If you experience chest pressure or pain accompanied by sweating, nausea, or shortness of breath; sudden, severe dyspnea at rest;...
Dr. Nordestgaard[/caption]
MedicalResearch.com Interview with:
Ask T. Nordestgaard, MD PhD
Postdoctoral research fellow
Division of Preventive Medicine
Brigham and Women's Hospital
Boston, MA 02215
MedicalResearch.com: What is the background for this study?
Response: Elevated Lp(a) is associated with high risk of CVD in multiple cohorts. We have recently shown that Lp(a) in the highest quintile is associated with 30-year risk of CVD; however, among healthy individuals, these results may be driven only by those with very extreme Lp(a) levels (e.g., above the 99th percentile).
Therefore, in this follow-up study, we examined associations between various clinical thresholds of Lp(a) and CVD across 30 years of follow-up among apparently healthy women.
Dr. Holly Kramer[/caption]
Dr. Holly Kramer MD, MPH
Professor of Public Health Sciences and Medicine
Division of Nephrology and Hypertension
Loyola University Chicago
MedicalResearch.com: What is the background for this survey? How is UACR measured? Would you explain the significance of albumin in the urine and what creatinine represents?
Response: Approximately 36 million people live with type 2 diabetes (T2D) in the U.S. today, with cardiovascular disease (CVD) being the number one cause of death for this patient population. About 1 in 3 adults with T2D has UACR >30 mg/g with prevalence approaching 40% in older patients.
Compared to patients with T2D alone, those with elevated UACR face:
Prof. Fairbairn[/caption]
Prof. Timothy Fairbairn MBChB, PhD FRCP
and
[caption id="attachment_71775" align="alignleft" width="150"]
Dr. Bell[/caption]
Dr. Jack Bell
Liverpool Heart and Chest Hospital
Liverpool, UK
MedicalResearch.com: What is the background for this study?
Response: Coronary computed tomography angiography (CCTA) is a non-invasive heart scan used in the first-line investigation of patients with suspected stable coronary artery disease (CAD). While CCTA clearly shows blockages in coronary arteries, it is limited in its ability to estimate reduced blood flow, which is necessary to diagnose angina.
An artificial intelligence-based tool (Heartflow) has been developed that analyses CCTA images and provides an estimate of blood flow: CT-derived fractional flow reserve (FFR-CT). The real-world, retrospective English FISH&CHIPS study demonstrated that including FFR-CT as a decision-making tool in the diagnosis of stable CAD reduces the number of subsequent invasive and non-invasive tests performed.
Whether FFR-CT could also be used prognostically, to predict future major cardiovascular events, was not fully understood. Previous studies have had small patient numbers, short follow-up and investigated combined cardiovascular outcomes. We performed an analysis on the national FISH&CHIPS population, which was large enough to determine if FFR-CT adds incremental value to traditional cardiovascular risk factors in predicting cardiovascular outcomes and death.
Dr. Tsuda[/caption]
Takeshi Tsuda, MD
Senior Pediatric Cardiologist
Nemours Cardiac Center
Nemours Children’s Health
Delaware
MedicalResearch.com: What is the background for this study? Would you briefly explain the condition of Duchenne Muscular Dystrophy?
Response: Duchenne muscular dystrophy (DMD) is a genetic muscle disorder causing progressive muscle weakness and wasting, resulting in severe disability during childhood due to absence of dystrophin protein in the muscle cells. Cardiac disease (cardiomyopathy) also develops during early adolescence, potentially leading to heart failure.
Because of its insidious progression, the onset of DMD cardiomyopathy is not clearly identified. Early treatment is essential for better outcomes, but the recognition of the preclinical stages of disease is challenging.
MedicalResearch.com: Is Unrelieved Wall Stress a commonly recognized echocardiogram finding?
Response: Duchenne muscular dystrophy cardiomyopathy is a unique myocardial abnormality caused by the absence of dystrophin, which serves not only as a cytoskeletal protein to maintain cellular integrity but also as a mechano-sensor to adjust wall stress to normalize myocardial oxygen demand. Dystrophin deficiency results in lack of these functions, resulting in rapid myocyte death without compensatory response to normalize wall stress.
By our methods, we are able to identify the unrelieved wall stress (increase in iWS) as an early sign of DMD cardiomyopathy before visible ventricular dysfunction prevails, not by the known routine approach.
Photo by Pavel Danilyuk[/caption]
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Prof. Ananth[/caption]
Cande V. Ananth PhD MPH
Professor and Vice Chair for Academic Affairs
Chief, Division of Epidemiology and Biostatistics
Department of Obstetrics, Gynecology, and Reproductive Sciences
Rutgers Robert Wood Johnson Medical School, NJ
Editor-in-Chief, Paediatric and Perinatal Epidemiology
MedicalResearch.com: What is the background for this study?
Response: The rate of twin pregnancies worldwide has risen in recent decades, driven by fertility treatments and older maternal ages.
MedicalResearch.com: What are the main findings?
Response: Compared to singleton pregnancies with normal blood pressure, people with twins with normal blood pressure were around twice as likely to be hospitalized with cardiovascular disease. For those with twins with high blood pressure during pregnancy, the risk was more than eight times higher.
Pexels Image[/caption]
Heart attacks are not just a male health issue. Every year, 30,000 women in the UK are admitted to hospital after having a heart attack. Despite this, women are 50% more likely than men to receive an incorrect initial diagnosis, delaying critical care.
The most common heart attack symptom for both sexes is chest pain or discomfort that doesn’t subside. However, women often experience additional symptoms that can easily be missed, such as:
Dr. Hazen[/caption]
Stanley Hazen, MD, PhD
Chair, Cardiovascular & Metabolic Sciences
Lerner Research Institute
CoSection head, Preventive Cardiology & Cardiovascular Rehabilitation
Heart, Vascular and Thoracic Institute
Cleveland Clinic
MedicalResearch.com: What is the background for this study?
Response: One of the unique features of COVID is that in some subjects, there unfortunately appear to be long term adverse effects that can occur following resolution of the acute infection. These studies add to the growing body of data showing that COVID-19 infection can enhance risk for experiencing adverse cardiac events (heart attack, stroke, and death) over time.
While a traditional open surgical approach may be better depending on the case, robotic surgery presents an array of advantages...
Dr. Stein[/caption]
Evan A Stein MD PhD FACC
COO/CSO
LIB Therapeutics
Cincinnati. OH USA 45227
MedicalResearch.com: What is the background for this study?
Response: Cardiovascular disease (CVD) remains the main cause of morbidity and mortality worldwide and is increasing in rapidly industrializing countries and is projected to cause more than >20 million deaths annually over the next 15 years. Low-density lipoprotein cholesterol (LDL-C) is well established as a major, easily modifiable, risk factor for CVD. Reductions with statins and, more recently, PCSK9 inhibitors, all agents which directly or indirectly upregulate the LDL receptor and enhance LDL-C clearance, have demonstrated CVD event reductions in cardiovascular outcome trials. Extensive data from these trials, provide a rough estimate that every 40 mg/dL reduction in LDL-C will reduce the risk of major CV cardiovascular events by 22% to 24%. Furthermore, trials with PCSK9 inhibitors added to statins which achieve substantial additional LDL-C reduction show and CVD event reduction remains linear to very low LDL-C levels without signals of adverse events.
Based on this body of evidence, recent revisions to national and international guidelines, now advocate for greater LDL-C reductions and lower LDL-C treatment goals, for patients not achieving these goals on statins alone. The current consensus target goal for LDL-C in patients with CVD, or who are at very-high risk for of CVD, is now less than <55 mg/dL, and <70 mg/dL for those at high risk.
This global trial of over 900 patients with CVD, or at very or high risk for CVD, on maximally tolerated statins assessed the 52-week efficacy and safety of monthly lerodalcibep.
Dr. Hoshi[/caption]
Rosangela Akemi Hoshi, Ph.D.
Lemann Foundation Cardiovascular Research Postdoctoral Fellowship
Center for Lipid Metabolomics
Divisions of Preventive and Cardiovascular Medicine
Brigham and Women's Hospital
Boston, MA
MedicalResearch.com: What is the background for this study? Would you describe the IgG N-glycan profile?
Response: Glycans are sugar coatings of proteins, made of monosaccharide building blocks, that are involved in a variety of biological pathways. Different sugar structures can dictate or modify the protein’s activity through specific interactions with cellular receptors. For example, proteins lacking glycans have a reduced level or a complete loss of function. Glycans are of such importance that the 2022 Nobel Prize in chemistry was awarded for glycan-based science.
In this study, we examined glycans attached to Immunoglobulins G (IgG) and their link with incidence of cardiovascular disease (CVD) due to their impact on IgG inflammatory properties. Since inflammation is not only a cause, but also an aggravating factor and a mediator of a worse prognosis in cardiometabolic disorders and CVD, we investigated whether different glycan structures may characterize an at-risk phenotype for CVD development.
Determining glycan profiles involved in multiple conditions can serve prognostic and diagnostic purposes. Yet, unlike other types of macromolecules, glycans are still not as much explored, characterizing a promising but underappreciated class that should be further investigated.
There seems to be a clear association of certain gut species with atherosclerosis, but more studies are needed to determine...
Prof. Myeong-Ki Hong[/caption]
MedicalResearch.com Interview with:
Myeong-Ki Hong, MD PhD
Professor of Cardiology
Yonsei University College of Medicine
Severance Cardiovascular Hospital
Seoul, Korea
MedicalResearch.com: What is the background for this study?
Response: The background of this study was to compare the long-term clinical outcomes between the two distinct strategies regarding statin intensity in patients with coronary artery disease (CAD).
One is to titrate statin intensity to meet a target low-density lipoprotein cholesterol (LDL-C) level (treat-to-target strategy), the other is to maintain high-intensity statin without a target goal (high-intensity statin strategy).
Dr. Ditah Chobufo[/caption]
Dr. Muchi Ditah Chobufo MD MPH
Cardiology Fellow
West Virginia University
MedicalResearch.com: What is the background for this study?
Response: Ischemic heart diseases are a significant cause of morbidity and mortality in the USA. Also, there exists alarming ethnic disparities in mortality rates following acute myocardial infarction. To this effect, significant efforts have been deployed over the years to curb its burden and reduce extant disparities. It is in this light that we set out to analyze general and ethnic specific trends in acute myocardial infarction related age adjusted mortality rates (AAMR) in the entire USA from 1999-2020.
MedicalResearch.com Interview with: [caption id="attachment_60090" align="alignleft" width="200"] Dr. Leyba[/caption] Katarina Leyba, MBA, MD University of Colorado School of Medicine MedicalResearch.com: What is the background...
Dr. Wadhera[/caption]
Rishi K. Wadhera, MD, MPP, MPhil
Section Head, Health Policy and Equity,
Richard A. and Susan F. Smith Center for Outcomes Research
Associate Program Director
Cardiovascular Medicine Fellowship at Beth Israel Deaconess Medical Center
Assistant Professor of Medicine,
Harvard Medical School
@rkwadhera
MedicalResearch.com: What is the background for this study?
Response: High and rising prescription drug costs in the United States contribute to medication non-adherence and financial strain among adults with cardiovascular risk factors or disease. As a result, addressing prescription drug costs in patients with chronic conditions has become a national priority.
In response to these growing concerns, federal policymakers passed the Inflation Reduction Act on August 16, 2022, which aims to address high out-of-pocket drug costs for adults enrolled in Medicare Part D, by placing a $2000 annual cap on out-of-pocket prescription drug costs and expanding eligibility for full low-income subsidies to individuals that reduce deductible costs and prescription copayments (among several other provisions). It is unclear how these provisions will affect Medicare beneficiaries with cardiovascular risk factors and/or conditions.
Dr. Hayek[/caption]
Salim S. Hayek MD
Assistant Professor
Medical Director of the Frankel Cardiovascular Center Clinics
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Essentially, immune checkpoint myocarditis is a rare but deadly complication of immune checkpoint inhibitors – amazing drugs that are increasingly used for the treatment of various cancers. Most patients present late, and when they do, they’re very ill and have a 50% chance of death.
Diagnosing ICI myocarditis is challenging, given there is no one test that can differentiate it from other causes of cardiac injury. It is important to diagnose it fast, early and accurately in order to start immunosuppressive therapy as soon as possible.
What we did in this study was look at commonly measured biomarkers in all patients receiving ICI at the University of Michigan.
What we found was that patients who developed ICI myocarditis had early signs of muscle destruction (rise in CPK) levels and hepatitis (rise in AST, ALT), and that all patients who had myocarditis with bad outcomes had rises in all of the aforementioned biomarkers. Creatinine phosphokinase was the most sensitive.
Dr. Simin Liu[/caption]
Simin Liu MD MPH ScD
Professor of Epidemiology at the School of Public Health,
Professor of Medicine (Endocrinology) and
Professor of Surgery at the Alpert School of Medicine
Brown University
MedicalResearch.com: What is the background for this study?
Response: Our research team has been researching the roles of environmental and genetic determinants of chronic diseases for nearly three decades, with special emphasis on evaluating micronutrients, minerals, and trace elements in relation to cardiometabolic outcomes, and findings of which have contributed to the design of several large, randomized trials of dietary supplements in the US (Liu JAMA 1999; 2011; Diabetes Care 2005a,b; Diabetes 2006). Several large intervention trials have consistently shown beneficial effects on clinical cardiometabolic outcomes of a diet pattern rich in micronutrients, although research on micronutrient supplementation has mainly focused on the health effects of a single or a few vitamins and minerals.
We decided to take a comprehensive and systematic approach to evaluate all the publicly available/accessible studies reporting all micronutrients including phytochemicals and antioxidant supplements and their effects on cardiovascular risk factors as well as multiple CVDs.
Dr. Curhan[/caption]
Sharon G. Curhan, MD, ScM|
Director, CHEARS: The Conservation of Hearing Study
Channing Division of Network Medicine
Department of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02114
MedicalResearch.com: What is the background for this study?
Response: Herpes zoster, commonly known as “shingles,” is a viral infection that often causes a painful rash. Shingles can occur anywhere on the head or body. Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person has chickenpox, the virus stays in their body for the rest of their life. Years and even decades later, the virus may reactivate as shingles. Almost all individuals age 50 years and older in the US have been infected with the varicella zoster virus and therefore they are at risk for shingles.
About 1 in 3 people will develop shingles during their lifetime, and since age is a risk factor for shingles, this number may increase as the population ages. The risk is also higher among individuals of any age who are immunocompromised due to disease or treatment. A number of serious complications can occur when a person develops shingles, such as post-herpetic neuralgia (long-lasting pain), but there was limited information on whether there are other adverse long-term health implications of developing shingles.
There is a growing body of evidence that links VZV, the virus that causes shingles, to vascular disease. VZV vasculopathy may cause damage to blood vessels and increase the risk of stroke or coronary heart disease. Although some previous studies showed a higher risk of stroke or heart attack around the time of the shingles infection, it was not known whether this higher risk persisted in the long term. Therefore, the question we aimed to address in this study was to investigate whether shingles is associated with higher long-term risk of stroke or coronary heart disease.
To address this question, we conducted a prospective longitudinal study in 3 large US cohorts of >200,000 women and men, the Nurses’ Health Study (>79,000 women), the Nurses’ Health Study II (almost 94,000 women) and the Health Professionals Follow-Up Study (>31,000 men), without a prior history of stroke or coronary heart disease. We collected information on shingles, stroke and coronary heart disease on biennial questionnaires and confirmed the diagnoses with medical record review. We followed the participants for up to 16 years and evaluated whether those who had developed shingles were at higher risk for stroke or coronary heart disease years after the shingles episode. The outcomes we measured were incident stroke, incident coronary heart disease [defined as having a non-fatal or fatal myocardial infarction (heart attack) or a coronary revascularization procedure (CABG, coronary artery bypass graft or percutaneous transluminal coronary angioplasty)]. We also evaluated a combined outcome of cardiovascular disease, which included either stroke or coronary heart disease, whichever came first.
Dr. Donahue[/caption]
Katrina E. Donahue, M.D., M.P.H.
Professor and Vice Chair of Research
Chapel Hill Department of Family Medicine
University of North Carolina
Dr. Donahue joined the U.S. Preventive Services Task Force in January 2020.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Heart disease and stroke are the leading causes of death in the U.S. The Task Force found that people who are 40 to 75 years old and at high risk for heart disease should take a statin to help protect their health.
People in this age group who are at increased risk but not high risk should make an individual decision with their healthcare professional about whether taking a statin is right for them. There is not enough research to determine whether statins are beneficial for people 76 years and older.
Dr. Morgan[/caption]
Dr Holly Morgan M.B., B.Ch.
Clinical Research Fellow and REVIVED investigator
King's College London
MedicalResearch.com: What is the background for this study?
Response: Coronary artery disease is the commonest cause of heart failure. Whilst individually tailored pharmacological and device therapy (optimal medical therapy, OMT) is the cornerstone of management of ischemic heart failure, rates of death and hospitalization for heart failure remain unacceptably high in this population. Given the causative relationship between coronary disease and heart failure, coronary revascularization has long been considered as a treatment option for these patients. Whilst there is randomized evidence to support surgical revascularization with coronary artery bypass grafting (1), none previously existed for percutaneous coronary intervention (PCI) in stable ischemic left ventricular dysfunction. Despite this, patients are frequently offered PCI in this setting (particularly if unsuitable for surgery); driven by the belief that hibernating myocardium will improve in function if blood flow is restored, regardless of the revascularization method. This approach was supported in some international guidelines, though recommendations varied.
The REVIVED-BCIS2 trial aimed to establish whether revascularization with PCI in addition to OMT would improve event free survival in patients with ischemic left ventricular dysfunction, when compared to OMT alone (2). Inclusion criteria included a left ventricular ejection fraction of ≤35%, extensive coronary artery disease (British Cardiovascular Intervention Society jeopardy score ≥6, indicating significant stenoses in the left main coronary artery, proximal left anterior descending coronary artery, dominant circumflex artery, disease in multiple vessels or a combination of these) and viability in at least four dysfunctional myocardial segments which were amenable to PCI. The main exclusion criteria were acute myocardial infarction within 4 weeks of randomisation, angina which limited the patient’s quality of life or decompensated heart failure or sustained ventricular arrhythmia within 72 hours.
The primary composite outcome was all-cause death or hospitalization for heart failure; minimum follow up was 24 months. Key secondary outcomes included the change in left ventricular ejection fraction from baseline to follow-up at six and twelve months, myocardial infarction, unplanned revascularization and quality of life assessed with the Kansas City Cardiomyopathy Questionnaire and EQ-5D-5L.
MedicalResearch.com Interview with: Jean Shin Department of Family Medicine Korea University College of Medicine Seoul,Republic of Korea
MedicalResearch.com: What is the background for this study?
Response: Younger age at menopause is a possible risk factor for cardiovascular diseases. However, data on the association among premature menopause, age at menopause, and the risk of heart failure and atrial fibrillation are lacking. We aimed to examine the association of premature menopause and age at menopause with the risk of heart failure and atrial fibrillation.
Left: Mario Gaudino, MD PhD; Right: Antonino Di Franco, MD[/caption]
Mario F.L. Gaudino, M.D. PhD
Attending Cardiac SurgeonDepartment of Cardiothoracic Surgery
Antonino Di Franco, MD
Adjunct Clinical Assistant Professor of Cardiothoracic Surgery
Weill Cornell Medicine
MedicalResearch.com: What is the background for this study? What is the aim of this review?
Response: Biological and socio-cultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the two sexes. Despite the growing recognition of sex-specific determinants of outcomes, representation of women in clinical studies remains low, and sex-specific management strategies are generally not provided in guidelines.
We summarized the current evidence on sex-related differences in patients with CAD, focusing on the differential outcomes following medical therapy, percutaneous coronary interventions, and coronary artery bypass surgery.
Dr. Sesso[/caption]
Howard D. Sesso, ScD, MPH
Associate Professor of Medicine
Division of Preventive Medicine
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study? How does the amount of flavanols in the study arm compare to what might be obtained in a typical diet?
Response: The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled clinical trial that tested the effects of two promising dietary supplements on cardiovascular disease (CVD) and cancer in 21,442 older adults. Cocoa flavanols have been shown to have favorable vascular effects in small and short-term clinical trials. The 500 mg/day flavanols tested in COSMOS exceeds that readily obtained in the diet typically from cocoa, tea, grapes, and berries. Of note, flavanol content in not typically listed on food labels.
COSMOS also tested a multivitamin, the most common dietary supplement taken by US adults and previously linked with a potential modest reduction in cancer in a previous long-term trial of men conducted by our research group at the Division of Preventive Medicine at Brigham and Women’s Hospital.
Dr. PJ.Devereaux[/caption]
PJ Devereaux MD PhD
Professor of Medicine, and
of Health Research Methods, Evidence and Impact
McMaster University
President of the Society of Perioperative Research and Care
MedicalResearch.com: What is the background for this study?
Response: More than 1 million patients undergo cardiac surgery in the United States and Europe annually. Although cardiac surgery has the potential to improve and prolong a patient’s quality and duration of life, it is associated with complications. Prognostically important heart injury – detected by an elevated blood concentration of either cardiac troponin or creatine kinase myocardial MB isoform (CK-MB) – is one of the most common complications after cardiac surgery and is associated with increased mortality.
Although elevated CK-MB was historically used to define heart injury after cardiac surgery, this assay is no longer available in many hospitals worldwide, and consensus statements have recommended high-sensitivity cardiac troponin assays as the preferred biomarker. Based on expert opinion, the Fourth Universal Definition of Myocardial Infarction suggested that a cardiac troponin concentration >10 times the upper reference limit, in patients with a normal baseline measurement, should be the threshold used in the diagnosis of heart attack along with evidence of ischemia (e.g., ischemic ST changes on an ECG) in the first 48 hours after coronary artery bypass grafting (CABG). Although the Academic Research Consortium-2 Consensus stated there was no evidence-based threshold for cardiac troponin after CABG, they endorsed a threshold for the diagnosis of heart attack of ≥35 times the upper reference limit together with new evidence of ischemia, based on expert opinion. They also defined a threshold of ≥70 times the upper reference limit as a stand-alone criterion for clinically important periprocedural myocardial injury.
Globally, many hospitals now use high-sensitivity cardiac troponin assays; however, limited data are available to define a prognostically important degree of myocardial injury after cardiac surgery based on these assays. We undertook the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Study to examine clinical outcomes after cardiac surgery.
A primary objective was to determine the relationship between postoperative levels of high-sensitivity cardiac troponin I and the risk of death 30 days after cardiac surgery. 
Dr. Ogedegbe[/caption]
Gbenga Ogedegbe, MD, MPH
Dr. Adolph & Margaret Berger Professor of Population Health
Director, Division of Health & Behavior
Director Center for Healthful Behavior Change
Department of Population Health
NYU Langone Health
NYU School of Medicine
Member of the U.S. Preventive Services Task Force
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Atrial Fibrillation (AFib) is the most common type of irregular heartbeat and a major risk factor for stroke, and it often goes undetected. For this recommendation, the Task Force evaluated whether screening adults over the age of 50 who do not have any signs or symptoms of AFib can help prevent strokes.
In its evidence review, Task Force expanded its scope to include a search for studies on portable and wearable devices such as smartphones and fitness trackers in addition to electrocardiography (ECG). Despite this consideration, the Task Force found insufficient evidence to recommend for or against screening for AFib. This is consistent with the Task Force’s 2018 recommendation.