MedicalResearch.com Interview with:
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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:
-
- 5-times higher risk of hospitalization for heart failure
- 4-times higher risk of CV mortality
- 3-times higher risk of myocardial infarction
Interestingly, once thought of as a traditional renal biomarker, urine albumin-to-creatinine ratio (UACR)
>30 is also a critical biomarker and urgent signal of cardiovascular (CV) risk.
When checking UACR, we look at two things: the amount of albumin leaking into the urine and the creatinine level. Albumin shouldn’t be getting through the kidneys’ filters at all, so when we see a UACR
>30 mg/g, it’s a sign of systemic vascular endothelial dysfunction. So, if albumin is leaking through the blood vessels inside the kidneys, there’s also damage in the vessels across other organs, like the heart.
UACR is such an important early indicator of CV risk in T2D because even small increases follow a clear ‘rule of three’s’. Healthy kidneys secrete 3 mg/g of albumin to creatinine per day, but when it rises to 30 mg/g, a tenfold increase that signals vascular dysfunction and increasing CV risk. At 300 mg/g, another tenfold increase, the damage is more advanced, and CV risk accelerates.
Patients with eGFR >
60 BUT UACR >30 mg/g can have up to 3.6 times increased risk of CV mortality.
As a nephrologist, I’ve been vocal about the potential for this common urine test that we regularly perform, a UACR test, in helping detect CV risk, not just kidney damage, in more patients.
Dr. Kruger[/caption]
MedicalResearch.com: What is the background for this study?
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Dr. Felicione[/caption]
Response: Alcohol consumption, especially heavy alcohol consumption, is associated with many health risks and nearly 200 different health conditions and diseases. Reducing alcohol consumption reduces the risks and harms from alcohol. Previous research has demonstrated that people have reduced their alcohol consumption when they have access to cannabis. Cannabis beverages have emerged in States where cannabis is legal for adult or medical use.
Dr. Thorne[/caption]
Sally Thorne RN, PhD, FAAN, FCAHS, FCAN, CM
Professor Emeritus, School of Nursing
Co-Principal Investigator with :
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Dr. Pesut[/caption]
Dr. Barbara Pesut PhD, RN
Professor in the School of Nursing
Principal Research Chair in Palliative and End of Life Care
University of British Columbia
MedicalResearch.com: What is the background for this study?
Response: Medical assistance in dying (MAiD) was legalized in Canada in June of 2016 for Canadians who were facing a reasonably foreseeable natural death and met an explicit set of eligibility criteria as determined by qualified health care providers (physicians or nurse practitioners). In 2021, the legislation was extended to include the possibility of MAiD for persons who were suffering from a ‘grievous and irremediable’ medical condition but for whom natural death was not immediately foreseeable. As assisted dying represented a significant change in available options for Canadians with terminal or chronic conditions, requiring significant practice adaptations and including numerous legal, social, ethical, moral implications, the health research community has been working in consultation with clinicians, service providers and governments to generate knowledge that ensures safe, ethical and equitable practice in this regard. 
Dr. Chunmiao Zheng[/caption]
Chunmiao Zheng, PhD
AGU Fellow, Chair Professor
Hydrologic Science
Eastern Institute of Technology
Ningbo, China
MedicalResearch.com: What is the background for this study?
Response: Per- and polyfluoroalkyl substances (PFAS) are a class of artificially synthesized chemicals widely used in industrial production and consumer goods manufacturing. These substances are persistent in the environment, can accumulate through the food chain, and enter the human body and build up over time, posing a potential threat to health. As an important component of the global diet, marine fish may serve as a major source of PFAS intake for humans. However, the contribution of marine fish as a source of PFAS exposure and the associated health risks still lack systematic assessment on a global scale.
Samson Nivins PhD
Postdoctoral Researcher, specializing in Perinatal and Pediatric Neurology
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Dr. Stone[/caption]
Co-author Meredith Stone, PhD
Assistant Director for Cell Therapy Translation
in Dr. Davila’s lab at Roswell Park - presenting author
MedicalResearch.com: What is the background for this study?
Response: While CD19-targeted CAR T cell therapy has garnered clinical success and FDA approval for the treatment of large B cell lymphoma, approximately half of patients suffer from primary resistance or relapse. Increasing evidence suggests that resistance mechanisms are supported by the tumor microenvironment (TME). Cytokines secreted by CAR T cells can remodel the TME, determining the phenotype and function of other immune cells.
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. 
