/L at presentation, patients are at extremely low risk of myocardial infarction or cardiac death at 30 days, with fewer than 1 in 200 patients missed. Importantly, this threshold identifies almost 50% of all patients as low risk after a single blood test. As admission or observation of these patients is estimated to cost as much as $11 billion per year in the United States, this strategy has major potential to improve the efficiency of our practice. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC / 14.11.2017

MedicalResearch.com Interview with: Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Overall, the incidence of myocardial infarction (MI) in the US has declined. However, it has remained stable in adults <50 years of age. We evaluated the statin eligibility of a cohort of adults who had an MI at a young age using current guidelines - the 2013 ACC/AHA guidelines for cholesterol treatment and the 2016 USPSTF guidelines on use of statins for primary prevention. In, our study we found that only 49% of these young adults would have been eligible for statin therapy prior to their MI according the 2013 ACC/AHA guidelines, and only 29% would have been eligible according to the USPSTF guidelines, despite a high prevalence of cardiovascular risk factors. These numbers were even more striking for women where only 18% were eligible for statin therapy according to the USPSTF guidelines. (more…)
Author Interviews, Education, Heart Disease, Pediatrics / 13.11.2017

MedicalResearch.com Interview with: Young girl learning Hands-Only CPR at the American Heart Association Hands-Only CPR training kiosk at Cincinnati-Northern Kentucky International Airport. copyright American Heart Association 2017 Photos by Tommy Campbell PhotographyMimi Biswas M.D., MHSc University of California Riverside School of Medicine and Riverside Community Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This started as  My son's science project. He wanted to make a video game to teach CPR based on a science fair website. It grew to teaching the whole 6th grade using the AHA CPR training kit alone vs adding the video game or music, staying alive, to help with compression rate.  We found that a 12 year can easily learn the basic concepts of calling for help and starting hands only CPR and they can physically perform effective CPR at this age. (more…)
Author Interviews, Heart Disease, JAMA, Mental Health Research / 07.11.2017

MedicalResearch.com Interview with: Dr. Keun-Hwa Jung MD PhD Program in Neuroscience, Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University First author: Dr. Woo-Jin Lee MD Department of Neurology Seoul National University Hospital Seoul, South Korea  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cerebral white matter hyperintensity is a prevalent consequence of brain aging process and associated with various complications. One of the main mechanisms underlying the progression of white matter hyperintensity is chronic dysfunction of the glymphatic system which maintains metabolic homeostasis in brain. Glymphatic system is the route where the cerebrospinal fluid enters into the brain parenchyma and is cleared out with soluble wastes to the perivascular space of the cerebral small veins, peri-meningeal lymphatic vessels, deep cervical lymph nodes, and finally to the right atrium. Although the integrity of the glymphatic system is dependent on the adequate drainage of cerebral veins and lymphatics to the downstream chamber, the right atrium, the impact of hemodynamic changes in right-sided cardiac chambers on the development of white matter hyperintensity have not been elucidated. (more…)
Author Interviews, Heart Disease / 07.11.2017

MedicalResearch.com Interview with: Nayan Agarwal MD Intervention Cardiology Fellow University of Florida, Gainesville, FL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Optimal antiplatelet strategy post CABG remains controversial with guidelines still evolving. Though aspirin monotherapy is the therapy of choice, but some studies have suggested a benefit of dual antiplatelet (DAPT). Question also remains if choice of antiplatelet therapy strategy is influenced by clinical presentation (acute coronary syndrome [ACS] versus non ACS) or CABG technique ( off pump versus on pump). The current meta-analysis of 8 randomized control trials and 9 observational studies with a total of 11,135 patients demonstrated that at a mean follow up of 23 months, major adverse cardiac events (MACE) (10.3% versus 12.1%, RR 0.84, confidence interval (CI) 0.71-0.99); all-cause mortality (5.7% versus 7.0%, RR 0.67, CI 0.48-0.94) and graft occlusion (11.3% versus 14.2%, RR- 0.79, CI- 0.63- 0.98) were less with DAPT compared with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. Subgroup analysis demonstrated that benefit of DAPT was independent of clinical presentation (ACS versus non ACS) or CABG technique (off pump versus on pump). (more…)
Author Interviews, Heart Disease, NEJM, UCLA / 05.11.2017

MedicalResearch.com Interview with: Bruno Péault PhD Professor and Chair, Vascular Regeneration Center For Cardiovascular Science MRC Centre for Regenerative Medicine Scientific Director, BHF Laboratories The University of Edinburgh and Professor, David Geffen School of Medicine at UCLA Orthopaedic Hospital Research Center University of California at Los Angeles Los Angeles, CA 90095-7358 MedicalResearch.com: What is the background for this study? Response: Kidney, lung, liver, muscle, heart are among the many organs which can be severely affected by fibrosis, a natural scarring process whereby healthy tissues are replaced by a fibrous non-functional substitute. For instance, the billions of cardiac muscle cells that die after a heart infarct, consequently to blood supply interruption, are replaced by a fibrotic scar that cannot contract, reducing the capacity of the heart to pump blood, and leading often to heart failure. There is currently no efficient treatment of fibrotic scars, the basic cellular component of which is the myofibroblast, a cell of unremarkable appearance and unclear origin. The transforming growth factor β (TGFβ) molecule triggers fibrosis development after being activated, via the extra-cellular matrix, by αv integrins, which are adhesion molecules present at the surface of the target cells. To gain further insight into the cells that drive fibrosis in the heart and skeletal muscle, and explore ways to control this deleterious process, mice were used in which cells expressing the β receptor for PDGF (platelet derived growth factor) have been genetically tagged with a green fluorescent protein, a system previously used by Prof. Neil Henderson to trace fibrosis in the diseased liver (cells naturally expressing PDGFRβ are, in their vast majority, perivascular cells surrounding small blood vessels, as well as some interstitial fibroblasts). Skeletal muscle was injured by a small incision or with a targeted injection of cardiotoxin, a snake venom compound that locally kills myofibers, while the heart was damaged by prolonged infusion of angiotensin II. In both settings, progression of fibrosis was followed over time and contribution of green fluorescent cells – i.e. those expressing PDGFRβ – was assessed. (more…)
Author Interviews, Biomarkers, Heart Disease, JACC, Karolinski Institute / 25.10.2017

MedicalResearch.com Interview with: Martin Holzmann PhD Department of Medicine Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge Stockholm, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been a few studies in the general population that indicate that subjects with detectable and elevated high-sensitivity troponin T (hs-cTnT) levels have an increased risk of death and cardiovascular disease. However, in clinical practice troponins are not used for anything else than to rule in or rule out myocardial infarction in the emergency department. In addition, in a previous publication we have shown that patients with persistently elevated troponin levels are rarely investigated or followed-up to exclude heart disease. Therefore, we wanted to investigate how the association between different levels of hs-cTnT are associated with outcomes in patients with chest pain but no MI or other acute reasons for having an acutely elevated troponin level. (more…)
Author Interviews, Heart Disease / 22.10.2017

MedicalResearch.com Interview with: Parveen K. Garg, MD, MPH Assistant Professor of Clinical Medicine Keck Hospital of USC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial fibrillation is the most commonly presenting cardiac arrhythmia in clinical practice, affecting over 2 million people in the United States. This arrhythmia accounts for up to 15% of all strokes and annual costs for AF treatment are estimated at over 6.5 billion dollars. Despite the growing public health challenge that AF poses, effective prevention strategies are lacking. In 2010, the American Heart Association identified metrics of ideal cardiovascular health known as Life’s Simple 7 to target for the primary prevention of cardiovascular disease. We wanted to determine whether adherence to these health metrics helps prevent atrial fibrillation as well. Therefore, we examined the association between the Life’s Simple 7 (LS7) and incident atrial fibrillation in the REasons for Geographic And Ethnic Differences in Stroke (REGARDS) study. We found that individuals in this study with optimal cardiovascular health (high adherence to LS7 metrics) had an over 30% lower risk of developing atrial fibrillation compared to those with inadequate cardiovascular health (low adherence to LS7 metrics). We also observed that even minor improvements in adherence to the LS7 (increase in total score by 1-point) were associated with a 5% lower risk of atrial fibrillation. (more…)
Author Interviews, Heart Disease / 20.10.2017

MedicalResearch.com Interview with: Deepika Laddu PhD Assistant Professor Department of Physical Therapy College of Applied Health Sciences The University of Illinois at Chicago Chicago, IL 60612  MedicalResearch.com: What is the background for this study? Response: Recent findings in population-based cohort studies on cumulative exercise dose have caused some controversy and debate showing U-shaped trends of association between physical activity and disease risk. Our objective was to better understand this association between physical activity and cardiovascular disease risk from young adulthood to middle age. Given that engagement in physical activity is a continuously evolving behavior throughout life, this study looked at the physical activity trajectories of 3,175 black and white participants in the multicenter, community-based, longitudinal cohort CARDIA study who reported physical activity patterns over 25 years (from 1985 through 2011), and assessed the presence of coronary artery calcification, or CAC, among participants. Unique to this study is the evaluation of long-term exercise patterns from young adulthood into middle age in CARDIA participants. Based on the trajectories (or patterns of change) of physical activity over 25 years, participants were categorized into three distinct trajectory groups: trajectory group one was defined as exercising below the national guidelines (less than 150 minutes a week), group two as meeting the national guidelines for exercise (150 minutes a week), and group three as exercising three-times the national guidelines (more than 450 minutes a week). (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, PLoS / 19.10.2017

MedicalResearch.com Interview with: Professor Kazem Rahimi, FRCP MD DM MSc FES Deputy Director, The George Institute for Global Health UK Associate Professor of Cardiovascular Medicine, University of Oxford Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mitral regurgitation, the most common heart valve disorder in high-income countries, has until now been considered a degenerative disorder, which results from damage over time due to ‘wear and tear’. As a result, the focus of medical practitioners has been on treating the disorder – by repairing or replacing the valve – rather than preventing it. This is partly because there has been a lack of large-scale, longitudinal studies investigating the effect of risk factors on the condition. We set out to analyse data on 5.5 million patients in the UK over 10 years. Our findings show, for the first time, that elevated blood pressure is an important risk factor for mitral regurgitation. Consistent with prior evidence on blood pressure associations with other cardiovascular disease - such as stroke and heart attacks – we found an association with mitral regurgitation that is continuous across the whole spectrum of blood pressure. More specifically, every 20 mmHg higher baseline systolic blood pressure is associated with a 26% increased risk of mitral regurgitation, with no threshold below or above which this relationship is not true. The association we found was only partially mediated by conditions that are established causes of secondary mitral regurgitation, which suggests that high blood pressure has a direct and independent effect on valve degeneration. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, OBGYNE / 17.10.2017

MedicalResearch.com Interview with: Cuilin Zhang MD, PhD Senior Investigator Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health. Bethesda, MD 20817 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gestational diabetes (GDM) is a common pregnancy complication. The American Heart Association identifies gestational diabetes as a risk factor for cardiovascular disease (CVD) in women, based on consistent evidence for the relationships between gestational diabetes and subsequent hypertension, dyslipidemia, type 2 diabetes, vascular dysfunction and atherosclerosis. Also, previous studies identify GDM as a risk factor for intermediate markers of CVD risk; however, few are prospective, evaluate hard cardiovascular disease end points, or account for shared risk factors including body weight and lifestyle. (more…)
Annals Thoracic Surgery, Author Interviews, Gender Differences, Heart Disease, Surgical Research, Women's Heart Health / 06.10.2017

MedicalResearch.com Interview with: Habib Jabagi B.Sc., M.Sc., M.D. Department of Surgery University of Ottawa , Ottawa MedicalResearch.com: What is the background for this study? What are the main findings Response: Women with coronary artery disease (CAD) are at a significant disadvantage compared to men, as they do not consistently receive the same intensive treatment. For example, when surgery is done in men, it is more common to use arteries, as opposed to saphenous veins from the leg to complete the bypass graft. Arteries, such as the left internal thoracic artery, appear to have much better long-term patency than veins, which translates into improved outcomes. The motivation for this study was to see if our centre, which has embraced the use of arteries quite aggressively, has suffered the same gender disparities with respect to the use of multiple arterial revascularization strategies in coronary artery bypass grafting (CABG). (more…)
Author Interviews, BMJ, Gender Differences, Heart Disease / 02.10.2017

MedicalResearch.com Interview with: Min Zhao PhD student Julius Center for Health Sciences and Primary Care, Clinical Epidemiology University Medical Center Utrech MedicalResearch.com: What is the background for this study? Response: Heart disease is still one of leading causes of deaths and disability worldwide. Management of modifiable risk factors, including both medical treatment target and healthy lifestyle, reduce the chance of new heart attack among those who survived a previous heart attack (so-called secondary prevention). Previous studies have demonstrated that the secondary prevention of heart disease is poorer among women than men. However, most studies were performed in Western populations. We aimed to assess whether sex differences exist on risk factor management and to investigate geographic variations of any such sex differences. Our study is a large-scale international clinical audit performed during routine clinic visit. We recruited over 10,000 patients who had survived a previous heart attack from 11 countries in Europe, Asia, and the Middle East. (more…)
Author Interviews, Columbia, Heart Disease, Orthopedics / 28.09.2017

MedicalResearch.com Interview with: Dr. Mathew Maurer, Medical Director The Hypertrophic Cardiomyopathy Center NewYork-Presbyterian/Columbia University Medical Center. MedicalResearch.com: What is the background for this study? Response: Transthryretin cardiac amyloidosis (TTR-CA) is an underdiagnosed type of cardiomyopathy in which TTR (transthyretin, also known as prealbumin), a protein that forms amyloid fibrils, deposits in the heart. The deposits cause thickening of the ventricular wall and diastolic as well as systolic dysfunction. It is usually discovered around age 75 and presents more commonly in men than in women. With advances in non-invasive diagnostic modalities and growing awareness, TTR-CA is being diagnosed increasingly more frequently. Additionally, there are several emerging treatments that are under active investigation. Most of these therapies prevent disease progression and don’t address the amyloid already deposited in the heart. Accordingly, it is imperative that we diagnose TTR-CA before patients develop significant amyloid heart disease. However, this presents a great challenge since there are few known clinical predictors that might alert even the most astute physician that a patient is at such risk. With identification of predictors that may appropriately raise the index of clinical suspicion, clinicians may begin to pick up more subtle (and perhaps not yet clinically significant) forms of TTR-CA and initiate treatment before significant damage occurs. The few known clinical predictors of TTR-CA include bilateral carpal tunnel syndrome and lumbar spinal stenosis, and numerous studies found TTR on biopsies and autopsies of other musculoskeletal sites, particularly in hip and knee joints. (Just last week, and also discussed here on MedicalResearch.com, biceps tendon rupture was also shown to occur more frequently in TTR-CA!) We suspected that patients who ultimately develop TTR-CA may first develop clinically significant hip and knee disease, enough to even warrant a hip (THA) or knee (TKA) replacement. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Orthopedics / 22.09.2017

MedicalResearch.com Interview with: Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA MedicalResearch.com: What is the background for this study? Response: Amyloidosis due to aberrant folding of proteins. These misfolded proteins can deposit in various parts of the body and lead to organ dysfunction. The two most common types of amyloidosis affecting the heart include transthyretin and light chain amyloidosis. Transthyretin is a protein produced by the liver which supports the transport of thyroxine and retinol. Wild-type transthyretin amyloidosis (ATTRwt, previously known as senile amyloidosis) occurs due to deposition of misfolded fibrils derived from transthyretin and primarily affects elderly men. Once considered a rare disease, it is now reported to be responsible for nearly 13% of heart failure with preserved ejected fraction and increased wall thickness. Rupture of the biceps tendon is a rare occurrence in the general population (<1 per 1000). We noticed a ruptured biceps tendon in several patients with wild-type transthyretin amyloidosis and performed this study to further evaluate this finding in a group of patients with wild-type transthyretin amyloidosis and in a control group of age-matched patients with non-amyloid heart failure. (more…)
Annals Internal Medicine, Author Interviews, Exercise - Fitness, Heart Disease / 19.09.2017

MedicalResearch.com Interview with: Kevin M. Harris, MD Director, Fellowship Training; Director, Echocardiography Allina Health, Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Response: Triathlon is a popular endurance sport which combines swimming, bicycling and running. We investigated the death rate in the triathlon since its inception in the United States in 1985 through 2016. Specifically we were able to look at the rate of death in USAT races from 2006 to 2016. We identified 135 deaths/cardiac arrests over the time period. 85% of victims were male and victims averaged 47 years. Most deaths and cardiac arrests occurred in the swim. 15 of the deaths were traumatic occurring during the bike portion. The rate of death was 1.74 per 100,000 participants. The death rate was significantly higher for males than females and increased significantly for men > 40 years. On autopsy, nearly half of those victims were found to have significant cardiovascular disease. (more…)
Author Interviews, Boehringer Ingelheim, Columbia, Heart Disease, J&J-Janssen, Merck, NEJM / 14.09.2017

MedicalResearch.com Interview with: Professor Christopher P. Cannon MD Executive Director, Cardiometabolic Trials, Baim Institute Cardiologist Brigham and Women's Hospital Baim Institute for Clinical Research Columbia University College of Physicians and Surgeons MedicalResearch.com: What is the background for this study? What are the main findings? Response: The trial explored whether a dual therapy approach of anticoagulation and P2Y12 antagonist - without aspirin - in non-valvular atrial fibrillation (AF) patients following percutaneous coronary intervention (PCI) and stent placement would be as safe, and still efficacious, as the current standard treatment – triple therapy. For more detailed background on the study, readers may want to review the first paragraph of the article in the New England Journal of Medicine. Results showed significantly lower rates of major or clinically relevant non-major bleeding events for dual therapy with dabigatran, when compared to triple therapy with warfarin. In the study, the risk for the primary safety endpoint (time to major or clinically relevant non-major bleeding event) was 48 percent lower for dabigatran 110 mg dual therapy and 28 percent lower for dabigatran 150 mg dual therapy (relative difference), with similar rates of overall thromboembolic events. (more…)
Author Interviews, Heart Disease, NEJM, Stroke, Surgical Research / 13.09.2017

MedicalResearch.com Interview with: Prof. Jean-Louis MAS Université Paris Descartes INSERM UMR S 894 Service de Neurologie et Unité Neurovasculaire Hôpital Sainte-Anne Paris  MedicalResearch.com: What is the background for this study? Response: Stroke is a major cause of death, disability and dementia affecting 17 million people each year worldwide. About 80% of strokes are ischemic strokes due to occlusion of a cerebral artery by a thrombus, itself the consequence of various arterial or heart diseases. In 30 to 40% of cases, no definite cause of ischemic stroke can be identified. Cryptogenic stroke is the term used to refer to these strokes of unknown etiology. The patent foramen ovale (PFO) is a defect between the upper two heart chambers (called atria) though which a thrombus of venous origin may reach the systemic circulation and cause a stroke. This mechanism is called paradoxical embolism. Several case-control studies have shown an association between PFO and cryptogenic ischemic stroke, particularly in patients less than 60 years old, in those who have an atrial septal aneurysm (defined as an abnormal protrusion of the interatrial septum in the right or the left atrium or both) in addition to a PFO, and in those who have a PFO with a large right-to-left shunt. These findings suggested that a PFO might be responsible for stroke and that PFO closure with a device may decrease the risk of stroke recurrence. However, the causative relationship between PFO and stroke and the best strategy to prevent stroke recurrence have long been a hot topic of debate. Three previous randomized clinical trials failed to demonstrate any superiority of PFO closure over antithrombotic therapy. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 07.09.2017

MedicalResearch.com Interview with: Mario Goessl, MD, PhD, FACC, FAHA, FESC, FSCAI Director, Research and Education, Center for Valve and Structural Heart Disease Director, LAAC/Watchman™ Program Program Director, Fellowship in Advanced Adult Structural and Congenital Heart Disease Interventions and Interventional Cardiology Fellowship Minneapolis Heart Institute | Abbott Northwestern Hospital, part of Allina Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to investigate if asymptomatic patients with severe aortic stenosis benefit clinically from adherence to current national guidelines that suggest close follow up within 6-12 months. (more…)
AstraZeneca, Author Interviews, Eli Lilly, Merck / 07.09.2017

MedicalResearch.com Interview with: Dragana Radovanovic, MD  Head of AMIS Plus Data Center Hirschengraben Zürich MedicalResearch.com: What is the background for this study? What are the main findings? Response: What we know so far? When a woman suffers a heart attack she is older, has consequently more cardiovascular risk factors such as hypertension, has more comorbidities, is less likely to receive the same therapies and more likely to die in hospital. Furthermore, we know from many hospital statistics and administrative data bases that in-hospital mortality of acute myocardial infarction patients has been on the decrease from 1970 to the early 2000’s. We then wanted to know what the situation looks like in Switzerland and therefore analyzed in-hospital mortality over the last 20 years with regard to gender, age and therapies. For this study we used the data of the nationwide AMIS Plus registry (Acute Myocardial Infarction in Switzerland) which exists since 1997 and continuously prospectively collects clinical data of patients hospitalized with acute myocardial infarction. We have found that during the last 20 years (from 1997 to the end of 2016) in-hospital mortality of patients with acute myocardial infarction in Switzerland has halved. Although in-hospital mortality was consistently higher in women, overall age-adjusted mortality has decreased more prominently in women compared to men. Especially in patients aged below 60 years a significant decrease in in-hospital mortality was observed in women but not in men. (more…)
Author Interviews, Heart Disease / 07.09.2017

MedicalResearch.com Interview with: Nassir F. Marrouche, MD Professor, Internal Medicine Cardiology University of Utah  MedicalResearch.com: What is the background for this study? Response: Study the effectiveness of catheter ablation of Atrial Fibrillation in patients with heart failure in improving hard primary endpoints of mortality and heart failure progression when compared to conventional standard treatment (more…)
Author Interviews, Boehringer Ingelheim, Heart Disease, PAD / 03.09.2017

MedicalResearch.com Interview with: John Eikelboom MBBS Associate Professor, Division of Hematology & Thromboembolism Department of Medicine Canada Research Chair in Cardiovascular Medicine Canadian Institutes for Health Research McMaster University MedicalResearch.com: What is the background for this study? Response: Cardiovascular disease affects 1 in 25 persons around the world and a total of more than 300 million individuals. Thrombus formation at the site of a ruptured atherosclerotic plaque is the commonest mechanism of myocardial infarction and ischemic stroke in patients with cardiovascular disease. Aspirin is effective for the prevention of these complications but reduces the risk by only 19% during long term therapy. Rivaroxaban has previously been tested in the ATLAS ACS-2 TIMI 51 trial at doses of 2.5 mg twice daily or 5 mg twice daily on top of background antiplatelet therapy and has been shown to reduce major adverse cardiovascular events as well as mortality. We tested these same doses of rivaroxaban for the prevention of cardiovascular death, stroke or myocardial infarction in patients with stable cardiovascular disease. (more…)
Author Interviews, Heart Disease, Nutrition / 02.09.2017

MedicalResearch.com Interview with: Dr. Mahshid Dehghan, PhD Investigator- Nutrition Epidemiology Program Population Health Research Institute Senior Research Associate – Department of Medicine McMaster University MedicalResearch.com: What is the background for this study? Response: For decades, dietary guidelines have largely focused on reducing total fat and saturated fat intake based on the idea that reducing fat consumption should reduce the risk of CVD. But this did not take into account what nutrients replace saturated fats in the diet. Given that carbohydrates are relatively inexpensive, reducing fats (especially saturated fat) is often accompanied by increased carbohydrate consumption. This approach continues to influence health policy today. The guidelines were developed some 4 decades back mainly using data from some Western countries (such as Finland) where fat and saturated fat intakes were very high (eg total fat intake was >40% of caloric intake and saturated fats was >20% of caloric intake). It is not clear whether the harms seen at such high levels applies to current global intakes or countries outside North America and Europe where fat intakes are much lower. The PURE (Prospective Urban Rural Epidemiology) study is a large international cohort study of more than 157,000 people aged 35 to 70 years from 18 low-income, middle-income, and high-income countries on 5 continents. In this study, 135,335 individuals with dietary information and without cardiovascular disease at baseline were included in the study. Standardized questionnaires were used to collect information about demographics, socio-economic factors, lifestyle behaviors, health history and medication use. Standardized case-report forms were used to record data on major cardiovascular events and mortality during follow-up, which were adjudicated centrally in each country by trained physicians using standard definitions. The participants were followed-up for 7.5 years, during which time 4784 major cardiovascular events and 5796 deaths were recorded. (more…)
Author Interviews, Education, Heart Disease / 31.08.2017

MedicalResearch.com Interview with: Dr. Julien Vaucher  Physician and clinical research fellow (joint first author) Department of Internal Medicine Lausanne University Hospital Lausanne, Switzerland MedicalResearch.com: What is the background for this study? Response: Since the sixties, traditional studies have found that people who stay longer in the educational system subsequently develop less coronary heart disease. However, whether this association is causal is not clear, partly because randomised controlled trials are practically infeasible in this area. In our study, we used a genetic approach, called Mendelian randomization, that represents the next best thing to do.Based on genetic variants randomized by nature, we were able to randomize individuals according to 162 genetic markers that associate with more or less education. In other words, we used genetic markers, free from condounding factors, as proxies of education to reproduce the conditions of a trial. Then, if the genetic markers also associate together with coronary heart disease, the association between education and coronary heart disease is likely to be causal. (more…)
Author Interviews, Diabetes, Heart Disease, Pharmacology / 31.08.2017

MedicalResearch.com Interview with: Todd Hobbs, MD Vice President and Chief Medical Officer Novo Nordisk North America  MedicalResearch.com: Would you tell us a little about liraglutide? How does it work to control diabetes/blood sugar?  Response: Victoza® (liraglutide) is a human glucagon-like peptide-1 (GLP-1) analog that was approved by the U.S. Food and Drug Administration (FDA) in 2010 to help lower blood sugar in adults with type 2 diabetes. Victoza® is the #1 prescribed (GLP-1) receptor agonist. Victoza® is a non-insulin, once-a-day medication that helps lower blood sugar levels in adults with type 2 diabetes by increasing glucose-dependent insulin release, inhibiting glucagon secretion, and slowing gastric emptying. On August 25, the FDA approved a new indication for Victoza®, making it the only type 2 diabetes treatment approved to reduce the risk of major adverse cardiovascular (CV) events, heart attack, stroke and CV death, in adults with type 2 diabetes and established CV disease. (more…)
Annals Internal Medicine, Author Interviews, Cleveland Clinic, Heart Disease, Social Issues / 30.08.2017

MedicalResearch.com Interview with: Jarrod Dalton PhD Department of Quantitative Health Sciences Cleveland Clinic , Cleveland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Accurate risk assessment is critical for identifying patients who are at high risk of cardiovascular events such as heart attacks and strokes. We evaluated the performance of a widely-used risk assessment tool against the socioeconomic position of patients’ neighborhoods of residence. This tool, called the Pooled Cohort Equations Risk Model, or PCERM, was developed in 2013 jointly by the American College of Cardiology and the American Heart Association (ACC/AHA). We found that the PCERM model accurately characterized risk among patients from affluent communities, but performed more poorly among patients from disadvantaged communities. In particular, for these patients, major cardiovascular events occurred at rates that were as much as 2-3 times than predicted from the PCERM model. (more…)
AHA Journals, Author Interviews, Genetic Research, Heart Disease, Lipids, UCLA / 28.08.2017

MedicalResearch.com Interview with: Tamer Sallam, MD PhD Assistant Professor of Medicine Co-Director UCLA Center for Lipid Management Lauren B. Leichtman and Arthur E. Levine CDF Investigator Assistant Director, STAR Program Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles, California 90095-1679 MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study is extension of our previous work published in Nature showing that a gene we named LeXis (Liver expressed LXR induced sequence) plays an important role in controlling cholesterol levels. What is unique about  LeXis is that it belongs to a group of newly recognized mediators known as long noncoding RNAs. These fascinating factors were largely thought to be unimportant and in fact referred to as “junk DNA” prior the human genome project but multiple lines of evidence suggest that they can be critical players in health and in disease. In this study we tested whether we can use  LeXis “gene therapy”  to lower cholesterol and  heart disease risk. This type of approach is currently approved or in testing for about 80 human diseases. Our finding was that a single injection of LeXis compared with control significantly  reduced heart disease burden in mouse subjects. Although the effect size was moderate we specifically used a model that mimics a very challenging to treat human condition known as familial hypercholesterolemia..Familial hypercholesterolemia is one of the most common genetic disorders affecting up to 2 million Americans and characterized by 20 fold  fold increase risk of early heart attacks and often suboptimal response to currently available treatments. (more…)