Author Interviews, Heart Disease, JAMA, Primary Care, Stroke, USPSTF / 06.09.2022

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, NEJM / 30.08.2022

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Heart Disease, Menopause / 05.08.2022

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.  (more…)

Author Interviews, Heart Disease, Salt-Sodium / 20.07.2022

MedicalResearch.com Interview with Weihao Liang on behalf of Professor Chen Liu Department of Cardiology, Sun Yat-sen University First Affiliated Hospital Guangzhou, Guangdong, China MedicalResearch.com:  What is the background for this study?    Response: -Salt intake restriction is frequently recommended in heart failure guidelines, but is restricting salt intake to "as least as possible" appropriate? Evidence is lacking. Besides, the effect of salt restriction on patients with heart failure with preserved ejection fraction isn’t clear as they have often been excluded from relevant studies. (more…)
Author Interviews, Gender Differences, Heart Disease, JACC, Surgical Research / 06.04.2022

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Chocolate, Heart Disease, Supplements / 16.03.2022

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Biomarkers, Heart Disease, NEJM / 03.03.2022

MedicalResearch.com Interview with: 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.  (more…)
Author Interviews, Heart Disease, JAMA, NYU, USPSTF / 02.02.2022

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Lipids / 16.11.2021

MedicalResearch.com Interview with: Nicholas A. Marston, MD, MPH Thrombolysis in Myocardial Infarction (TIMI) Study Group Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: There has been recent debate about how much of lipid-associated cardiovascular risk is from LDL cholesterol versus triglycerides. However, genetic studies suggest that apolipoprotein B is actually the primary driver of atherosclerotic risk. Since there is exactly one apoB lipoprotein on each lipid particle (LDL, IDL, VLDL), its measurement is a surrgate for the total number of apoB-containing lipoproteins. So in this study, we asked the question: Do common measures of cholesterol concentration, triglyceride concentration, or their ratio carry predictive value for cardiovascular risk beyond the number of apo-B containing lipoproteins? (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA, Technology / 05.10.2021

MedicalResearch.com Interview with: Pinar Zorlutuna, PhD Sheehan Family Collegiate Professor of Engineering Aerospace and Mechanical Engineering Chemical and Biomolecular Engineering (Concurrent) Bioengineering Graduate Program University of Notre Dame  MedicalResearch.com: What is the background for this study? Response: Acute myocardial infarction (AMI) is the primary cause of death among cardiovascular diseases. The current clinical standard of diagnosis combines echocardiogram (ECG) and several circulating protein biomarkers from plasma. In their current state, both are incapable of distinguishing between patients with and without complete coronary occlusion, unless additional invasive testing is implemented, and both have significant false positive rates. MicroRNAs (miRNAs) have shown great potential as rapid and discriminating biomarkers for acute myocardial infarction (AMI) diagnosis. (more…)
AHA Journals, Author Interviews, Obstructive Sleep Apnea, UCSF / 21.06.2021

MedicalResearch.com Interview with: Yerem Yeghiazarians, MD Professor of Medicine Leone-Perkins Family Endowed Chair in Cardiology San Francisco Board Past-President, American Heart Association Co-Director, Adult Cardiac Catheterization Laboratory Director, Peripheral Interventional Cardiology Program Director, Translational Cardiac Stem Cell Program Cardiovascular Research Institute Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research Associate Member in Experimental Therapeutics, UCSF Helen Diller Cancer Center University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: Obstructive sleep apnea is very common, undiagnosed and undertreated. The AHA Scientific Statement was prepared to increase awareness amongst physicians and patients about this condition and to encourage more screening and therapy as appropriate. Obesity is certainly one of the significant risk factors for sleep apnea and we highlight this in the Scientific Statement: “The risk of OSA correlates with body mass index, and obesity remains the one major modifiable risk factor for OSA. In a population-based cohort study of 690 subjects, a 10% weight gain was associated with nearly 32% increase in the apnea-hypopnea index (AHI), and even modest weight control was effective in reducing the new occurrence of sleep-disordered breathing. An even stronger correlation exists between OSA and increased waist circumference and neck size. Neck sizes predisposing to OSA are usually >17 and 16 in for men and women, respectively.” (more…)
Author Interviews, Dermatology, Heart Disease, JACC, NYU / 17.05.2021

MedicalResearch.com Interview with: Michael S. Garshick, MD Assistant Professor Department of Medicine Grossman School of Medicine NYU MedicalResearch.com: What is the background for this study? Response: Patients with psoriasis have a 50% higher risk of cardiovascular disease when compared to patients without psoriasis, the mechanisms of which are still under investigation Dyslipidemia is also highly prevalent in psoriasis including elevation in a variety of lipoproteins causal in atherosclerosis. Lipoprotein(a) is an LDL like particle which is associated with atherosclerosis, atherothrombosis, and the development of clinical cardiovascular disease. Traditionally lipoprotein(a) is felt to be inherited rather than acquired, but some evidence suggest that lipoprotein(a) is elevated in those with underlying inflammatory conditions and associated with systemic inflammation including circulating IL-6. We therefore aimed to determine if lipoprotein(a) is elevated in psoriasis and associated with underlying systemic inflammatory profiles and biomarkers of cardiovascular risk.  (more…)
Author Interviews, Heart Disease, Menopause, Osteoporosis / 12.05.2021

MedicalResearch.com Interview with: Yeonyee E. Yoon, MD, PhD Associate Professor Division of Cardiology, Cardiovascular Center Seoul National University Bundang Hospital South Korea  MedicalResearch.com: What is the background for this study? Response: Although atherosclerotic cardiovascular disease (ASCVD) has been traditionally considered to affect men predominantly, it is nearly common in women. ASCVD is the leading cause of death in both men and women globally, and the population-adjusted risk of ASCVD mortality in women is significantly greater than that in men. Nevertheless, the current focus on the 10-year ASCVD risk estimated by a risk-scoring algorithm such as the Pooled Cohort Equation has shown unsatisfactory accuracy in women. Therefore, new strategies beyond the conventional risk stratification algorithm are needed to improve identification for women at high risk for ASCVD. ASCVD and osteoporosis are major age-related diseases contributing to significant morbidity and mortality in women, and previous epidemiologic studies have suggested a potential association between these diseases. Given that millions of women are screened for osteoporosis using dual-energy X-ray absorptiometry (DXA), potential associations between low bone mineral density (BMD) and ASCVD in women would provide an opportunity to improve the risk stratification of women without any additional costs. Therefore, we aimed to investigate whether the evaluation of BMD provides independent and incremental prognostic values for ASCVD prediction in women.  (more…)
Author Interviews, COVID -19 Coronavirus, Heart Disease, JACC, Social Issues / 12.05.2021

MedicalResearch.com Interview with: Kobina Hagan MBBS, MPH Postdoctoral Fellow Center for Outcomes Research, Houston Methodist Research Institute MedicalResearch.com: What is the background for this study? Response: Before the COVID-19 vaccination roll-out, risk mitigation guidelines including respiratory hygiene, social distancing, and job flexibility, were the most effective preventive measures against coronavirus transmission. Social determinants of health scholarships had identified social circumstances to limit adherence to these mitigation guidelines. Individuals with underlying cardiovascular disease are identified as high-risk phenotypes for severe COVID-19 outcomes. In addition, research efforts during the early and middle waves of the pandemic had identified coronavirus exposure risk as a greater mediator of the observed COVID-19 disparities, compared to clinical susceptibility from comorbidities. Yet, population-based evidence on the practice of these mitigation guidelines in this high-risk group were lacking. Consequently, we believed there was a need to robustly characterize COVID-19 risk mitigation practices among adults with cardiovascular disease in the nation. The COVID-19 Household Impact Survey was a survey conducted by the National Opinion Research Center at the University of Chicago, to provide statistics about health, economic security, and social dynamics of the US adult household population nationwide and for 18 geographic areas (10 states, 8 metropolitan statistical areas) between April and June 2020. This survey complemented the Household Pulse Survey by the Census Bureau. In this study we described the COVID-19 risk mitigation practices among patients with CVD and evaluated the association between cumulative social determinants of health burden (a measure of social adversity) and adherence these measures.  (more…)
Author Interviews, Gender Differences, Heart Disease, NYU, Women's Heart Health / 11.05.2021

MedicalResearch.com Interview with: Darcy Banco, MD, MPH Internal Medicine Resident NYU Langone Health MedicalResearch.com: What is the background for this study? Response: We became interested in this question because of recent epidemiological data showing that despite improvements in the number of heart attacks in overall population, that number is rising among young adults (<= 55 years old) and in particular, young women. Compared to young men, young women with heart attack experience more delays in care and have higher mortality and poorer quality of life after heart attack. Despite these findings, there was also a study that asked young adults who had experienced heart attack: “When you first went for help, did the health care providers think that you were having a problem with your heart?” Women were more likely to answer no to this question. Therefore, our study asked: Are young women evaluated and treated differently than men when presenting to the emergency room with symptoms of chest pain? (more…)
Author Interviews, Gender Differences, Heart Disease, JAMA / 22.04.2021

MedicalResearch.com Interview with: First Author Michelle Lee, MD, PharmD Fellow-in-training, Health Services Research & Development Michael E. DeBakey VA Medical Center, Houston, TX   Senior & Corresponding Author Salim S. Virani, MD, PhD, FACC, FAHA, FASPC Professor, Section of Cardiovascular Research Director, Cardiology Fellowship Training Program Baylor College of Medicine Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center Co-Director, VA Advanced Fellowship in Health Services Research & Development Michael E. DeBakey VA Medical Center, Houston, TX Investigator, Health Policy, Quality and Informatics Program Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation Houston, TX MedicalResearch.com: What is the background for this study? Response: Atherosclerotic cardiovascular disease (ASCVD), defined as ischemic heart disease (IHD), ischemic cerebrovascular disease (ICVD), or peripheral arterial disease (PAD), is the leading cause of death globally. Particularly in young ASCVD patients, secondary prevention with antiplatelet therapy and statins are extremely important in reducing disease burden. (more…)
Author Interviews, Heart Disease, Red Meat / 15.04.2021

MedicalResearch.com Interview with: Dr Zahra Raisi-Estabragh, PhD fellow Cardiologist Trainee at Queen Mary University of London and Barts Health NHS Trust MedicalResearch.com: What is the background for this study? Response: Previous studies have linked greater consumption of red and processed meat to poorer clinical cardiovascular outcomes, for example, higher risk of having a heart attack or of dying from heart disease. However, the biological mechanisms underlying these relationships are not well understood. Furthermore, the impact of meat intake on more direct measures of heart health, such as, structure and function of the heart and blood vessels, has not been previously studied in large cohorts. Examining how meat intake may influence different aspects of cardiovascular health can help us better understand its health effects.  (more…)