Author Interviews, Heart Disease / 06.11.2023

MedicalResearch.com Interview with: Prakriti Gaba, MD Cardiovascular Medicine Fellow Brigham and Women's Hospital Deepak L. Bhatt MD MPH Director of Mount Sinai Fuster Heart Hospital Dr. Valentin Fuster Professor of Cardiovascular Medicine Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study?  Response: Accurate classification of acute myocardial infarction is instrumental for the appropriate diagnosis and effective management of patients suffering from this widely prevalent cardiovascular condition. In the past, there have been a variety of clinical scores published to advise clinicians on the best classifications schemes for patients with acute MI. These have included the Thrombolysis in Myocardial Infarction (TIMI) risk score, the HEART score, and the Killip classification. The strength of these traditional scores includes their practicality, as they can be implemented at the bedside to rapidly assist with prognostication. Nonetheless, as technologic advancements have made imaging and tissue identification more accessible, national and international committees are looking to revise traditional classification schemes of acute MI with novel ones leveraging multimodal approaches. (more…)
Author Interviews, Heart Disease, NEJM / 28.12.2019

MedicalResearch.com Interview with: Jean-Claude Tardif CM, MD, FRCPC, FCCS, FACC, FAHA, FESC, FCAHS Director, Montrel Heart Institute Research Center Professor of medicine Canada Research Chair in translational and personalized medicine University of Montreal endowed research chair in atherosclerosis Montreal Heart Institute MedicalResearch.com: What is the background for this study? Response: Inflammation appears to play an important role in atherosclerosis. Inhibition of interleukin-1ß by canakinumab reduced the rate of cardiovascular events by 15% CANTOS. In contrast, methotrexate did not affect cardiovascular outcomes or plasma markers of inflammation in CIRT. Colchicine is an inexpensive, orally administered, potent anti-inflammatory medication that has been used for centuries. Colchicine is currently indicated for the management of patients with gout, familial Mediterranean fever and pericarditis. In the LODOCO study, patients with stable coronary disease treated with colchicine 0.5 mg once daily experienced fewer cardiovascular events as compared with those not receiving colchicine. However, that study enrolled only 532 patients and was not placebo-controlled. Because acute coronary syndromes are associated with higher risks of recurrent events and exacerbated inflammation, we conducted the COLchicine Cardiovascular Outcomes Trial (COLCOT) in patients with a recent myocardial infarction to evaluate the effects of colchicine on cardiovascular outcomes and its long-term safety and tolerability. (more…)
Author Interviews, Diabetes, Heart Disease / 06.09.2019

MedicalResearch.com Interview with: Nicolas Danchin MD, FESC Professor of Medicine, Consultant Cardiologist Intensive Cardiac Care Unit Hôpital Européen Georges Pompidou Paris, France MedicalResearch.com: What is the background for this study? Response: FAST-MI is a programme of nationwide French surveys, carried out every 5 years in France since 2005 in patients hospitalised with STEMI or NSTEMI. Patients are included consecutively for one month and 10-year follow-up is organized. We can thus analyse patients' outcomes in relation with their profile. Knowing that diabetic patients represent a large proportion of patients with AMI, we thought it would be worthwhile determining whether they suffered specific complications, and in particular, heart failure, both at the acute stage and in the subsequent months. (more…)
Author Interviews, Heart Disease, JAMA, NIH, Stroke / 27.05.2019

MedicalResearch.com Interview with: Lenore J. Launer, PhD. Chief Neuroepidemiology Section Intramural Research Program National Institute on Aging MedicalResearch.com: What is the background for this study? What are the main findings? Response: The prevalence of cerebral infarction on MRI can be as high as 30% in community-based studies. These lesions detected on brain MRI, are often clinically silent, but are associated with impairments in cognitive and physical function and can increase the risk for clinical events. For a large number, the origin of these brain lesions is unknown. There is also a lack of population-based data on unrecognized myocardial infarction, which is associated with an increased for clinical coronary disease and mortality. Unrecognized MI was detected in 17% of participants using state-of-the-art cardia MRI, a more sensitive measure of the lesions, than the standard ECG. We investigated the contribution to these lesions of recognized and unrecognized myocardial infarction [MI] identified on cardiac MRI. We found both recognized and unrecognized myocardial infarction increased the risk for cerebral infarction, and that in particular unrecognized MI was associated with cerebral infarction of embolic origins of an unknown source. Given their prevalence, unrecognized MI may be an underestimated contributor to the risk for cerebral infarction in older persons.  (more…)
Author Interviews, Heart Disease, JACC / 13.02.2019

MedicalResearch.com Interview with: Srikanth Yandrapalli, MD Chief Resident in Internal Medicine at New York Medical College at Westchester Medical Center Program  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Risk factors play an important role in the development of and progression of coronary heart disease, thus necessitating strategies to address the leading modifiable risk factors to reduce the burden of coronary heart disease. Data are lacking regarding therecent temporal trends in the prevalence of these risk factors during a first AMI in US young adults. In our study, we report that among young adults in the US with a first acute myocardial infarction, the prevalence rates of major modifiable risk factors were very high with over 90% of patients having at least 1 such risk factor. Significant sex and racial disparities were observed. Sex differences in the rates of certain  risk factors were clearly evident with males having higher rates of smoking, dyslipidemia, and drug abuse, whereas females had higher rates metabolic risk factors like diabetes mellitus, hypertension, and obesity. Sex differences in the rates of certain risk factors narrowed with increasing age and over time. Blacks had higher rates of hypertension, obesity, and drug abuse, Whites had higher rates of smoking, Hispanics had higher rates of diabetes mellitus and patients of Asian/Pacific Islander race had higher rates of dyslipidemia. Prevalence rates progressively increased between 2005 and 2015 except for dyslipidemia for which a decreasing trend was noted more recently. (more…)
AHA Journals, Author Interviews, Heart Disease, Surgical Research / 13.11.2018

MedicalResearch.com Interview with: Dr. Srikanth Yandrapalli New York Medical College NYMC · Cardiology MedicalResearch.com: What is the background for this study? What are the main findings? Response: Selection of coronary artery bypass grafting over percutaneous coronary intervention during an acute myocardial infarction is influenced by the extent of coronary artery disease and patient comorbidities. Prior studies have shown sex and racial differences in coronary artery diseaseburden. We sought to identify if there are any sex and racial differences in the utilization of  coronary artery bypass grafting over percutaneous coronary intervention during a revascularized first  acute myocardial infarction in the US. We found that males had a higher coronary artery bypass grafting rate than women, and compared to Whites, Blacks had lower coronary artery bypass grafting rate and Asians had higher coronary artery bypass grafting at the time of a first myocardial infarction. (more…)
Author Interviews, Heart Disease, JACC / 06.05.2018

MedicalResearch.com Interview with: Robin Nijveldt  MD PhD FESC Radboudumc, Department of Cardiology and VU University Medical Center Department of cardiology the Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know from previous studies that patients with unrecognized myocardial infarcts have worse prognosis than people without infarcts. It was currently unknown in how many patients presenting with a first acute myocardial infarction had previous unrecognized MI, and if so, if this is still a prognostic marker on long term follow-up. In this paper we studied 405 patients from 2 academic hospitals in the Netherlands, with an average follow-up duration of 6.8 years. We found that silent MI was present in 8.2% of patients presenting with first acute MI, and that silent MI is a strong and independent predictor for adverse long-term clinical outcome such as death (HR 3.69) or the composite end point of death, reinfarction, ischemic stroke, or CABG (HR 3.05). Additionally, it appears that ECG is of limited value to detect silent MI, since our study did not reveal an association with long-term clinical outcome. (more…)
Author Interviews, Heart Disease / 10.01.2017

MedicalResearch.com Interview with: Dr. Mohammed Qintar, MD Cardiovascular Fellow St Luke’s Health System Kansas City MedicalResearch.com: What is the background for this study? What are the main findings? Response: One in four patients experience recurrent chest pain after acute myocardial infarction, but not all patients present with cardiac chest pain secondary to coronary ischemia. The frequency of non-cardiac chest pain re-hospitalitzation after acute myocardial infarction and its impact on patients’ health status has not been described after acute myocardial infarction (AMI). Both providers evaluating these patients and patients who have recently suffered an AMI are understandably concerned about any recurrent chest pain symptoms, and often present for urgent evaluation of these symptoms. In the first year after acute myocardial infarction, we found that a third of patients hospitalized for evaluation of chest pain actually presented with non-cardiac chest pain. Compared with patients not hospitalized with chest pain, non-cardiac chest pain hospitalization was associated with worse angina-related quality of life and general mental and physical health status. The quality of life for patients hospitalized with non-cardiac chest pain was similar to patients hospitalized with cardiac chest pain, suggesting a significant impact on their quality of life even though their pain did not reflect underlying coronary ischemia. (more…)
AHA Journals, Alcohol, Author Interviews, Heart Disease / 20.06.2014

Dr. Darryl P. Leong MBBS(Hons) MPH PhD FRACP FESC Hamilton General Hospital 237 Barton Street East CanadaMedicalResearch.com: Interview with: Dr. Darryl P. Leong MBBS(Hons) MPH PhD FRACP FESC Hamilton General Hospital 237 Barton Street East Canada   MedicalResearch: What are the main findings of the study? Dr. Leong: The main findings of this study are that while low-moderate levels of alcohol use are associated with a reduced risk of myocardial infarction, this protective association was not seen in peoples of all ethnicities. Secondly, heavy alcohol use (≥6 drinks) within a 24 hour period was associated with a significant increase in the immediate risk of myocardial infarction. (more…)
Author Interviews, Heart Disease / 11.06.2014

Laurie Lambert, PhD Unité d'évaluation en cardiologie Institut national d'excellence en santé et en services sociaux (INESSS) Montréal, QuébecMedicalResearch.com Interview with: Laurie Lambert, PhD Unité d'évaluation en cardiologie Institut national d'excellence en santé et en services sociaux (INESSS) Montréal, Québec MedicalResearch: What are the main findings of the study? Dr. Lambert: Patients with ST-elevation myocardial infarction (STEMI) are frequently transferred for percutaneous coronary reperfusion from a hospital without this capability. Favourable outcomes depend on minimizing delays to treatment. A major component of delay is the time from the patient’s arrival at the first hospital’s emergency department to departure to the hospital where percutaneous reperfusion will be performed, the ‘door-in-door-out’ time or DIDO. We characterized this component of delay in a systematic field evaluation of STEMI treatment over a large and populous geographic area. The major contributors to DIDO time were the delays
  • (1) from the initial in-hospital ECG acquisition to transfer activation by the emergency physician and
  • (2) from arrival of the transfer ambulance at the first hospital to departure of the ambulance for the primary percutaneous coronary intervention center. When the DIDO interval was timely (30 minutes or less as recommended by guidelines), reperfusion treatment was far more frequently within guideline-recommended delays (90 minutes or less). In fact, this benchmark of DIDO time was met in only 14% of cases. We identified a number of factors associated with untimely DIDO, an important one being an ambiguous presenting ECG. DIDO times were faster when patients arrived at the first hospital by ambulance particularly when retransfer to the second hospital was with the same ambulance that had remained on standby.
(more…)
Gender Differences, Heart Disease / 04.06.2014

Luke Kim, M.D., FACC, FSCAI Assistant Professor of Medicine Interventional Cardiac and Endovascular Laboratory Greenberg Division of Cardiology, Department of Medicine Weill Cornell Medical College/The New York Presbyterian HospitalMedicalResearch.com Interview with: Luke Kim, M.D., FACC, FSCAI Assistant Professor of Medicine Interventional Cardiac and Endovascular Laboratory Greenberg Division of Cardiology, Department of Medicine Weill Cornell Medical College/The New York Presbyterian Hospital MedicalResearch: What are the main findings of this study? Dr. Kim: The main findings of the study include:
  1. From 2007-2011, there was no significant change in the rate of acute MI in both male and female cohorts in U.S. . Although there was a decline in the rate of ST-elevation (STEMI) in those ≥55 years old, the rate remains steady in patients < 55 years old, especially in the female cohort after 2009.
  2. Female patients <55 years old with MI were sicker at baseline than the male counterparts with more likelihood of having diabetes, hypertension, chronic renal insufficiency, peripheral vascular disease, congestive heart failure and obesity.
  3. Female patients were more likely to present with non– STEMI vs. STEMI and more likely to develop shock complicating their MIs.
  4. Female patients are less likely to undergo coronary artery revascularization including percutaneous coronary intervention and coronary artery bypass surgery.
  5. Unadjusted risk of death was higher in female vs male (5.2% vs. 3.7%, p<0.001) along with higher incidence of stroke (0.5% vs. 0.3%, p<0.001), bleeding (4.9% vs. 3.0%, p<0.001), vascular complication (0.6% vs. 0.4%, p<0.001) and ARF (11.6% vs. 9.6%, p<0.001). After adjustment, death (OR 1.10 CI 1.04-1.17), stroke (OR 1.31 CI 1.10-1.55), bleeding (OR 1.30 CI 1.22-1.37), and vascular complications (OR 1.33 CI 1.15-1.55) were all significantly higher for female cohort.
(more…)
Author Interviews, BMJ, Heart Disease, Nutrition / 02.05.2014

Shanshan Li, Doctoral candidate Department of Epidemiology Harvard School of Public Health, 655 Huntington Avenue Boston, MA 02115, USAMedicalResearch.com Interview with: Shanshan Li, Doctoral candidate Department of Epidemiology Harvard School of Public Health, 655 Huntington Avenue Boston, MA 02115, USA MedicalResearch.com: What are the main findings of the study? Answer: This is the first study to show that greater intake of dietary fiber, especially cereal fiber, was inversely associated with all-cause mortality. Participants increased their average dietary fiber intake after myocardial infarction (MI), and the greater the increase, the lower was the risk of subsequent all-cause and cardiovascular mortality. Overall, the benefits for increased fiber intake were strongest for fiber from cereal and grain sources. (more…)