Author Interviews, Heart Disease, JACC, Surgical Research / 22.05.2023

MedicalResearch.com Interview with: Aloke V. Finn MD Medical Director/Chief Scientific Officer CVPath Institute Inc. Gaithersburg, MD 20878   MedicalResearch.com: What is the background for this study? Response:Transcatheter left atrial appendageal closure (LAAC) has become an established therapeutic approach for prevention of stroke in subjects with non-valvular atrial fibrillation who are ineligible for long-term oral anticoagulation.  Device-related thrombus (DRT), developing after LAAO procedures occurs in a small proportion but patients receiving these devices but is associated with critical embolic events such as ischemic stroke. Thrombogenicity and delayed endothelialization of fabric play a role in the development of DRT.  Fluorinated polymers are known to have thromboresistant properties which may favorably modify blood biomaterial interactions of a LAAO device. In this study we compared the thrombogenicity and endothelial coverage (EC) after left atrial appendage occlusion (LAAO) between a novel fluoropolymer-coated Watchman (FP-WM (Watchman FLX PRO) and the conventional uncoated Watchman FLX (WM). (more…)
Author Interviews, Cost of Health Care, Heart Disease, JACC / 26.02.2023

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Cleveland Clinic, Diabetes, JACC, Surgical Research, Weight Research / 14.04.2022

MedicalResearch.com Interview with: Amgad Mentias, MD MS FACC FESC Assistant Professor, CCLCM Section of Clinical Cardiology, Heart and Vascular Institute. Cleveland, OH 44195Amgad Mentias, MD MS FACC FESC Assistant Professor, CCLCM Section of Clinical Cardiology, Heart and Vascular Institute. Cleveland, OH 44195  MedicalResearch.com:  What is the background for this study?    Response:  There is evidence that bariatric or weight loss surgery can decrease the risk of heart attack, stroke, and death in young and middle age patients with obesity and diabetes. However, the evidence is less clear for older patients and patients without diabetes. There is also no long-term data on outcomes of bariatric surgery in the Medicare beneficiaries. So, in our study, we aimed to report long-term outcomes of bariatric surgery from a contemporary nationwide cohort from the US, while also looking into outcomes in patients older than 65 years, and patients without type 2 diabetes specifically. (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, Blood Pressure - Hypertension, Cognitive Issues / 05.04.2022

MedicalResearch.com Interview with: Dr. Yangfeng Wu Peking University Clinical Research Institute Peking University MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: It is well-established that elevated blood pressure (BP) at single time point can contribute to increased risks of suffering accelerated cognitive decline, dementia, and mortality. Nevertheless, BP levels could experience significant alterations as time goes, indicating the necessity of monitoring BP longitudinally. In other words, using blood pressure levels measured at baseline to predict future outcomes in a longitudinal cohort with a long-term follow-up period ≥20 years, becomes controversial. Cumulative BP levels have been indicated as a feasible approach for evaluating long-term exposure of BP levels, which might have the ability to respond to this controversy. This is the main reason why we performed this research to evaluate the predictive values of cumulative BP levels, especially additional values beyond baseline blood pressure levels, for future neurocognitive and longevity outcomes. (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, Cost of Health Care, CT Scanning, Heart Disease, JACC, Statins / 14.01.2021

MedicalResearch.com Interview with: Prasanna Venkataraman MBBS Thomas H. Marwick MBBS, PhD Baker Heart and Diabetes Research Institute Monash University, Melbourne Melbourne, Australia   MedicalResearch.com: What is the background for this study?
  • Coronary artery calcium score (CAC) quantifies coronary calcium as determined by computed tomography and is a good surrogate marker for overall coronary plaque burden. It can help to reclassify patients at intermediate risk – many of whom are actually at low risk and can be reassured. Conversely, the finding of coronary calcium can also motivate patients (and their clinicians) to more aggressively control their cardiovascular risk factors. This is particularly problematic in those with a family history of premature coronary artery disease, where standard risk prediction tools are less accurate. However, CT CAC does not routinely attract third party payer support limiting its access and utilisation.
  • We screened 1084 participants who have a family history of premature coronary disease and a 10-year Pooled cohort Equation (PCE) cardiovascular risk >2% with CAC. We then assessed the cost-effectiveness of commencing statins in those with any coronary calcium compared to a strategy of no CAC testing and commencing statins if their PCE risk was ≥7.5% consistent with current guidelines. 
(more…)
Author Interviews, Heart Disease, JACC / 17.11.2020

MedicalResearch.com Interview with: Simon Winther, MD, PhD Associate professor Department of Cardiology, Gødstrup Hospital Herning, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Both European and American guidelines have traditionally recommended estimating the pre-test probability (PTP) of CAD based on the classic Diamond-Forrester approach using sex, age, and type of chest complaints. However, The European Society of Cardiology (ESC) has recently suggested a novel concept of Clinical Likelihood of CAD as a more comprehensive assessment of CAD probability but no strategy has been proposed. I this study, we improve the estimation of the likelihood of obstructive coronary artery disease (CAD) by combining the classic pre-test probability model (Diamond–Forrester approach using sex, age, and symptoms) with clinical risk factors and coronary artery calcium score in symptomatic patients with suspected CAD. Hence, we propose a simple clinical tool for the individual estimation of clinical likelihood of CAD. The tool was developed by stepwise simplification of advanced machine learning models without significant loss of accuracy and the model were validated the both European and North American cohorts.  (more…)
Author Interviews, Heart Disease, JACC, Omega-3 Fatty Acids / 27.10.2020

MedicalResearch.com Interview with: Antoni Bayes-Genis, MD, PhD, FESC, FHFA Head, Heart Institute. Hospital Universitari Germans Trias i Pujol Full Professor, Autonomous University Barcelona MedicalResearch.com: What is the background for this study? What are the main findings? Response: Omega-3 fatty acids are incorporated into the phospholipids of cellular membranes, including cardiac contractile cells, and have a wide range of demonstrated physiological effects. Several potential mechanisms have been investigated, including antiarrhythmic, anti-inflammatory, and endothelial. Omega-3 fatty acids lower heart rate and improve heart rate variability, both associated with lower sudden cardiac death risk, one of the complications that may occur after a myocardial infarction. Increased omega-3 fatty acids also enhance arterial elasticity by increasing endothelium-derived vasodilators, which is associated with blood pressure–lowering effects. They also have a cardioprotective effect on platelet-monocyte aggregation, and lower triglyceride levels. (more…)
Author Interviews, Brigham & Women's - Harvard, Cognitive Issues, Heart Disease, JACC, Lipids / 23.05.2020

MedicalResearch.com Interview with: Robert P. Giugliano, MD, SM Senior Investigator, TIMI Study Group Cardiovascular Medicine Brigham and Women's Hospital Professor of Medicine Harvard Medical School Boston, MA  MedicalResearch.com: What is the background for this study? Response: Some prior studies had suggested that lipid lowering therapies were associated with impaired cognition.  We sought to explore this question in a prospectively designed substudy of the large FOURIER randomized, double-blind clinical trial utilizing patient self-surveys administered the end of the study to determine whether patients themselves noticed any changes in cognition over the duration of the trial. The survey tool was a shortened version of the Everyday Cognition Questionnaire (see attached) that asks patients 23 questions that assess memory and executive function (including subdomains of planning, organization, and divided attention). The questions are in the format of "Compared to the beginning of the study, has there been any change in .....", and are graded as 1=better/no change, 2=questionable/occasionally worse, 3=consistently a little worse, 4=consistently much worse. (more…)
Author Interviews, Cannabis, Columbia, Heart Disease, JACC / 21.01.2020

MedicalResearch.com Interview with: Ersilia DeFilippis, MD Second-year cardiology fellow Columbia University Irving Medical Center and NewYork-Presbyterian MedicalResearch.com: What is the background for this study? Response: Marijuana use has been increasing significantly and is the most commonly illicit drug used in the United States. In recent years, more states have been legalizing its use for both recreational and medicinal purposes. We have all seen news reports regarding the rise of vaping-related health hazards. Yet, data are limited regarding the cardiovascular effects of marijuana which is what drove us to explore this topic. (more…)
Author Interviews, Biomarkers, Geriatrics, Heart Disease, JACC / 02.07.2019

MedicalResearch.com Interview with: Martin Bødtker Mortensen, læge PhD Afdelingen for Hjertesygdomme Aarhus Universitetshospital Danmark  MedicalResearch.com: What is the background for this study?   Response: The background for the study is a combination of two things: First, the proportion and number of elderly people 65 years of age or older are increasing fast worldwide. Second, given the dominant impact of age on estimated risk for cardiovascular disease, nearly all elderly individuals eventually become statin eligible under current guidelines – just because of aging alone. Thus, to limit overtreatment of elderly individuals, we wanted to find “negative” risk markers that can be used to identify elderly individuals at truly low cardiovascular risk who are less likely to benefit from statin therapy despite advancing age. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 16.06.2019

MedicalResearch.com Interview with: Fausto Biancari, MD, PhD Professor University of Turku and University Oulu, Finland MedicalResearch.com: What is the background for this study? Response: Current data is scarce regarding the short- and midterm benefit of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic valve stenosis. MedicalResearch.com: What are the main findings? Response: In this observational study on 2841 low-risk patients with aortic valve stenosis from the Finnish nationwide FinnValve registry, propensity score matching analysis showed similar 30-day and three-year survival after TAVR and SAVR. (more…)
Author Interviews, Heart Disease, JACC / 12.06.2019

MedicalResearch.com Interview with:

J.L. Mehta, MD, PhD

Distinguished Professor of Medicine and Physiology and Biophysics

Stebbins Chair in Cardiology

University of Arkansas for Medical Sciences

Central Arkansas Veterans Healthcare System

Little Rock, AR 72205

MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Aspirin is commonly used for primary prevention of cardiovascular disease events in a variety of subjects around the world. Recent studies, however, show that routine use of aspirin without assessment of risk for cardiovascular disease events may not be appropriate, and may even be harmful.  (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC / 11.06.2019

MedicalResearch.com Interview with: Prof. Dr. med. Dirk Sibbing, MHBA, FESC Oberarzt, Medizinische Klinik und Poliklinik I Ludwig-Maximilians-Universität (LMU) München Chairperson ESC Working Group on Thrombosis München, Germany  MedicalResearch.com: What is the background for this consensus statement? What are the main findings that led to these conclusions? Response: The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment concepts. Such concepts may include escalation or de-escalation of P2Y12 inhibiting therapy. Alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early vs. chronic treatment) and patient risk for ischemic and bleeding complications. As always in clinical medicine, guidance by means of biomarkers or risk scores is always helpful and warranted. Here specifically, a tailored DAPT approach may be potentially guided by platelet function (PFT) or genetic testing. (more…)
Author Interviews, Heart Disease, JACC / 10.04.2019

MedicalResearch.com Interview with: Susana Ravassa PhD Program of Cardiovascular Diseases, CIMA University of Navarra, and IdiSNA Navarra Institute for Health Research Pamplona, Spain  MedicalResearch.com: What is the background for this study? Response: Atrial fibrillation (AF) is an evolving epidemic responsible for substantial morbidity, mortality and health-care expenditure. In particular, when AF and heart failure (HF) occur in combination, clinical evolution is particularly poor. Left atrial (LA) myocardial interstitial fibrosis (MIF) is the main structural lesion in AF and considered as the main factor responsible for the perpetuation of this pathology. In addition, it is known that MIF is associated with a lower effectiveness of the treatment of AF by pulmonary vein isolation with catheter ablation. Therefore, the identification of biomarkers related to MIF, as an affordable and minimally invasive approach, is of great interest to detect patients at risk of AF, as well as to monitor their response to the LA ablation therapy. We had previously demonstrated that the deleterious impact of MIF in the heart is due to alterations in both the quality (i.e., extent of cross-linking among collagen fibrils and type of collagen fibers that determine their rigidity and resistance to degradation [collagen cross-linking or CCL]) and the quantity (i.e., extent of collagen fibers that occupy the myocardial tissue [collagen deposition or CD]) of fibrotic tissue. We have shown that certain circulating biomarkers related to collagen type I metabolism are associated with CCL and CD. On the one hand, the serum carboxy-terminal propeptide of procollagen type I (PICP), released during the conversion of procollagen type I into fibril-forming mature collagen type I, is directly correlated with myocardial CD. On the other hand, the ratio of serum carboxy-terminal telopeptide of collagen type I to serum matrix metalloproteinase-1 (serum CITP:MMP-1 ratio) is inversely correlated with myocardial CCL, as the higher is the cross-linking among collagen type I fibrils the lower will be the cleavage of CITP by MMP-1 during the process of degradation of the fiber. Interestingly, we have previously reported that the combination of these biomarkers identifies patients with heart failure presenting with a complex pattern of MIF characterized by both increased CCL and CD (CCL+CD+) showing a higher risk of adverse clinical evolution as compared with heart failure  patients without this combination of biomarkers. As both increased CCL and CD have been found in the left atrial myocardium in patients with AF, we designed this investigation to explore whether the CCL+CD+ combination of biomarkers is associated with AF. (more…)
Author Interviews, Heart Disease, JACC, Technology / 20.03.2019

MedicalResearch.com Interview with: Annapoorna Kini, MD Zena and Michael A Wiener Professor of Medicine Director of the Cardiac Catheterization Laboratory Mount Sinai Heart at Mount Sinai Hospital MedicalResearch.com: What is the background for this study?  
  • Expanding indication and use of Transcatheter aortic valve replacement (TAVR) poses a unique problem of coronary access after valve implantation.
  • Troubleshooting tools and techniques have been published but are not available at the fingertips of the user at all the times.
  • We tried to address this unique problem with an innovative educational mobile application (app) called "TAVRcathAID".
(more…)
Author Interviews, Heart Disease, Infections, Opiods / 18.03.2019

MedicalResearch.com Interview with: Serena Day, MD Ohio State University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The idea for this research came from my own observations of patients that I was caring for in the hospital first as an Internal Medicine Resident and now as a senior Cardiology Fellow. I did my residency here at Ohio State and noticed a marked increase in the number of patients with endocarditis that we were caring for just in my short time here as a trainee. Over 5 years, we saw an increase of 436% in intravenous drug use related endocarditis. How this disease is treated as changed as well. It used to be that if a patient was a good surgical candidate, we would offer a replacement valve. Now, we see that these patient's have such a high rate of recurrent intravenous drug use and reinfection of their heart valves that we now treat with antibiotics only rather than surgery. In many cases, the infection never goes away because we can't offer definitive therapy with surgery due to their high relapse and reinfection rates of nearly 50%. (more…)
Author Interviews, Heart Disease, JACC, Sleep Disorders / 14.01.2019

MedicalResearch.com Interview with: José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics JM-USDA-HNRCA at Tufts University Boston, MA 02111 MedicalResearch.com: What is the background for this study? Response: The current knowledge supports the notion that poor sleep is associated with cardiovascular risk factors such as obesity, hypertension, and diabetes. Besides, there is some proof that poor sleep might be related to the development of atherosclerosis; however, this evidence has been provided by studies including few participants and, in general, with sleep disorders, such as sleep apnea. Our research has used state-of-the-art imaging technology to measure plaque buildup in the arteries, and objective measures of sleep quantity and quality in about 4000 participants of the PESA CNIC- Santander Study. Moreover, this is the first study to look at the multiterritory development of plaques versus other studies that looked exclusively at the coronary arteries. Therefore, this combination provides stronger evidence than previous studies about the risk of poor sleep on the development of atherosclerosis. (more…)
Author Interviews, JACC, Karolinski Institute, OBGYNE, Pediatrics, Weight Research / 12.01.2019

MedicalResearch.com Interview with: Martina Persson, M.D, PhD Karolinska Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that maternal obesity increases risks of adverse fetal outcomes, including congenital malformations of the heart. However, it is unclear if maternal overweight and obesity associate with risks of specific and more complex congenital heart defects. We conducted a population-based cohort study in Sweden using data from several health registries. The study included more than 2 million live, singletons born between 1992-2012. Risks (prevalence rate ratios) of complex heart defects (Tetralogy of Fallot, transposition of the great arteries (TGA), atrial septal defects (ASD), aortic arch defects, and single ventricle heart) and several specific heart defects were estimated in infants to mothers with overweight and increasing degree of obesity. We found that risks of aortic arch defects, ASD and patent ductus arteriosus (in term infants) increased with maternal obesity severity. On the other hand, we found no clear associations between maternal BMI and risks of several other complex and specific heart defects.  (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC, Surgical Research / 22.11.2018

MedicalResearch.com Interview with: Peter Hu MD Cleveland ClinicPeter T. Hu MD Department of Cardiology Cleveland Clinic MedicalResearch.com: What is the background for this study? What are the main findings? Response: Among patients with blockages in multiple coronary vessels, we studied predictors and outcomes of having a staged versus one-time multivessel percutaneous coronary intervention. By "staged" we mean performing coronary intervention only on one vessel, letting the patient recover, and fixing the other blockages at a later date. We know that multivessel coronary artery disease is very common - present in up to 2/3 of patients who require coronary interventions. Previous studies in patients with STEMI (ST-elevation myocardial infarction) suggested that staged multivessel PCI was associated with lower risk of death compared with one-time multivessel revascularization. Outside of STEMI patients, very little data exist in a broader group of patients who undergo coronary interventions to multiple vessels. In our study, we found an association between doing a staged PCI and lower long-term mortality benefit compared with fixing multiple blockages at once. What was surprising was there seemed to be a correlation with the degree of benefit from staged PCI based on the symptoms and signs the patient presented with. The association with improved outcomes was strongest in patients with STEMI, followed by those with NSTEMI, unstable angina, and stable angina, respectively. We also found that the decision to perform staged PCI was driven by patient and procedural characteristics, as well as other unmeasured site variation.  (more…)
Alcohol, Author Interviews, Heart Disease, JACC, UCLA / 02.01.2017

MedicalResearch.com Interview with: Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption. In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships. (more…)