Author Interviews, Heart Disease, JAMA, NIH, Stroke / 27.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49363" align="alignleft" width="128"]Lenore J. Launer, PhD.Chief Neuroepidemiology Section Intramural Research ProgramNational Institute on Aging Dr. Launer[/caption] 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. 
Author Interviews, Heart Disease, JACC / 13.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47482" align="alignleft" width="200"]Srikanth Yandrapalli, MD Chief Resident in Internal Medicine at New York Medical College at  Westchester Medical Center Program  Dr. Yandrapalli[/caption] 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.
AHA Journals, Author Interviews, Heart Disease, Surgical Research / 13.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45845" align="alignleft" width="125"]MedicalResearch.com Interview with: Dr. Srikanth Yandrapalli New York Medical College NYMC · Cardiology Dr. Yandrapalli[/caption] 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.
Author Interviews, Biomarkers, Heart Disease, JACC / 20.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42561" align="alignleft" width="200"]Martin J Holzmann MD, PhD Dr. Holzmann[/caption] Martin J Holzmann MD, PhD Functional Area of Emergency Medicine Department of Internal Medicine, Solna, Karolinska Institutet Stockholm, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to investigate how the introduction of the new high-sensitivity cardiac troponin T (hs-cTnT) assay affected incidence of myocardial infarction (MI) use of coronary angiography, cardiac revascularizations, and prognosis in patients with myocardial infarction. We found that the incidence of MI increased by approximately 5%, with no change in mortality, but with an 11% reduced risk of reinfarctions, and a small increase in coronary angiographies, and cardiac revascularizations by 16%, and 13%, respectively. 
Author Interviews, Heart Disease, JACC / 06.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41522" align="alignleft" width="200"]Robin Nijveldt  MD PhD FESC Radboudumc Department of Cardiology The Netherlands Dr. Nijveldt[/caption] 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.
Annals Internal Medicine, Author Interviews, Biomarkers, Heart Disease / 19.04.2017

MedicalResearch.com Interview with: Martin P. Than, MBBS Emergency Department, Christchurch Hospital and Dr John W Pickering, PhD Associate Professor Senior Research Fellow in Acute Care Emergency Care Foundation, Canterbury Medical Research Foundation, Canterbury District Health Board | Christchurch Hospital Research Associate Professor | Department of Medicine | University of Otago Christchurch New Zealand MedicalResearch.com: What is the background for this study? Response: Patients being investigated for possible acute coronary syndrome comprise one of the largest groups of patients presenting to emergency rooms. Troponin assays have developed such that they can now measure with greater accuracy much lower concentrations of troponin. A large retrospective registry based study and a couple of smaller prospective studies suggested that patients with a very low concentrations of troponin T (below the current limit of detection of 5 ng/L) measured with Roche Diagnostic’s high-sensitivity troponin T (hsTnT) assay on presentation to the emergency department (ie single blood draw) are very unlikely to be having a myocardial infarction (MI). Our study gathers the current best evidence for using concentrations below the limit of detection in conjunction with no evidence of new ischaemia on ECG to safely risk stratify patients to a very low-risk group for MI and, therefore, potentially identify patients safe for early discharge.
Author Interviews, Depression, Diabetes, Heart Disease, Pharmacology, Women's Heart Health / 08.06.2015

Dr. Karin Rådholm MD Ph.D. Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Local Care West, County Council of Östergötland, Linköping, SwedenMedicalResearch.com Interview with Dr. Karin Rådholm MD Ph.D. student Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University Department of Local Care West, County Council of Östergötland, Linköping, Sweden MedicalResearch: What is the background for this study? Dr. Rådholm: Psychosocial risk factors and depressive disorders often co-occur with general medical comorbidities, such as myocardial infarction. Depression is more common in patients with diabetes than in patients without diabetes. About 10-30% of patients with diabetes have a comorbid depressive disorder, which is double the estimated prevalence of depression in individuals without diabetes. There is an association between comorbid depressive symptoms and diabetes complications. This is believed to be mainly due to poor adherence to treatment recommendations and diabetes self-management activities, but could also possibly be due to biological and behavioural causes that could predispose for both metabolic and affective disorders. The general risk of myocardial infarction is strongly dependent on age and sex, where men have an earlier disease onset compared to women. In the general population women are at much lower risk for ischemic heart disease mortality than men are. However, women with diabetes are at especially high risk for coronary heart disease, relatively more so than men with type 2 diabetes, meaning that the impact of diabetes on the risk of coronary death is significantly greater for women than men. The age- and gender-specific risk for myocardial infarction due to diabetes with coexistent depression has not previously been described. Data on all dispensed drug prescriptions in Sweden are available in the Swedish Prescribed Drug Register and all myocardial infarctions are registered in the Myocardial Infarction Statistics. These registers are population-based and have a total national coverage and high validity, which has been previously shown. Prescribed and dispensed antidiabetics and antidepressants were used as markers of disease. Our objective was to prospectively explore the gender- and age-specific risk of first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared to participants with no pharmaceutical treatment for diabetes or depression in a nationwide register study.
Author Interviews, Compliance, Emory, Heart Disease / 04.05.2015

Andre Paixao, MD Division of Cardiology Emory University Atlanta, GA, 30322.MedicalResearch.com Interview with: Andre Paixao, MD Division of Cardiology Emory University Atlanta, GA, 30322. Medical Research: What is the background for this study? Dr. Paixao: Despite advances in cardiovascular prevention, coronary heart disease remains a major cause of morbidity and mortality. Understanding risk factor burden and control as well as perceived risk prior to acute myocardial infarction (MI) presentation may identify opportunities for system-based interventions to promote adherence to evidence based recommendations and improve overall cardiovascular health. Medical Research: What are the main findings? Dr. Paixao: Our study assessed predicted risk and risk factor control prior to Myocardial Infarction (MI) presentation in 443,117 patients included in the NCDR ACTION Registry-GWTG. Only 36.1% of patients met all assessed risk factor control metrics (i.e. LDL cholesterol, non-HDL cholesterol, nonsmoking status and aspirin use among those with prior cardiovascular disease). Risk factor control was suboptimal in the primary and secondary prevention groups. Prior cardiovascular disease was present in 41.6% of patients presenting with an acute MI. Among those without prior cardiovascular disease or diabetes, only 13.4% were classified as high risk based on the Framingham Risk Score.
Author Interviews, Heart Disease, Imperial College, JAMA, Outcomes & Safety / 01.04.2015

intra-aortic balloon pump, WikipediaMedicalResearch.com Interview with: Sayan Sen, PhD International Centre for Circulatory Health, National Heart and Lung Institute Imperial College London London, United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Sayan Sen: Intra-aortic balloon pumps (IABP) are often used in Acute Myocardial Infarction, particularly in patients with cardiogenic shock. We analysed the available Randomized Controlled Trials (RCT) and observational studies, spanning 30 years, to establish the evidence for this use. There is no identifiable group of patients with Acute Myocardial Infarction that have been demonstrated to derive a mortality benefit from insertion of an IABP. The studies, including over 17000 patients, have studied mortality in patients receiving IABP in comparison to mortality of patients that received no IABP in the era of no reperfusion, fibrinolysis and primary percutaneous intervention.  This lack of mortality reduction with IABP in AMI is consistent in patients with and without cardiogenic shock across both RCTs and observational studies; questioning the continued use of this technology in Acute Myocardial Infarction.
Author Interviews, Heart Disease, JAMA, Karolinski Institute / 18.02.2015

Karolina Szummer, MD, PhD Section of Cardiology, Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm, Sweden MedicalResearch.com Interview with: Karolina Szummer, MD, PhD Section of Cardiology, Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Please note: This work is comparing the anticoagulant fondaparinux with low-molecular-weight heparin (not heparin). Medical Research: What is the background for this study? What are the main findings? Dr. Szummer: Since the publication of the OASIS-5 trial in 2006, many hospitals chose to change their medical practice and start using fondaparinux instead of low-molecular-weight heparin in the treatment of myocardial infarctions. In this study from the nation-wide near-complete myocardial infarction registry we were able to follow how the use of fondaparinux instead of low-molecular-weight heparin translated in clinical life was associated to a reduction in bleeding events and death. It is a very satisfying study, that confirms that the randomized clinical trial results are transferred with improvements in outcome to the treated patients.
Author Interviews, Heart Disease / 11.11.2014

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016. Medical Research: What is the background for this study? What are the main findings? Dr. Bangalore: The evidence to support beta blocker use for patients with myocardial infarction stems from outdated studies performed in the era prior to modern reperfusion and modern medical therapy. It is not know if the mortality benefit of beta blockers for MI are seen in the modern era. Our data from randomized trials suggest a significant interaction between reperfusion era status and beta blocker benefit such that in the modern era beta blockers provide no mortality benefit when compared with controls. However, they are associated with short term (30-days) benefit for reduction in recurrent MI and angina but at the expense of increase in the risk of heart failure, cardiogenic shock and drug withdraw due to adverse events. The benefits were only short term (30-days).
Author Interviews, Diabetes, Heart Disease / 29.09.2014

MedicalResearch.com Interview with: Jorge F. Saucedo MD Allstate Foundation, Judson B. Branch Chair of Cardiology Head, Division of Cardiology Co-Director Cardiovascular Institute NorthShore University HealthSystem Clinical Professor of Medicine University of Chicago Pritzker School of Medicine Talla A. Rousan, MD Oklahoma City, OK. First author of study. Medical Research: What are the main findings of the study? Answer: It was found that patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have a higher in-hospital mortality rate compared to patients without DM. Patients with insulin-requiring diabetes mellitus presenting with non-ST-segment elevation myocardial infarction had higher in-hospital mortality rate than patients with non-insulin requiring diabetes mellitus.
Author Interviews, General Medicine, Heart Disease, JACC, Karolinski Institute / 23.09.2014

Agneta Åkesson Associate professor, senior lecturer  Photo by Anna Persson                                                                   Nutritional Epidemiology IMM Institute of Environmental Medicine Karolinska Institutet Stockholm, SwedMedicalResearch.com Interview with Agneta Åkesson Associate professor, senior lecturer                                                  Nutritional Epidemiology IMM Institute of Environmental Medicine Karolinska Institutet Stockholm, Sweden Medical Research: What are the main findings of the study? Dr. Åkesson: Our study indicates that a healthy diet together with low-risk lifestyle practices such as being physically active, not smoking and having a moderate alcohol consumption, and with the absence of abdominal adiposity may prevent the vast majority of myocardial infarctions in men.
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.