3. Medical Disclaimer | Terms and Conditions
• The contents of the Hemodialysis.com Site, such as text, graphics, images, and
other material contained on the Hemodialysis.com Site ("Content") are for
informational purposes only. The Content is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. Always seek the advice of
your physician or other qualified health provider with any questions you may have
regarding a medical condition. Never disregard professional medical advice or
delay in seeking it because of something you have read on the Hemodialysis.com
Site!
• If you think you may have a medical emergency, call your doctor or 911
immediately. Hemodialysis.com does not recommend or endorse any specific
tests, physicians, products, procedures, opinions, or other information that may be
mentioned on the Site. Reliance on any information provided by Hemodialysis.com
or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on
the Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site is
solely at your own risk.
• The Site may contain health- or medical-related materials that are sexually explicit.
If you find these materials offensive, you may not want to use our Site. The Site
and the Content are provided on an "as is" basis.
Read more interviews on Hemodialysis.com
4. Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly
population.
Angina.com Interview with Kai M Eggers, MD, PhD
Department of Medical Sciences, Cardiology, Uppsala University
Uppsala, Sweden
• Angina.com: What are the main findings of the study ?
• Dr. Eggers: One main finding was that troponin I levels in our elderly study
participants increased significantly over five years time. Troponin is reflective of
myocardial abnormalities and in fact, the most pronounced increases were seen in
subjects with evidence of heart disease or risk factors for its development.
Accordingly, we found that subjects with higher troponin levels at baseline or
greater increases had a significant risk for death, even when other risk factors or
biomarkers were taken into account.
• Another important result of our study was that we for the first time were able to
measure troponin I levels in almost all of our study participants. This depends on
the analytical performance of the applied assay from Abbott and is at difference to
other studies in general populations in whom troponin remained undetectable in
at least every third subject.
Angina.com: Were any of the findings unexpected ?
• Dr. Eggers: We suspected that troponin I would be a strong risk predictor but were
surprised to see that it remained independently prognostic in analyses that were
adjusted for CRP and NT-proBNP, biomarkers that have received much greater
attention in studies performed in community populations.
5. Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly
population.
Angina.com Interview with Kai M Eggers, MD, PhD
Department of Medical Sciences, Cardiology, Uppsala University
Uppsala, Sweden
(cont)
• Angina.com: Were any of the findings unexpected ?
• Dr. Eggers: We suspected that troponin I would be a strong risk predictor but were surprised to see that it
remained independently prognostic in analyses that were adjusted for CRP and NT-proBNP, biomarkers that have
received much greater attention in studies performed in community populations.
• Angina.com: What should clinicians and patients take home from this study ?
• Dr. Eggers:Troponins are usually measured in patients with the suspicion of a heart attack. We have learned from
our study that troponins can also be detected in presumably healthy subjects. This must be taken into account
when interpreting troponin results in elderly patients who are admitted because of chest pain. Another important
point is that troponin levels appear to increase with aging as result of age-related changes of the heart. This is
discussed more in detail in another paper from our group published this month in Clinical Chemistry, and must
probably be considered when defining reference levels for troponin.
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Eggers: I would like to see a study investigating whether lifestyle changes or medical interventions could
influence troponin levels, and whether this also might reflect better outcome. This issue has for example been
investigated in an interesting paper from deFilippi and colleagues published last year in JACC demonstrating that
physical exercise was related to a smaller increase in troponin levels over time. If we could show that troponin
levels would mirror the beneficial cardiac effects of this kind of interventions, then this would be a big step
towards personalized preventive strategies.
• Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of
mortality in an elderly population.
• Citation:
• Eggers KM, Venge P, Lindahl B, Lind L.
• Department of Medical Sciences, Uppsala University, Sweden.
J Am Coll Cardiol. 2013 Mar 6. pii: S0735-1097(13)00936-4. doi: 10.1016/j.jacc.2012.12.048. [Epub ahead of print]
6. Estimating the effect of long-term physical activity on cardiovascular disease and mortality: evidence from the Framingham Heart Study
Angina.com Interview with
Susan M. Shortreed PhD
Assistant Investigator Biostatistics Unit, Group Health Research Institute
Group Health Research InstituteSeattle, WA 98101
• Angina.com: What are the main findings of the study?
• Dr. Shortreed: Physical activity throughout ones life is linked with longer life.
• Angina.com: Were any of the findings unexpected?
• Dr. Shortreed: The findings of this study confirmed that long-term physical activity has health
benefits.
• Our study followed individuals for a longer period of time than many previous studies in order to
understand their physical activity habits and monitor their health outcomes.
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Shortreed: Continued physical activity through out one’s life is important to a long
life. Clinicians should talk with their patients about the benefits of physical activity and advise
them on appropriate levels of physical activity considering their overall health. Patients should ask
their clinician about the health benefits of physical activity and talk with their clinician before
increasing their amount and intensity of physical activity.
• The Centers for Disease Control and Prevention has some great online information and resources
for both clinicians and patients on recommended physical activity levels for all ages.
7. Estimating the effect of long-term physical activity on cardiovascular disease and mortality: evidence from the Framingham Heart Study
Angina.com Interview with
Susan M. Shortreed PhD
Assistant Investigator Biostatistics Unit, Group Health Research Institute
Group Health Research InstituteSeattle, WA 98101
(Cont)
• Angina.com: What further research do you recommend as a result
of your study?
• Dr. Shortreed: We recommend studies investigate the long-term
effects of physical activity in women and in diverse populations.
• To investigate the effects of long-term physical activity, we
recommend studies record information on activity levels over time
and use appropriate analytic methods to quantify the link between
long-term effects of physical activity and health benefits.
• Citation:
• Estimating the effect of long-term physical activity on
cardiovascular disease and mortality: evidence from the
Framingham Heart Study
• Heart. 2013 Mar 8. [Epub ahead of print]
• Shortreed SM, Peeters A, Forbes AB.
Monash University, , Melbourne, Australia.
8. Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery
Angina.com Interview with Hong Liu, MD
Anesthesiology and Pain Medicine, University of California Davis Health System,
4150 V Street Suite 1200, Sacramento, CA, 95817
• Angina.com: What are the main findings of the study?
• Dr. Liu: Perioperative dexmedetomidine use in cardiac surgical
patients were more likely to have better in-hospital, 30-day and 1-
year survival. The perioperative use of dexmedetomidine is
also associated with a significant decrease in the incidence of
postoperative overall complications and delirium.
• There was no evidence of adverse hemodynamic side effects of
dexmedetomidine in patients undergoing cardiac surgery.
• Angina.com: Were any of the findings unexpected?
• Dr. Liu: Our study did not find perioperative dexmedetomidine
improving postoperative kidney function.
• On the contrary, it worsened postoperative renal function.
9. Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery
Angina.com Interview with Hong Liu, MD
Anesthesiology and Pain Medicine, University of California Davis Health System,
4150 V Street Suite 1200, Sacramento, CA, 95817
(cont)
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Liu: Dexmedetomidine used in clinical practice have many desirable effects
including analgesia, anxiolysis, inhibition of central sympathetic outflow and
reduction of systemic norepinephrine release that improve hemodynamic stability,
positively affect myocardial oxygen supply and demand and may provide
myocardial protection. It also increased urine output. If indicated, physicians
should consider use it.
• Because of the above-mentioned properties of this medication, patients may have
bradycardia and polyuria right after surgery.
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Liu: Multicenter randomized, prospective trial. Dose-dependent on kidney
protection
• Citation:
• Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery
• Fuhai Ji, Zhongmin Li, Hung Nguyen, Nilas Young, Pengcai Shi, Neal Fleming, and
Hong Liu
• Circulation. 2013;CIRCULATIONAHA.112.000936published online before print
March 19 2013, doi:10.1161/CIRCULATIONAHA.112.000936
10. Effect of Intensive versus Moderate Lipid-Lowering Therapy on Epicardial Adipose Tissue in Hyperlipidemic Postmenopausal Women: A
Substudy of the BELLES (Beyond Endorsed Lipid Lowering with EBT Scanning) Trial)
Angina.com Interview with Paolo Raggi, MD, FACC, FACP, FASNC, FCCT
Director, Mazankowski Alberta Heart Institute
Professor of Medicine, University of Alberta
Capital Health Chair in Cardiac Sciences Edmonton, AB T6G 2B7, Ca
• Angina.com: What are the main findings of the study?
• Dr. Raggi: The present study was a sub-analysis of the BELLES study,
originally designed to assess the effect of intensive versus moderate
lipid-lowering therapy on coronary artery calcium in post-
menopausal women.
• In the present sub-analysis, the effect on epicardial adipose tissue
(EAT) was examined; EAT has recently emerged as a local source of
inflammation and a surrogate and a possible active component in
the pathogenesis of coronary atherosclerosis and of the formation
of vulnerable atherosclerotic plaques. The main findings of the
present sub-analysis are that although both treatment strategies
resulted in halting the progression of EAT increase with age, only
intensive lipid-lowering therapy was associated with a decrease in
EAT volume.
11. Effect of Intensive versus Moderate Lipid-Lowering Therapy on Epicardial Adipose Tissue in Hyperlipidemic Postmenopausal Women: A
Substudy of the BELLES (Beyond Endorsed Lipid Lowering with EBT Scanning) Trial)
Angina.com Interview with Paolo Raggi, MD, FACC, FACP, FASNC, FCCT
Director, Mazankowski Alberta Heart Institute
Professor of Medicine, University of Alberta
Capital Health Chair in Cardiac Sciences Edmonton, AB T6G 2B7, Ca
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Raggi: The decrease in EAT volume was not associated with the
decrease in LDL (bad) cholesterol. This mostly unexpected finding
denotes that the beneficial effect of statin therapy on EAT is
mediated through other mechanisms than LDL lowering; the most
plausible mechanism is through the well-known anti-inflammatory
effects of statins.
• Angina.com: What should clinicians and patients take away from
this study?
• Dr. Raggi: This study provides another possible link between the
beneficial effects of statins on cardiovascular risk; i.e. EAT volume
modulation. It also provides possible evidence for a greater
beneficial effect of intensive versus moderate lipid-lowering
therapy. Finally, EAT may be used as surrogate of the effectiveness
of risk-reduction therapies.
12. Effect of Intensive versus Moderate Lipid-Lowering Therapy on Epicardial Adipose Tissue in Hyperlipidemic Postmenopausal Women: A
Substudy of the BELLES (Beyond Endorsed Lipid Lowering with EBT Scanning) Trial)
Angina.com Interview with Paolo Raggi, MD, FACC, FACP, FASNC, FCCT
Director, Mazankowski Alberta Heart Institute
Professor of Medicine, University of Alberta
Capital Health Chair in Cardiac Sciences Edmonton, AB T6G 2B7, Ca
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Raggi: A study of statin therapy with both EAT measurement pre- and post-
treatment with adequate number of patients and follow-up to assess both
surrogate (i.e. EAT volume change) and clinical events (major adverse
cardiovascular events); if positive, this would establish the role of EAT volume
measurement as a surrogate of clinical outcome.
• Citation:
• Effect of Intensive versus Moderate Lipid-Lowering Therapy on Epicardial Adipose
Tissue in Hyperlipidemic Postmenopausal Women: A Substudy of the BELLES
(Beyond Endorsed Lipid Lowering with EBT Scanning) Trial)
• Alexopoulos N, Melek BH, Arepalli CD, Hartlage GR, Chen Z, Kim S, Stillman AE,
Raggi P.
• Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA,
USA.
J Am Coll Cardiol. 2013 Mar 13. pii: S0735-1097(13)01002-4. doi:
10.1016/j.jacc.2012.12.051. [Epub ahead of print]
13. Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox
Angina.com Interview with Giampaolo Niccoli, MD, PhD, FESC
Interventional Cardiologist
Assistant professor of Cardiology
Institute of Cardiology
Catholic University of the Sacred Heart Rome, Italy
• Angina.com: What are the main findings of the study?
• Dr. Niccoli :In this study, we aimed at comparing coronary artery disease features at the time of a
first acute coronary syndrome in type II diabetic and non-diabetic patients by coronary angiography
and by optical coherence tomography.
• In the angiographic substudy, diabetes was independently associated with both stenosis score and
extent index. Furthermore, well developed collateral circulation toward the culprit vessel was more
frequent in diabetic than in non-diabetic patients. In the optical coherence tomography substudy,
at minimal lumen diameter site lipid quadrants were less and the lipid arc was smaller in diabetic
than in non-diabetic patients. Furthermore, the most calcified cross-section along the culprit
segment had a greater number of calcified quadrants and a wider calcified arc in diabetic than in
non-diabetic patients. Superficial calcified nodules were more frequently found in diabetic than in
non-diabetic patients.
• Thus, in spite of potent pro-inflammatory, pro-oxidant and pro-thrombotic stimuli operating in type
II diabetes, diabetic patients exhibit substantially more severe coronary atherosclerosis than non-
diabetic patients at the time of a first acute coronary event. Better collateral development toward
the culprit vessel, a predominantly calcific plaque phenotype and, probably, yet unknown
protective factors operating in diabetic patients may explain these intriguing paradoxical findings.
14. Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox
Angina.com Interview with Giampaolo Niccoli, MD, PhD, FESC
Interventional Cardiologist
Assistant professor of Cardiology
Institute of Cardiology
Catholic University of the Sacred Heart Rome, Italy
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Niccoli : When investigating the association of coronary artery disease burden
and diabetes status in an acute setting, we found a more severe and extensive
coronary atherosclerosis as compared to non- diabetic patients, although pro-
thrombotic and pro-inflammatory stimuli are stronger in diabetic than non-
diabetic patients.
• Angina.com What should clinicians and patients take away from this study?
• Dr. Niccoli : As demonstrated in our study, at the time of their first acute coronary
syndrome, type II diabetic patients have more severe and extensive coronary
atherosclerosis as compared to non-diabetic patients. Thus, diabetic patients may
have protective factors that prevent a first acute coronary syndrome.
• Indeed, we also showed that type II diabetic patients had better collateral
circulation towards the culprit vessel than non-diabetic patients, Therefore,
physicians should consider this apparent contradiction which is probably
accounted for by the fact that diabetes offsets the detrimental effects of a high
extent index on collateral development. Furthermore, a more calcific
atherosclerosis may stabilize coronary plaque.
15. Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox
Angina.com Interview with Giampaolo Niccoli, MD, PhD, FESC
Interventional Cardiologist
Assistant professor of Cardiology
Institute of Cardiology
Catholic University of the Sacred Heart Rome, Italy
(cont)
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Niccoli : Further studies will probably identify other, and possibly more
important, causes of the paradox that in diabetic patients the first acute event
occurs in the presence of more severe coronary artery disease. Interestingly,
protective effect mediated by inhibition of matrix metalloproteinase-9, which
reduces elastin degradation might operate in the coronary circulation and should
be investigated.
• Citation:
• Severity of coronary atherosclerosis in patients with a first acute coronary event: a
diabetes paradox.
• Eur Heart J. 2013 Mar;34(10):729-41. doi: 10.1093/eurheartj/ehs393. Epub 2012
Nov 27.
• Niccoli G, Giubilato S, Di Vito L, Leo A, Cosentino N, Pitocco D, Marco V, Ghirlanda
G, Prati F, Crea F.
• Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1,
00168 Rome, Italy.
16. Sexual Function After Left Ventricular Assist Device
Angina.com Author Interview: Peter Eckman, M.D.
Department of Medicine
Cardiovascular Division, University of Minnesota Medical School,
420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455
• Angina.com: What are the main findings of the study?
• Dr. Eckman: We found that 71% of men and 79% of women with a continuous flow
left ventricular assist device (LVAD) met criteria for sexual dysfunction, as
measured by the Changes in Sexual Function Questionnaire-14. Furthermore,
more than half of the survey respondents noted worsening in arousal and orgasm.
Age over 60 and history of ischemic heart disease were directly associated with
sexual dysfunction. Psychological issues, including fear of damaging the LVAD, self-
harm, device alarms, and hurting one’s partner were also cited, and most noted
that the equipment was “somewhat” or a “major” obstacle to sexual satisfaction.
Angina.com: Were any of the findings unexpected?
• Dr. Eckman: LVADs have been shown to significant improve quality of life, so the
relatively poorer sexual function was surprising. We were not surprised that older
age and history of ischemic heart disease were associated with worse function.
One participant said “Probably the least improved part of life before to after VAD.”
On the other hand, we were encouraged to see that a notable minority of patients
reported improvements in sexual function. We were also surprised that only a
minority of patients reported improvement in desire.
17. Sexual Function After Left Ventricular Assist Device
Angina.com Author Interview: Peter Eckman, M.D.
Department of Medicine
Cardiovascular Division, University of Minnesota Medical School,
420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455
(cont)
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Eckman: This data should inform subsequent studies designed to evaluate and
improve understanding of the specific factors involved in sexual health after LVAD
implant. Equipment was often cited as an obstacle, and improvements to external
components may have a favorable impact on sexual function. Willingness to
address concerns about sexual function may help minimize barriers to sexual
activity and satisfaction after LVAD
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Eckman: It is unclear if our findings were driven by physiologic changes such as
altered blood flow and endothelial function, or any of the myriad other factors
that impact sexual function. Study of the physiology of genital blood flow after
implant of continuous-flow LVAD may provide additional insight into the relative
importance of pathophysiology on sexual health after LVAD.
• Citation:
• Sexual Function After Left Ventricular Assist Device
• Eckman PM, Dhungel V, Mandras S, et al.
J Am Coll Cardiol. 2013;():.
doi:10.1016/j.jacc.2013.02.022.
18. Yield and Diagnostic Value of Stress Myocardial Perfusion Imaging in Patients
Without Known Coronary Artery Disease Presenting with Syncope
Angina.com Interview with Wael A. AlJaroudi MD
Division of Cardiovascular Disease American University of Beirut Medical Center
Riad El-Solh, Beirut 1107 2020, Lebanon
• Angina.com: What are the main findings of the study?
• Answer: In this study, we investigated the diagnostic yield of stress
myocardial perfusion imaging (MPI) for patients presenting for
syncope without prior history of known coronary artery disease (CAD). Out
of 700 patients, 659 (94%) had normal perfusion. Of the 41 patients with
abnormal MPI, 18 had a coronary angiogram and half of them were falsely
positive. The diagnostic yield of the stress MPI (95% CI) was 0.88% (0.3%,
2.6%), 1.3%(0.3%, 4.0%) and 2.4% (0.61%, 7.3%) for patients with low,
intermediate and high risk categories based on Framingham
scores, respectively. Also, an abnormal stress MPI did not have prognostic
value, in part due to the low numbers of abnormal studies and high false-
positive results.
• As such, stress MPI for evaluation of syncope in patients without known
CAD has a low diagnostic yield among all risk groups, and reaffirmation or
revision of the appropriateness criteria should be considered.
19. Yield and Diagnostic Value of Stress Myocardial Perfusion Imaging in Patients
Without Known Coronary Artery Disease Presenting with Syncope
Angina.com Interview with Wael A. AlJaroudi MD
Division of Cardiovascular Disease American University of Beirut Medical Center
Riad El-Solh, Beirut 1107 2020, Lebanon
(cont)
• Angina.com: Were any of the findings unexpected?
• Answer: Based on our clinical experience, we were expecting a low
diagnostic yield for stress MPI in such group of patients. However, there
are limited data that justify using stress MPI to rule out ischemia as a
cause of syncope in patients without known history of CAD. Given the high
economic burden and radiation exposure from these tests, we sought to
investigate whether indeed the diagnostic yield is high enough to justify
using these test or whether the appropriateness criteria needs revisiting.
• Angina.com: What should clinicians and patients take away from this
study?
• Answer: In patients without known CAD, syncope is not an anginal
equivalent, and therefore the diagnostic yield of stress MPI is very low
regardless of the Framingham score. Perhaps exercise stress
echocardiogram might have better since it looks at structure, dynamic
changes, and valves. This needs to be further studied and evaluated.
20. Yield and Diagnostic Value of Stress Myocardial Perfusion Imaging in Patients
Without Known Coronary Artery Disease Presenting with Syncope
Angina.com Interview with Wael A. AlJaroudi MD
Division of Cardiovascular Disease American University of Beirut Medical Center
Riad El-Solh, Beirut 1107 2020, Lebanon
(cont)
• Angina.com: What further research do you recommend as a result
of your study?
• Answer: It would be interesting to evaluate the diagnostic yield of
stress MPI for patients with known coronary artery disease and/or
ischemic cardiomyopathy presenting with syncope.
• Citation:
• Yield and Diagnostic Value of Stress Myocardial Perfusion Imaging in
Patients Without Known Coronary Artery Disease Presenting with
Syncope
• Wael A. AlJaroudi, M. Chadi Alraies, Oussama Wazni, Manuel D.
Cerqueira, and Wael A. Jaber
• Circ Cardiovasc Imaging. 2013;CIRCIMAGING.112.000051published
online before print February 15 2013,
doi:10.1161/CIRCIMAGING.112.000051
21. Renoprotective effect of remote ischemic postconditioning by intermittent balloon inflations
in patients undergoing percutaneous coronary intervention
Angina.com Interview with
Spyridon Deftereos, MD; Georgios Giannopoulos, MD
University of Athens, Athens, Greece
• Angina.com: What are the main findings of the study?
• Answer: The principal finding of this study is that a procedure of repeated
inflations and deflations of the stent balloon used to perform PCI
(percutaneous coronary intervention) in patients with non-ST-elevation
myocardial infarction leads to a reduction in the periprocedural acute
kidney injury rate. This effect seems to have a clinical impact, as it was
accompanied by a reduction (of borderline statistical significance) in the
30-day rate of death or rehospitalization for any cause.
• The physiological process underlying this procedure is termed “remote
ischemic conditioning” (“remote” because the conditioning stimulus is
applied to a site far away from the organ that is protected against tissue
damage; in our case, the conditioning stimulus is applied to the heart and
the conditioned organ is the kidney) and, although a lot of unanswered
questions remain as to its mechanisms, experimental and clinical evidence
has repeatedly demonstrated its existence.
22. Renoprotective effect of remote ischemic postconditioning by intermittent balloon inflations
in patients undergoing percutaneous coronary intervention
Angina.com Interview with
Spyridon Deftereos, MD; Georgios Giannopoulos, MD
University of Athens, Athens, Greece
(cont)
• Angina.com: Were any of the findings unexpected?
• Answer: Actually no. The study results could have gone either way; that is a
negative result would not have been a surprise either. However, we did have a
smaller retrospective study published a couple of years ago suggesting that remote
ischemic conditioning could be effective in this setting. Our present results show
that that hypothesis-generating study pointed to the right direction.
• Angina.com: What should clinicians and patients take away from this study?
• Answer: An important point associated with this study is that cardiac
interventionalists should always “remember the kidney” when performing cardiac
catheterizations, especially in patients with acute coronary syndromes (since these
patients are more vulnerable to acute renal damage compared to those
undergoing elective procedures). Effective measures of renoprotection, including
appropriate hydration, withholding of nephrotoxic drugs, parsimonious use of
contrast and, probably (if our results are confirmed by further clinical trials),
remote ischemic conditioning should be employed to reduce the likelihood of
renal damage.
23. Renoprotective effect of remote ischemic postconditioning by intermittent balloon inflations
in patients undergoing percutaneous coronary intervention
Angina.com Interview with
Spyridon Deftereos, MD; Georgios Giannopoulos, MD
University of Athens, Athens, Greece
(cont)
• Angina.com: What further research do you recommend as a result of your study?
• Answer: Our positive results, along with other recent ones, should prompt a larger
clinical study, powered enough to demonstrate clinical efficacy, if any, in terms of
hard clinical endpoints.
• Our study was underpowered to have a primary clinical endpoint, but the
secondary finding of a reduction in the 30-day clinical event rate is certainly
encouraging.
• Citation:
• Renoprotective effect of remote ischemic postconditioning by intermittent balloon
inflations in patients undergoing percutaneous coronary intervention
• Deftereos S, Giannopoulos G, Tzalamouras V, Raisakis K, Kossyvakis C, Kaoukis A,
Panagopoulou V, Karageorgiou S, Avramides D, Toutouzas K, Hahalis G, Pyrgakis V,
Manolis AS, Alexopoulos D, Stefanadis C, Cleman MW.
• Department of Cardiology, Athens General Hospital “G. Gennimatas”, Athens,
Greece.
• J Am Coll Cardiol. 2013 Mar 13. pii: S0735-1097(13)01001-2. doi:
10.1016/j.jacc.2013.02.023. [Epub ahead of print]
24. Duration of Ventilations during Cardiopulmonary Resuscitation by Lay-Rescuers and First Responders: Relationship between Delivering
Chest Compressions and Outcomes
Angina.com Interview with S.G. Beesems, MSc
afdeling Cardiologie
Kamer G4-248
Academisch Medisch Centrum 1105 AZ Amsterdam
• Angina.com: What are the main findings of the study?
• Answer: The results of our study show that lay-rescuers require a median ventilation time of 7
seconds to complete two ventilation attempts. Only 21% are able to fully meet the ventilation
guidelines of 2010. However, 97% of all rescuers provided chest compressions above the
recommended minimum of 60 chest compressions in one minute, 88% of all administered over 70
chest compressions in one minute and 63% of all administered over 80 chest compressions in one
minute. Hospital survival of patients with all rhythms was 25%. Therefore, the objective of
delivering sufficient chest compressions is met by all but a few rescuers.
• Angina.com: Were any of the findings unexpected?
• Answer: In our study, better survival was observed with longer ventilations. This is against the
findings of other studies with long interruptions of chest compressions, mainly caused by pauses
associated with defibrillation shocks. This paradox can be attributed to the fact that rescuers who
had the longest pauses for ventilations also arrived and shocked earlier with the AED. After
adjustment for the baseline factors, longer pauses for ventilation were not associated with worse
survival. It is also possible that the suggested detrimental effect of perishock pauses does not apply
to pauses for ventilation
25. Duration of Ventilations during Cardiopulmonary Resuscitation by Lay-Rescuers and First Responders: Relationship between Delivering
Chest Compressions and Outcomes
Angina.com Interview with S.G. Beesems, MSc
afdeling Cardiologie
Kamer G4-248
Academisch Medisch Centrum 1105 AZ Amsterdam
(cont)
• Angina.com: What should clinicians and patients take away from
this study?
• Answer: Lay-rescuers with CPR training that includes chest
compressions and ventilations are able to perform CPR better than
previously believed. Longer pauses for ventilations are not
associated with worse outcome. Guidelines may allow longer
pauses for ventilations without detriment to survival.
• Citation:
• Duration of Ventilations during Cardiopulmonary Resuscitation by
Lay-Rescuers and First Responders: Relationship between Delivering
Chest Compressions and Outcomes.
• Beesems SG, Wijmans L, Tijssen JG, Koster RW.
• 1Academic Medical Center, Amsterdam, The Netherlands.
Circulation. 2013 Mar 18. [Epub ahead of print]
26. Troponin I, but not BNP, is Associated with Phosphorus, Calcium and Vitamin D in Stable Coronary Artery Disease
Angina.com Interview with José Pedro L. Nunes M.D.
Associate professor at University of Porto, Portugal.
• Angina.com: What are the main findings of the study?
• Dr. Nunes: Elevated plasma cardiac troponin, elevated plasma phosphorus
and decreased plasma vitamin D are known to be associated with negative
outcomes. In this study, data was obtained from a relatively small number
of patients (sixty) with stable coronary artery disease and preserved left
ventricular function, and patients with higher values for cardiac troponin I
were shown to have higher plasma phosphorus, higher plasma calcium
and lower plasma 25-OH vitamin D values when compared to patients
with lower values for troponin. The same association was not found with
BNP.
•
Angina.com: Were any of the findings unexpected?
• Dr. Nunes: When you start an investigation, you do not know what you will
find, but previous studies, carried out in renal patients, had shown an
association between troponin levels and FGF-23, which itself is associated
to phosphorus.
27. Troponin I, but not BNP, is Associated with Phosphorus, Calcium and Vitamin D in Stable Coronary Artery Disease
Angina.com Interview with José Pedro L. Nunes M.D.
Associate professor at University of Porto, Portugal.
(cont)
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Nunes: Given the relatively small number of patients under study, the conclusions should be
seen with some caution. In any event, troponin is no longer seen solely as a marker for myocardial
infarction. Cardiac/renal connections could find here yet another important field of future research.
As stated in the text, “the hypothesis is raised that deleterious effects of higher phosphorus and/or
calcium and of lower vitamin D levels on the heart are reflected by an increase in plasma troponin
I”.
• Angina.com: What recommendations do you have for future research as a result of your study?
• Dr. Nunes: It would be important to try to confirm these findings in larger and different sets of
patients. If confirmed, these findings could be a starting point for significant advances in the
understanding of mechanisms of cardiac injury, perhaps involving diet, lack of sunlight exposure
and with a possible impact on vitamin D supplementation.
• Citation:
• Troponin I, but not BNP, is Associated with Phosphorus, Calcium and Vitamin D in Stable Coronary
Artery Disease
• Nunes J.P.L.
• Faculdade de Medicina da Universidade do Porto: Center for Research in Health Technologies and
Information Systems (Cintesis), Porto
• Kidney Blood Press Res 2013;37:43-47
(DOI:10.1159/000343399)
• Published online first (Issue-in-Progress)
28. Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction, Resuscitated Cardiac Arrest, and Cardiogenic
Shock : The Role of Primary Multivessel Revascularization
Angina.com Interview with Darren Mylotte MB BCh MD
ICPS – Institut Cardiovasculaire Paris Sud · Interventional Cardiology
• Angina.com: What are the main findings of the study?
• Dr. Mylotte: The study demonstrates the very high
mortality rate of patients with STEMI, cardiogenic shock
and resuscitated cardiac arrest: 65.4% at 6-months. It also
demonstrates that those with more extensive myocardial
ischemia due to more widespread coronary disease have
worse outcomes compared to those with less ischemia.
Furthermore, it demonstrates that in those with
multivessel coronary disease, multivessel PCI appears to
improve survival compared to culprit-only PCI. Finally,
successful PCI and multivessel PCI were independent
predictors of 6-month survival in those with multivessel
disease.
29. Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction, Resuscitated Cardiac Arrest, and Cardiogenic
Shock : The Role of Primary Multivessel Revascularization
Angina.com Interview with Darren Mylotte MB BCh MD
ICPS – Institut Cardiovasculaire Paris Sud · Interventional Cardiology
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Mylotte: The fact that multivessel primary PCI was associated
with improved survival was not a surprise. Indeed the study
hypothesis stemmed from other data suggesting enhanced
outcomes in this critically-ill patient population. However, the
magnitude of the survival advantage (absolute survival advantage
23.5%) was unexpected. While this may also reflect some selection
or treatment bias, there is a clear signal that in selected cases
multivessel PCI is advantageous.
• Angina.com: What should clinicians and patients take away from
this study?
• Dr. Mylotte: I think that the central message of this study is that in
patients with multivessel disease and cardiogenic shock, refractory
to culprit-artery PCI, that further revascularization should be
considered.
30. Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction, Resuscitated Cardiac Arrest, and Cardiogenic
Shock : The Role of Primary Multivessel Revascularization
Angina.com Interview with Darren Mylotte MB BCh MD
ICPS – Institut Cardiovasculaire Paris Sud · Interventional Cardiology
(cont)
• Angina.com: What further research do you recommend as a result of your
study?
• Dr. Mylotte: I think that this study highlights the need for further randomized trials
comparing revascularization strategies in this very high-risk group of patients.
Furthermore, it demonstrates the limitations of coronary revascularization and
that other treatments need to be developed in order to significantly improve
outcomes.
• Citation:
• Primary percutaneous coronary intervention in patients with acute myocardial
infarction, resuscitated cardiac arrest, and cardiogenic shock: the role of primary
multivessel revascularization.
• Mylotte D, Morice MC, Eltchaninoff H, Garot J, Louvard Y, Lefèvre T, Garot P.
• Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, and
Hôpital Claude Galien, Quincy, France.
JACC Cardiovasc Interv. 2013 Feb;6(2):115-25. doi: 10.1016/j.jcin.2012.10.006.
Epub 2013 Jan 23.
31. Genetic Determinants of Dabigatran Plasma Levels and Their Relation to Bleeding.
Angina.com Interview with Guillaume Paré MD, MSc, FRCPC
Assistant ProfessorPathology and Molecular Medicine (primary)
Clinical Epidemiology & Biostatistics
Canada Research Chair in Genetic and Molecular Epidemiology
Director, Genetic and Molecular Epidemiology Laboratory Visiting Scientist, Harvard Medical School McMaster University
• Angina.com: What are the main findings of the study?
• Dr. Pare: We conducted a genome-wide association study of dabigatran peak and trough
concentration in 2,944 RE-LY participants with both genetic and pharmacokinetic data. The CES1
SNP rs2244613 was associated with a 15% decrease in trough concentrations per allele, and the
ABCB1 SNP rs4148738 and CES1 SNP rs8192935 were associated with peak concentrations at
genome-wide significance (P<9 x 10-8), also with a gene-dose effect. CES1 encodes for the liver
carboxylesterase 1 enzyme, an esterase responsible for the biotransformation of dabigatran
etexilate into the active metabolite, dabigatran. The ABCB1 gene encodes for P-glycoprotein, an
ATP-dependent drug efflux pump for xenobiotic compounds with broad substrate
specificity. Dabigatran etexilate, but not dabigatran, is an ABCB1 substrate and ABCB1 inhibitors
increase dabigatran bioavailability by 10-20%. When tested for association with bleed, the CES1
SNP rs2244613 was associated with a lower risk of any bleeding (OR=0.67, 95%CI 0.55-0.82; P=7 x
10-5) in dabigatran-treated participants, and with a consistent but non-significant lower risk of
major bleeding (OR=0.66, 95%CI 0.43-1.01). Importantly, the interaction between treatment
(warfarin versus all dabigatran) and carrier status was statistically significant (P=0.002) with carriers
having less bleeding with dabigatran than warfarin (HR=0.59, 95%CI 0.46-0.76; P=5.2 x 10-5) in
contrast to no difference in noncarriers (HR=0.96, 95%CI 0.81-1.14; P=0.65).
32. Genetic Determinants of Dabigatran Plasma Levels and Their Relation to Bleeding.
Angina.com Interview with Guillaume Paré MD, MSc, FRCPC
Assistant ProfessorPathology and Molecular Medicine (primary)
Clinical Epidemiology & Biostatistics
Canada Research Chair in Genetic and Molecular Epidemiology
Director, Genetic and Molecular Epidemiology Laboratory Visiting Scientist, Harvard Medical School McMaster University
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Pare: While the two gene loci identified were to be expected given dabigatran
etexilate’s metabolism, we were surprised by the strength of the genetic effects,
especially on bleeds. Also, dabigatran etexilate was thought to be converted into
dabigatran completely and immediately by esterases. Identification of a genetic
variant of CES1 associated with drug exposure suggests that biotransformation into
dabigatran could be a rate-limiting factor in certain individuals.
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Pare: These results are significant as the relative risk of bleeding was 0.73
(95%CI 0.63-0.86) for the 32.8% of RE-LY participants that are rs2244613 minor
allele carriers versus noncarriers, whereas the reported relative risk of bleeding
was 0.86 (95% CI 0.81-0.93) for the lower (110 mg bid) versus higher dose (150 mg
bid) of dabigatran in the overall study. The observed genetic effect was thus larger
than the effect of drug dosage in the parent study, suggesting a potential role of
genetics to help determine the optimal dose of dabigatran etexilate in individual
patients. For example, carriers of the protective allele could perhaps be safely
prescribed the higher dose of dabigatran etexilate even if elderly.
33. Genetic Determinants of Dabigatran Plasma Levels and Their Relation to Bleeding.
Angina.com Interview with Guillaume Paré MD, MSc, FRCPC
Assistant ProfessorPathology and Molecular Medicine (primary)
Clinical Epidemiology & Biostatistics
Canada Research Chair in Genetic and Molecular Epidemiology
Director, Genetic and Molecular Epidemiology Laboratory Visiting Scientist, Harvard Medical School McMaster University
(cont)
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Pare: Many key questions remain to be addressed. Among them is whether the CES1
SNP rs2244613 is associated with ischemic events as well as bleeds. Indeed, despite the large
sample size, only 66 dabigatran etexilate-treated individuals suffered from any ischemic event in
the genetic analysis sub-group of the RE-LY trial and power to detect a genetic association was
accordingly limited. Larger studies will therefore be necessary to properly answer this
question. Finally, clinical utility of CES1 genotyping will need to be assessed through rigorous
studies carefully evaluating the health benefit and cost of incorporating genotypes into dose
selection decisions.
• Citation:
• Genetic Determinants of Dabigatran Plasma Levels and Their Relation to Bleeding.
• Paré G, Eriksson N, Lehr T, Connolly S, Eikelboom J, Ezekowitz MD, Axelsson T, Haertter S, Oldgren J,
Reilly P, Siegbahn A,
• Syvänen AC, Wadelius C, Wadelius M, Zimdahl-Gelling H, Yusuf S, Wallentin L.
1Population Health Research Institute, Hamilton Health Sciences and McMaster University,
Hamilton, Canada.
Circulation. 2013 Mar 6. [Epub ahead of print]
34. Rivaroxaban Reduces Spontaneous and Large Myocardial Infarctions: Findings from the ATLAS ACS 2 – TIMI 51 Trial
Angina.com Interview with Matthew A. Cavender, M.D.
Research Fellow, TIMI Study Group
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts 02115
• Angina.com: What are the main findings of the study?
• Dr. Cavender: The ATLAS ACS 2 – TIMI 51 trial showed that
treatment with rivaroxaban reduces cardiovascular death,
myocardial infarction and stroke. To better understand how this
drug improves cardiovascular outcomes, it was important to
understand the effect of the rivaroxaban on specific types of
myocardial infarctions.
• Angina.com: Were any of the findings unexpected?
• Dr. Cavender: In the overall trial, rivaroxaban 2.5 mg twice daily
reduced cardiovascular death, myocardial infarction, or stroke. In
addition, rivaroxaban 2.5 mg was shown to reduce cardiovascular
death. The present study offers insight into the possible
mechanisms leading to this mortality benefit since rivaroxaban
reduces both spontaneous and large myocardial infarctions.
35. Rivaroxaban Reduces Spontaneous and Large Myocardial Infarctions: Findings from the ATLAS ACS 2 – TIMI 51 Trial
Angina.com Interview with Matthew A. Cavender, M.D.
Research Fellow, TIMI Study Group
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts 02115
(cont)
• Angina.com: What should clinicians and patients take away from
this study?
• Dr. Cavender: Our analysis showed the majority of myocardial
infarctions in the ATLAS ACS 2 – TIMI 51 trial occurred
spontaneously due to plaque rupture and coronary artery
thrombosis. Rivaroxaban was given to patients to prevent these
types of thrombotic events. We found that treatment with
rivaroxaban significantly reduced spontaneous myocardial
infarctions by approximately 20%, and both the 2.5 and 5 mg doses
had directionally similar effects.
• Citation:
• Presented at 2013 ACC American College of Cardiology March 2013
Rivaroxaban Reduces Spontaneous and Large Myocardial
Infarctions:
Findings from the ATLAS ACS 2 – TIMI 51 Trial
36. Value of Myocardial Perfusion Imaging in Renal Transplant Evaluation
Angina.com Interview with: Dr. Chong Ghee Chew
Department of Nuclear Medicine, PET and Bone Mineral Densitometry, Royal Adelaide Hospital, Adelaide, SA
• Angina.com: What are the main findings of the study?
• Answer: This is a retrospective audit of the cardiac outcomes of renal
failure patients who had been transplanted in South Australia between
1999 to 2009, who had myocardial perfusion SPECT scan for the transplant
assessment. The results represent ”real world” outcomes as the scans
were performed in the 3 major teaching hospitals in SA. 2 endpoints –
“soft” = inpatient care with angina +/- PCI +/- CABG, and “hard” =
inpatient care with myocardial infarction or cardiac death. With a negative
scan this cohort had a statistically significant lower soft endpoint event
rate than a positive scan …3.9% vs 20.8%, hazard ratio of 4.4 at 5 years
post scan. The hard endpoint event rate was also lower for those with a
negative scan but the difference did not reach statistical significance. The
event rates of hard and soft endpoints were no different for the negative
scans that were performed with a tachycardic stress (treadmill exercise,
dobutamine or external wire right atrial pacing) versus dipyridamole
induced coronary vasodilatation.
37. Value of Myocardial Perfusion Imaging in Renal Transplant Evaluation
Angina.com Interview with: Dr. Chong Ghee Chew
Department of Nuclear Medicine, PET and Bone Mineral Densitometry, Royal Adelaide Hospital, Adelaide, SA
(cont)
• Angina.com: Were any of the findings unexpected?
• Answer: No
• Angina.com: What should clinicians and patients take away from this
study?
• Answer: Myocardial perfusion SPECT scan is a good predictor of cardiac
events in renal failure patients who are being considered for
transplantation.
• This is a valid test for transplant assessment.
• Angina.com: What further research do you recommend as a result of
your study?
• The study did not include patients who were assessed but were not
transplanted. We are planning another similar audit to look at this cohort.
• Citation:
• ACC 2013 American College Cardiology Presentation Spring 2013
38. Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction
Angina.com Interview with: Ivan Hanson, M.D.
Chief Interventional Cardiology Fellow
Beaumont Hospital, Royal Oak, MI
• Angina.com: What are the main findings of the study?
• Dr. Hanson: Over half of patients with perioperative myocardial infarction (PMI)
have invasive angiographic evidence of plaque rupture (type 1 PMI). Patients with
type 1 PMI had more intraoperative hypotension, higher incidence of transmural
ischemia, larger infarct size and trended toward worse outcome.
• Angina.com: Were any of the findings unexpected?
• Dr. Hanson: Our hypothesis was that the majority of PMI events were due to
hemodynamic insults in the setting of stable, but severely stenotic, coronary artery
stenoses (type 2 PMI).
• Not only did we observe a higher incidence of type 1 PMI than type 2 PMI, but
type 1 PMI patients actually had greater incidence of intraoperative hypotension.
This challenges the notion that hemodynamic pertubations are more closely
associated with type 2 PMI.
• Furthermore, clinical assessment alone, including knowledge of intraoperative
hemodynamics and postoperative ECG findings, are insufficient to diagnose type of
PMI.
39. Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction
Angina.com Interview with: Ivan Hanson, M.D.
Chief Interventional Cardiology Fellow
Beaumont Hospital, Royal Oak, MI
(cont)
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Hanson: Our findings suggest that if a sophisticated understanding of type of
PMI is desired, invasive angiography may be useful.
• Patients that were formally assumed to have type 2 PMI may in fact have plaque
rupture and coronary thrombosis, which would not be expected to resolve by
optimization of coronary blood flow alone.
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Hanson: To test the hypothesis that tailoring management of PMI based on
angiographic findings results in optimal outcomes, a much larger study is required.
• I am also very interested in the invasive imaging characteristics of plaques that
lead to, or have caused, PMI.
• Citation:
• Angiographic and clinical characteristics of type 1 versus type 2 perioperative
myocardial infarction.
40. Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression
Angina.com Interview with Karina W. Davidson, PhD
Center for Behavioral Cardiovascular Health, Department of Medicine,
Columbia University Medical Center, New York, New York
• Angina.com: What are the main findings of the study?
• Dr. Davidson: With a grant from the National Institutes of Health’s National Heart, Lung, and Blood
Institute (NHLBI), Karina W. Davidson, PhD, director of the Center for Behavioral Cardiovascular
Health at Columbia University Medical Center (CUMC), together with her colleagues at multiple
sites in the U.S., completed a randomized controlled trial with 150 patients with elevated
depressive symptoms two to six months after their hospitalization for heart disease. Patients were
recruited from seven centers across the United States and were randomized to receive either six
months of their preferred depression care (therapy, antidepressants or both) or to receive
depression care determined by their physician upon notification that the patient had elevated
depressive symptoms.
• In the self-selected group, patients were given a choice of whether they wanted therapy or
antidepressants, or both. “We tried to help them really think through what does it take to take a pill
every day; what does it take to talk to a person about painful feelings and do homework, and really
consider what will fit into their life,” said Dr. Davidson. “And every six to eight weeks, we revisited
how their chosen treatment was working for them, and helped them make adjustments based
upon their feedback.”
41. Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression
Angina.com Interview with Karina W. Davidson, PhD
Center for Behavioral Cardiovascular Health, Department of Medicine,
Columbia University Medical Center, New York, New York
(cont)
• Therapy in this study was given virtually (by phone or web-based) to ensure that patients had access to clinicians
of a similar skill set – so two counselors (one at CUMC and another at Yale) provided the therapy in this study. The
virtual therapy also helped connect patients with therapists at times that were most convenient for them. “Maybe
8 p.m. at your home is the right time for you, but not 8 p.m. if you have to go for a clinic or hospital and wait half
an hour and travel back home afterwards, etc.,” said Dr. Davidson, who is also professor of behavioral medicine in
medicine, cardiology, and psychiatry, CUMC. The therapy used in the trial was problem solving treatment (PST) – a
practical, hands-on approach that asks patients to choose the problems in their life that they want to tackle,
teaches them how to problem solve, and then they go out and do homework to try the solutions and come back
and talk about what worked, what didn’t, and tackle the next problem.
• Findings showed that depressive symptoms were reduced more in the patient-selected, centralized depression
care group, than in the patients receiving usual care. At the start of the trial, patients had an average of 19 points
on the BDI depression scale – at the end of the trial, BDI scores in the patient-selected group were significantly
reduced by an average of 3-6 points more than the reduction that happened in the usual care group. Getting
down below 10 on the BDI puts one in the normal range – and almost half of the patients who received patient-
selected, centralized treatment get down to the normal range; whereas only one-third in the usual care group got
down to the normal range.
• Importantly, researchers found that running centralized depression care at seven sites nationwide was effective,
suggesting that it is feasible to deliver depression care to those who don’t have specialists in their area. Overall,
the total health care costs for the self-selected group was $325 less than the control group, even when factoring in
the cost of providing them with the therapy. The centralized depression care group demonstrated a trend towards
fewer hospitalizations, compared to the usual care group.
42. Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression
Angina.com Interview with Karina W. Davidson, PhD
Center for Behavioral Cardiovascular Health, Department of Medicine,
Columbia University Medical Center, New York, New York
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Davidson: Most depression trials in this area have gotten effect size of .3, which is one-third of
the standard deviation. And we got .6, or 2/3 of the standard deviation. So we had almost double
the size of treatment improvement compared to other people.
• The research team believes that the difference in their findings can be explained in the difference
between how previous published trials were conducted, versus how their trial was conducted. In
previous trials, patients were often offered either one type of treatment or usual care, and they
had to remain with that selection for the remainder of the trial. However, because it’s well known
that there isn’t one magic bullet for depression; one thing doesn’t work for all patients, the
CODIACS Vanguard trial was designed with a flexible algorithm that allowed the clinical team to
regularly liaise with the patients to help them keep different treatment options and combinations,
until one was found that suited them best.
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Davidson: About 1.2 million Americans survive an ACS event every year and many of them have
clinically significant and persistent depression. Post-ACS depression is also associated with an
increased risk of ACS recurrence and with an increase in the relative risk of all-cause mortality, the
authors write in the study background. These findings show that treating heart attack survivors for
depressive symptoms is feasible, effective, and even has the tantalizing possibility of being cost-
neutral. Importantly, treating depressive symptoms—as opposed to a diagnosis of depression—
should be determined by an alliance between a healthcare professional and the patient – and
regularly assessed for effectiveness and altered to continue to meet the patient’s needs.
43. Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression
Angina.com Interview with Karina W. Davidson, PhD
Center for Behavioral Cardiovascular Health, Department of Medicine,
Columbia University Medical Center, New York, New York
(cont)
• Angina.com: What further research do you recommend as a result of your
study?Dr. Davidson: Dr. Karina Davidson and her team plan to explore whether
these results can be replicated in a much larger nationwide randomized controlled
trial, to examine whether treating them for depressive symptoms lowers their risk
of death or having another heart attack.
• Citation:
• Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–
Acute Coronary Syndrome Depression: CODIACS Vanguard Randomized Controlled
Trial ONLINE FIRST
• Karina W. Davidson, PhD; J. Thomas Bigger, MD; Matthew M. Burg, PhD; Robert M.
Carney, PhD; William F. Chaplin, PhD; Susan Czajkowski, PhD; Ellen Dornelas, PhD;
Joan Duer-Hefele, RN; Nancy Frasure-Smith, PhD; Kenneth E. Freedland, PhD;
Donald C. Haas, MD, MPH; Allan S. Jaffe, MD; Joseph A. Ladapo, MD, PhD; Francois
Lespérance, MD; Vivian Medina, MSW; Jonathan D. Newman, MD, MPH; Gabrielle
A. Osorio, BS; Faith Parsons, BS; Joseph E. Schwartz, PhD; Jonathan A. Shaffer, PhD;
Peter A. Shapiro, MD; David S. Sheps, MD; Viola Vaccarino, MD, PhD; William
Whang, MD, MS; Siqin Ye, MD
• JAMA Intern Med. 2013;():1-8. doi:10.1001/jamainternmed.2013.915.
doi:10:1001/jama.2010.920
44. Direct-to-consumer television advertising exposure, diagnosis with high cholesterol, and statin use
Angina.com: Interview with Dr. Jeff Niederdeppe, Ph.D.
Assistant Professor
Department of Communication, Cornell University
(cont)
• Angina.com: What are the main findings of the study?
• Dr. Niederdeppe: We examined the relationship between exposure to direct-to-consumer
advertising (DTCA) for cholesterol-lowering drugs (most of which are statins) and two clinical
variables: diagnosis with high cholesterol, and taking a statin drug in the past year. We found that
greater exposure to statin DTCA was associated with an increased likelihood of being diagnosed
with high cholesterol and taking a statin to treat it. We also found that these relationships were
strongest for adults at comparatively low risk for cardiac events – those who tended to be younger,
did not have high blood pressure, and did not smoke regularly. We did not find positive
relationships between statin DTCA exposure and high cholesterol diagnosis or statin use for those
at higher levels of risk, or those who reported having a history of heart disease or a previous heart
attack.
• Angina.com: Were any of the findings unexpected?
• Dr. Niederdeppe: We were not surprised that statin DTCA exposure would be associated with high
cholesterol diagnosis and statin use among lower-risk people, since that pattern has been found
before for other types of pharmaceutical drugs. We were surprised, however, at the lack of a
positive relationship for those at higher risk. In fact, we even found a negative relationship between
DTCA exposure and statin use among high-risk women (those with a history of heart disease, a
previous heart attack, and/or diabetes). In other words, greater exposure to statin DTCAs was linked
to a lower likelihood of using the drug for this group. These results are puzzling and should be
considered preliminary, but we think that future work should see whether or not this pattern exists
in other studies with other populations.
45. Direct-to-consumer television advertising exposure, diagnosis with high cholesterol, and statin use
Angina.com: Interview with Dr. Jeff Niederdeppe, Ph.D.
Assistant Professor
Department of Communication, Cornell University
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Niederdeppe: I’ll first acknowledge that I am not an M.D., and that I understand each patient has a unique set
of risk factors, personal and family history, and medical profile. That said, one takeaway point is that we can
expect patients to learn about pharmaceutical drugs from DTCA, and that is going to influence the clinical
encounter. The average American is exposed to 16 hours of DTCA every year; in contrast they see the doctor an
average of 15 minutes per year. Clinicians should be prepared to discuss both the risks and benefits of heavily-
advertised pharmaceutical drugs.
• I would encourage patients to ask their doctor about the ratio of risks to benefits related to drugs they see
advertised. While all DTCAs have to disclose drug risks, the ads tend to do this in a way that focuses greater
attention on benefits than risks.
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Niederdeppe: Many statin DTCAs contain information about lifestyle changes (which are always recommended
first to reduce cholesterol) and pharmaceutical drugs. One important question is how these ads might influence
people’s lifestyle decisions – whether or not to engage in regular exercise, eat a heart-healthy diet, and maintain a
healthy weight. We don’t yet know enough about some of the secondary impacts that these ads may be having on
factors that influence the public’s health.
• Citation:
• Direct-To-Consumer Television Advertising Exposure, Diagnosis with High Cholesterol, and Statin Use.
• Niederdeppe J, Byrne S, Avery RJ, Cantor J.
• Department of Communication, Cornell University, 328 Kennedy Hall, Ithaca, NY, 14853, USA
J Gen Intern Med. 2013 Mar 6. [Epub ahead of print
46. Impact of Socioeconomic Deprivation and Area of Residence on Access to Coronary Revascularization and Mortality After a First Acute
Myocardial Infarction in Québec
Angina.com Interview with Cardiology Researcher:
Stéphane Rinfret MD, SM, FRCPC
Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada
• Angina.com: What are the main findings of the study?
• Dr. Rinfret : Study shows that patients unfortunately do not
persist with dual antiplatelet therapy as we like to think
they would do because of the consequences. A simple
telephone intervention clearly helped to reach almost
perfect adherence.
• Angina.com: Were any of the findings unexpected?
• Dr. Rinfret : Self-reported adherence is worth nothing. We
relied on pharmacy data. When we compared with the
answers patients gave to interviewers at 6 months and 1
year, there was very low correlation. Therefore pharmacy
data are absolutely required to assess true adherence.
47. Impact of Socioeconomic Deprivation and Area of Residence on Access to Coronary Revascularization and Mortality After a First Acute
Myocardial Infarction in Québec
Angina.com Interview with Cardiology Researcher:
Stéphane Rinfret MD, SM, FRCPC
Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Rinfret : We need to take responsibility and put systems in place to follow how
patients take their medication following stenting.
A simple advise not to stop the medication is clearly not enough.
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Rinfret : As newer DES will likely mandate a shorter DAT duration, a shorter
intervention with 1 or 2 calls may be enough.
This will have to be tested.
• Citation:
• Impact of Socioeconomic Deprivation and Area of Residence on Access to
Coronary Revascularization and Mortality After a First Acute Myocardial
Infarction in Québec
• Claudia Blais, PhD, Denis Hamel, MSc, Stéphane Rinfret, MD, SM, FRCPC
• Impact of Socioeconomic Deprivation and Area of Residence on Access to
Coronary Revascularization and Mortality After a First Acute Myocardial Infarction
in Québec
• Canadian Journal of Cardiology, Volume 28, Issue 2, March–April 2012,
Pages 169–177
48. Comparison of Coronary CT Angiography Image Quality With and Without Breast Shields.
Angina.com Interview with Dr. Eddie Hulten, MD MPH
Non-Invasive Cardiovascular Imaging
Brigham and Women’s Hospital
Harvard Medical School
• Angina.com: What are the main findings of the study?
• Dr. Hulten: We reviewed a convenience sample of patients who had
previously been scanned with bismuth breast shields while undergoing
coronary CT angiography. We found differences in noise and an
association of different plaque types by shielded versus non-shielded
groups. Image quality graded on a Likert scale was not significantly
different with no difference in uninterpretable segments according to
shielded versus not shielded.
• Angina.com: Were any of the findings unexpected?
• Dr. Hulten: We expected the difference in noise to be more dramatic and
the image quality to be poorer for the shielded patients. However, it is
important to note that most of the scans were performed using
retrospective ECG gating, which delivers a higher overall radiation than
most contemporary scans. Thus, the results should not be extrapolated to
patients scanned using prospectively-triggered ECG gating or high pitch
scans.
49. Comparison of Coronary CT Angiography Image Quality With and Without Breast Shields.
Angina.com Interview with Dr. Eddie Hulten, MD MPH
Non-Invasive Cardiovascular Imaging
Brigham and Women’s Hospital
Harvard Medical School
(cont)
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Hulten: Patients scanned with breast shields in this study had interpretable coronary CT
angiograms although the scans were noisier and had different plaque types detected, which could
be associated with the shielding. However, breast shields are not currently recommended for
clinical use by the SCCT or medical physicists due to concern for wasting radiation. Also other
radiation sparing techniques may be more effective, reproducible, and impact image noise less.
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Hulten: Study of additional radiation reducing methods during coronary CT angiography is
indicated. While breast shields are not recommended for routine clinical use, further evaluation of
shields’ impact upon coronary CT imaging may be warranted in specific research protocols.
• Citation:
• Comparison of Coronary CT Angiography Image Quality With and Without Breast Shields.
• Hulten E, Devine P, Welch T, Feuerstein I, Taylor A, Petrillo S, Luncheon M, Nguyen B, Villines TC.
• Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD.
AJR Am J Roentgenol. 2013 Mar;200(3):529-36. doi: 10.2214/AJR.11.8302.
50. Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes
Angina.com Interview with: Dr Kristine Færch PhD
BSc, MSc (Human Nutrison), PhD. STAR Researcher
Steno Diabetes Center
Niels Steensens Vej 1
DK-2820 Gentofte Denmark
• Angina.com: What are the main findings of the study?
• Dr. Færch: Our study underscores the heterogeneity of
type 2 diabetes. Individuals who develop type 2
diabetes have different underlying mechanisms
dependent on whether they are diagnosed with
diabetes by elevated fasting glucose, elevated 2-hour
glucose (after an oral glucose tolerance test) or
combined elevated fasting and 2-hour glucose. We
found very different trajectories of beta cell function,
obesity development and several cardiovascular risk
factors prior to diagnosis of diabetes in the three
groups.
51. Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes
Angina.com Interview with: Dr Kristine Færch PhD
BSc, MSc (Human Nutrison), PhD. STAR Researcher
Steno Diabetes Center
Niels Steensens Vej 1
DK-2820 Gentofte Denmark
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Færch: We expected to find different patterns of some cardiometabolic
risk factors, but we were surprised that the differences were so
pronounced in the different subtypes of type 2 diabetes – especially with
regard to beta cell function. A classic pattern of early beta cell
compensation followed by a progressive loss of beta cell function was only
found in 25% of the individuals who developed diabetes, whereas 20%
had a constant low beta cell function starting already 18 years before they
were diagnosed with diabetes.
• Angina.com: What should clinicians and patients take away from this
study?
• Dr. Færch: Most clinicians already acknowledge that type 2 diabetes is a
heterogeneous disease, but this study adds to a deeper understanding of
this heterogeneity. It is likely that the optimal treatment will differ among
patients with the different subtypes identified in our study.
52. Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of type 2 diabetes
Angina.com Interview with: Dr Kristine Færch PhD
BSc, MSc (Human Nutrison), PhD. STAR Researcher
Steno Diabetes Center
Niels Steensens Vej 1
DK-2820 Gentofte Denmark
(cont)
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Færch: First of all, it is important to study the underlying mechanisms of the
different type 2 diabetes subtypes in other populations because there may be
ethnic differences. If our findings are confirmed in other populations, the next step
will be to see how the different subtypes of type 2 diabetes respond to medication
in regard to glucose control and prevention of diabetic complications. Also, it will
be relevant to examine whether type 2 diabetes should be prevented differently in
high-risk individuals with impaired fasting glycemia (elevated fasting glucose) and
impaired glucose tolerance (elevated 2-hour glucose).
• Citation:
• Trajectories of cardiometabolic risk factors before diagnosis of three subtypes of
type 2 diabetes: a post-hoc analysis of the longitudinal Whitehall II cohort study
Dr Kristine Færch PhD,Daniel R Witte PhD,Adam G Tabák PhD,Leigh Perreault
MD,Christian Herder PhD,Eric J Brunner PhD,Prof Mika Kivimäki PhD,Dorte Vistisen
PhD
The Lancet Diabetes & Endocrinology – 21 February 2013
DOI: 10.1016/S2213-8587(13)70008-1
53. African American Race is a Correlate of Heart Failure in Breast Cancer Survivors: A study of 26,347 women identified with breast cancer
from 1973-2007
Angina.com Interview with Anna Valina-Toth, MD, PhD
Department of Internal Medicine
Case Western Reserve University at MetroHealth
• Angina.com: What are the main findings of the study?
• Answer: – In female breast cancer survivors, the risk of developing heart
failure is higher in African Americans compared to Caucasians.
• Angina.com: Were any of the findings unexpected?
• Answer: - We are not surprised that in breast cancer survivors, African
Americans have higher heart failure occurrence compared to
whites. African Americans, especially women, relative to whites, have
excessive prevalence of hypertension, obesity and obesity related diseases
(including diabetes), oxidative stress, inflammation, and endothelium
nitric oxide-dependent vascular dysfunction and vitamin D deficiency.
• All these aforementioned co-morbidities plausibly predispose African
Americans to higher risk of HF events including those who are breast
cancer survivors.
54. African American Race is a Correlate of Heart Failure in Breast Cancer Survivors: A study of 26,347 women identified with breast cancer
from 1973-2007
Angina.com Interview with Anna Valina-Toth, MD, PhD
Department of Internal Medicine
Case Western Reserve University at MetroHealth
(cont)
• Angina.com: What should clinicians and patients take away from this study?
• Answer:- This study reveals a significant health disparity in heart failure prevalence
that disproportionately affects African Americans compared to Caucasians in a
cohort of breast cancer survivors.
• Angina.com: What further research do you recommend as a result of your study?
• Answer:- Future research to determine whether non-invasive cardiac imaging and
pre-treatment with cardioprotective drugs such as ACE-inhibitors and beta
blockers prior to initiation of antracyclines and trastuzumab based-chemotherapy
would reduce the risk of heart failure in breast cancer patients especially in African
Americans who are predisposed to developing heart failure merit investigation.
• Citation:
• African American Race is a Correlate of Heart Failure in Breast Cancer Survivors: A
study of 26,347 women identified with breast cancer from 1973-2007 Presented at
ACC 2013 March 2013
55. Tooth Loss Is Highly Prevalent And Associated With Cardiovascular Risk Factors In Patients With Chronic Coronary Heart Disease In The
Global Stability Trial
Angina.com Interview with Dr. Ola Vedin, M.D.
Department of Medical Sciences/Uppsala Clinical Research Centre (UCR)
Uppsala University Uppsala SWEDEN
• Angina.com: What are the main findings of the study?
• Dr. Vedin: Self-reported tooth loss and gum bleeding, as markers of
periodontal disease, are common in this global population of
patients with established coronary heart disease (i.e. previous
myocardial infarction or verified coronary artery stenosis). Poor
dental health, especially tooth loss, is associated with several
established cardiovascular risk factors, including diabetes, smoking,
high blood pressure and obesity, but also with more novel ones
including Lp-PLA2.
Angina.com: Were any of the findings unexpected?
• Dr. Vedin: We were surprised by the large proportion of patients
with no or very few teeth and had expected somewhat stronger
associations between gum bleeding and cardiovascular risk factors.
56. Tooth Loss Is Highly Prevalent And Associated With Cardiovascular Risk Factors In Patients With Chronic Coronary Heart Disease In The
Global Stability Trial
Angina.com Interview with Dr. Ola Vedin, M.D.
Department of Medical Sciences/Uppsala Clinical Research Centre (UCR)
Uppsala University Uppsala SWEDEN
(cont)
• Angina.com: What should clinicians and
patients take away from this study?
• Dr. Vedin: There is an association between
self-reported tooth loss and cardiovascular
risk factors but we do not yet know whether
this relationship is causal.
• Periodontal disease in relation to
cardiovascular risk is a hot, but poorly
understood topic that needs further exploring.
57. Tooth Loss Is Highly Prevalent And Associated With Cardiovascular Risk Factors In Patients With Chronic Coronary Heart Disease In The
Global Stability Trial
Angina.com Interview with Dr. Ola Vedin, M.D.
Department of Medical Sciences/Uppsala Clinical Research Centre (UCR)
Uppsala University Uppsala SWEDEN
(cont)
• Angina.com: What further research do you recommend as a result of your study?
• Dr. Vedin: We are anticipating outcome data later this year when the study closes.
Then we can relate the data on dental health to cardiovascular outcome and, after
adjusting for common risk factors, clarify whether self-reported tooth loss and
gum bleeding may actually be associated with myocardial infarction and death.
• More widely speaking, there is a need for independent studies designed to
determine whether poor dental health, or periodontal disease, actually causes
coronary heart disease and if so, if periodontal treatment lowers cardiovascular
risk.
• Citation:
• Tooth Loss Is Highly Prevalent And Associated With Cardiovascular Risk Factors In
Patients With Chronic Coronary Heart Disease In The Global Stability Trial
• Dr. Vedin presented the study “Tooth Loss Is Highly Prevalent And Associated With
Cardiovascular Risk Factors In Patients With Chronic Coronary Heart Disease In The
Global Stability Trial” on Saturday, March 9 at 3:45 p.m., in Moscone Center, Expo
North during the ACC13 meeting
58. Sleep Apnea and Risk of Peptic Ulcer Bleeding
Angina.com Interview with: Chou, Kun-Ta, M.D
Taipei Veterans General Hospital, Taipei, Taiwan
• Angina.com: What are the main findings of the
study?
• Response: In this retrospective matched-control
cohort study including 35,480 patients (7,096
sleep apnea patients vs. 28,384 controls) with a
mean follow-up period of 3.57 years, we found
patients with sleep apnea experienced a 2.400-
fold (95% CI, 1.544-3.731, p<0.001) higher risk for
incident peptic ulcer bleeding after adjusting
other significant variables.
59. Sleep Apnea and Risk of Peptic Ulcer Bleeding
Angina.com Interview with: Chou, Kun-Ta, M.D
Taipei Veterans General Hospital, Taipei, Taiwan
(cont)
• Angina.com: Were any of the findings unexpected?
• Response: Sleep apnea is a common disease and
linked with a variety of cardiovascular diseases, such as
hypertension, atherosclerosis, and arrhythmia.
However, its impact on the affected individuals seems
more widespread than we would expect, not
exclusively limited to the cardiovascular system. The
gastrointestinal system is probable to be affected as
well. We found it surprising that sleep apnea confers a
higher risk for incident peptic ulcer bleeding, even
within a relatively short follow-up period in such a
young population (aged 46.61 years on average).
60. Sleep Apnea and Risk of Peptic Ulcer Bleeding
Angina.com Interview with: Chou, Kun-Ta, M.D
Taipei Veterans General Hospital, Taipei, Taiwan
(cont)
• Angina.com: What should clinicians and patients take
away from this study?
• Response: Our results suggest that sleep apnea is an
independent risk factor for peptic ulcer bleeding. Despite
clear conclusion provided, this study is limited by its
retrospective design and inability to include information
about the lifestyle of the enrollees, such as smoking,
alcohol consumption, obesity etc., which may possibly
confound our results.
• For treatment of peptic ulcer bleeding in clinical practice,
the clinicians should go through the traditional risk factors
in such patients. For those without apparent risk factors
identified, we may survey for sleep apnea as a potential
predisposing factor.
61. Sleep Apnea and Risk of Peptic Ulcer Bleeding
Angina.com Interview with: Chou, Kun-Ta, M.D
Taipei Veterans General Hospital, Taipei, Taiwan
(cont)
• Response: What further research do you recommend as a result
of your study?
• Response: Our study may prompt further elaborate prospective
research to confirm our conclusion and probe into the mechanism
underlying the linkage of sleep apnea and its gastrointestinal
complications.
• Citation:
• Sleep Apnea and Risk of Peptic Ulcer Bleeding: A Nationwide
Population-based Study
• Am J Med. 2013 Mar;126(3):249-255.e1. doi:
10.1016/j.amjmed.2012.08.017.
• Shiao TH, Liu CJ, Luo JC, Su KC, Chen YM, Chen TJ, Chou KT, Shiao
GM, Lee YC.
Department of Chest Medicine, Taipei Veterans General Hospital,
Taipei, Taiwan.
62. The Effect of Weight Loss on the Incidence of Heart Failure or Death in MADIT-CRT Patients
Angina.com Interview with Dr. Valentina Kutyifa, MD, MSc
University of Rochester Medical Center NY
• Angina.com: What are the main findings of the study?
• Dr. Kutyifa: In 170 of 994 (17%) patients implanted
with CRT-D in the MADIT-CRT clinical trial, an
unplanned, greater than – 2 kg weight loss was
observed at 12 months after device implantation. The
risk of heart failure or death was significantly higher in
patients with unanticipated, significant weight loss as
compared to those without weight loss. Each kilogram
weight loss was associated with 4% increase in the risk
of heart failure or death during an average of 29
months follow-up in the study. Patients with left
bundle branch block and significant weight loss (> –
2kg) doubled their risk of heart failure or death.
63. The Effect of Weight Loss on the Incidence of Heart Failure or Death in MADIT-CRT Patients
Angina.com Interview with Dr. Valentina Kutyifa, MD, MSc
University of Rochester Medical Center NY
(cont)
• Angina.com: Were any of the findings unexpected?
• Dr. Kutyifa: This study is consistent with the findings from other studies that have
looked at the obesity paradox, suggesting that patients with weight loss have
worse clinical outcome as compared to those without a weight loss. We need to
stress that in this particular study, patients were not following any dietary rules,
and they were not encouraged to lose weight, the weight loss was unanticipated.
• Angina.com: What should clinicians and patients take away from this study?
• Dr. Kutyifa: In patients with heart failure who receive a cardiac resynchronization
device with defibrillator (CRT-D), unintended weight loss increases the risk of heart
failure or death.
• It may be advisable for heart failure patients with unplanned significant weight
loss to consult their doctor, and physicians may perform diagnostic tests, refining
medical treatment if necessary, and monitor these patients more closely to
prevent the development of serious events.
• However, we still suggest implementing weight control under a physician’s
supervision in obese heart failure patients, because obesity is known to be
associated with diabetes, high blood pressure, and the development of coronary
artery disease.
64. The Effect of Weight Loss on the Incidence of Heart Failure or Death in MADIT-CRT Patients
Angina.com Interview with Dr. Valentina Kutyifa, MD, MSc
University of Rochester Medical Center NY
(cont)
• Angina.com: What further research do you recommend as a result of
your study?
• Dr. Kutyifa: The effects of weight loss needs to be further evaluated in
patients with an implanted CRT-D, and baseline obesity needs to be taken
into consideration. It would be interesting to see, if this effect is
maintained regardless of the baseline weight, and baseline body mass
index (BMI), or less obese patients would more affected than those with
obesity to start with.
• Citation:
• The Effect of Weight Loss on the Incidence of Heart Failure or Death in
MADIT-CRT Patients
• American College of Cardiology annual meeting in San Francisco
Abstract: 308
Valentina Kutyifa ,Mehmet Aktas, David Huang, Scott McNitt, Arthur Moss,
Wojciech Zareba, University of Rochester Medical Center, Heart Research
FollowUp Program, Rochester, NY, USA
65. Association of Body Mass Index with Risks of Myocardial Infarction and Ischemic Stroke in Young Women
Angina.com Interview with Michelle Schmiegelow
PhD student at the University of Copenhagen
• Angina.com: What are the main findings of the study?
• Answer: In this nationwide register-based study of 273,000 healthy
women with a median age of approximately 30 years, we found
obesity (body mass index >30 kg/m2) to be associated with a
significantly increased risk of myocardial infarction and ischemic
stroke within 4.5 years following childbirth. The absolute risks were
low, but the key message is clear.
• Angina.com: Were any of the findings unexpected?
• Answer: We found it surprising that the obesity-associated health
risk becomes apparent within a relatively short follow-up in such a
young population of women even following adjustment for
important cardiovascular risk factors.