angina.com heart disease interviews october 2012

Angina.com

Angina.com Research Interviews on Heart Disease , Coronary Artery Disease and Angina.

http://www.Angina.com/

Read more interviews on Hemodialysis.com

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.

Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction

Angina.com Author Interview: Dr Andrew Wragg, Consultant Cardiologist at BMI Healthcare.

• Angina.com: What are the main findings of the study?• This is the first large observational study exploring the safety and feasibility of discharge

from hospital two days after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI).

We showed in 2,653 patients that simple clinical criteria (TIMI III flow in the infarct related artery, LV ejection fraction >40%, rhythmic and hemodynamic stability, absence of heart failure, absence of severe co-morbidity) can be used to easily identify low risk patients.

These low-risk patients can then be discharged very early at two days after their PPCI in a manner that is both feasible and safe with low clinical event rates (Major adverse cardiac events) during follow-up.

However we would like to emphasize that this study does not attempt to investigate the direct effect of length of hospital stay on outcome in a causative manner. Rather this study presents data regarding the feasibility and safety of an early discharge policy.

• Read the rest of the interview on Angina.com

http://www.angina.com/author_interviews/hospital_discharge_two_days_after_pci_for_stemi.html



The mediating effect of the Mediterranean diet on the role of discretionary and hidden salt intake regarding non-fatal acute coronary syndrome or stroke events: A case/case-control

studyAngina.com Author Interview: Prof.DB Panagiotakos

• Angina.com: What are the main findings of the study?• This study highlighted the detrimental role of salt and salty food consumption on

cardiovascular events, and mainly on ischemic stroke events, as use of salt added in table was associated with 81% higher likelihood of stroke, while each unit increase of the score evaluating total salty food consumption (processed meat, canned food, fast food, feta-cheese, yellow-cheese, white-cheese, salted nuts, olives, prepared sauces, bread and rusks) was associated with 33% higher likelihood of stroke presence.

• Furthermore, the negative effect of salt and salty food consumption regarding stroke presence was more evident for participants with lower adherence to the Mediterranean diet.

• This is one of the few studies that have examined the role of salt intake and foods which are sources of hidden salt, under the perspective of adherence to the Mediterranean dietary pattern, offering additional information on cardiovascular disease prevention.


http://www.angina.com/author_interviews/mediterranean_diet_salt_intake_and_non_fatal_coronary_syndrome.html




Statins use and coronary artery plaque composition Results from the International Multicenter CONFIRM RegistryAngina.com Author Interview:

Ryo Nakazato, MD, PhD, FACC, FAHA, FASNC, FSCCTCedars-Sinai Medical Center

• Angina.com: What are the main findings of the study?• We evaluate the association of statin use to coronary artery plaque composition in patients without known

coronary artery disease undergoing coronary CT angiography.

Statin use was associated with increased prevalence of calcified plaque, but not coronary segments with non-calcified plaque.

• Statin use was associated with increasing numbers of coronary segments possessing CP, but not coronary segments with non-calcified plaque.

Further, in the subgroup of individuals with successful lipid control—as defined by LDL<130, TC<200 or HDL≥40 mg/dl—statin use was associated with increasing numbers of coronary segments possessing calcified plaque, but not for non-calcified plaque.

• Angina.com: What should clinicians and patients take away from this study?• Our findings may reflect a differential effect of statins on plaque progression by composition type, or

alternatively, may represent a conversion of non-calcified plaque to calcified plaque composition.

Germane to the latter, we noted that the use of statins and, in particular, the effectiveness of statins (as surrogate determined by achieving goal cholesterol levels), was associated with increasing presence and numbers of coronary segments with calcified plaque components.


http://www.angina.com/author_interviews/statin_use_and_coronary_artery_plaque_composition.html



Mortality risk of triglyceride levels in patients with coronary artery diseaseAngina.com Author Interview:

Takatoshi Kasai, MD, PhD Department of Cardiology, Juntendo University, School of Medicine

• Angina.com: What are the main findings of the study?• Elevated fasting triglyceride level is associated with increased risk of cardiac

mortality in patients following complete coronary revascularization.• Angina.com: Were any of the findings unexpected? • We expected to see our main findings since some other studies including

studies in the primary prevention filed. • Angina.com: What should clinicians and patients take away from this study?• Clinicians and patients should remind the importance of fasting triglyceride

levels to reduce cardiac mortality in patients with coronary artery disease. In addition, they should note that fasting triglyceride levels indicate mortality risk in the secondary prevention of CAD regardless of the presence or absence of other concomitant cardiovascular risks.


http://www.angina.com/author_interviews/triglyceride_level_mortality_and_cad.html


Mortality risk of triglyceride levels in patients with coronary artery diseaseAngina.com Author Interview: Takatoshi Kasai, MD, PhD

Department of Cardiology, Juntendo University, School of Medicine

• Angina.com: What are the main findings of the study?• Elevated fasting triglyceride level is associated with increased risk of cardiac

mortality in patients following complete coronary revascularization.• Angina.com: Were any of the findings unexpected? • We expected to see our main findings since some other studies including

studies in the primary prevention filed. • Angina.com: What should clinicians and patients take away from this study?• Clinicians and patients should remind the importance of fasting triglyceride

levels to reduce cardiac mortality in patients with coronary artery disease. In addition, they should note that fasting triglyceride levels indicate mortality risk in the secondary prevention of CAD regardless of the presence or absence of other concomitant cardiovascular risks.






Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial

Angina.com Author Interview: Dr. Louise Lind Schierbeck

• Angina.com: What are the main findings of the study?• In this randomized trial of newly postmenopausal women, the women on HRT had after 10

years a 50% statistically significantly reduced risk of a cardiovascular event or death. This persisted after the intervention stopped, thus 6 years later the risk was still reduced with 40% in the women who had received HRT.

Furthermore, it has previously been claimed that the risk of breast cancer is severely increased when using HRT; We DID NOT find this – actually, there was a trend towards a reduction in breast cancer in the HRT treated in DOPS, but this result was not statistically significant. Though, the HRT-treated women had a reduced risk of “death or breast cancer” – which was statistically significant after 10 years of treatment, but waned after further 6 years off-treatment.

• Angina.com: Were any of the findings unexpected? • Yes, the results on breast cancer actually surprised us, but may not be all that different

from what has been found in other trials, when those have been adjusted for baseline confounding.


http://www.angina.com/author_interviews/hormone_replacement_cv_events_recent_postmenopausal_women.html



Cognitive-Perceptual Factors in Noncardiac Chest Pain and Cardiac Chest Pain Angina.com Author Interview: Stefanie Schroeder

• Angina.com: What are the main findings of the study?• In our sample of patients with chest pain of unknown origin in an outpatient and inpatient

setting 70 % were classified as having non-cardiac chest pain (NCCP) based on the results of cardiac angiography (normal or near-normal coronary arteries with a luminal narrowing of less than 50%).

A range of cognitive-perceptual factors, such as subjective illness perceptions, were associated with the experience of chest pain in NCCP as well as in patients with a cardiac origin of chest pain (cardiac chest pain, CCP).

In multivariable analyses, somatic amplification was the only cognitive-perceptual factor that was higher in NCCP than in CCP and thus being able to differentiate between NCCP and CCP.

• Angina.com: Were any of the findings unexpected? • Previous research reported not only somatic amplification but also anxiety sensitivity as well

as illness perceptions to be more pronounced in patients with NCCP than in patients with CCP. In our study anxiety sensitivity and subjective illness perceptions did not turn out to be features specific for NCCP.


http://www.angina.com/author_interviews/beta_blocker_use_in_outpatients.html




β-Blocker Use and Clinical Outcomes in Stable Outpatients With and Coronary Artery DiseaseAngina.com Author Interview:

Sripal Bangalore, MD, MHA, FACC, FSCAI,

• Angina.com: What are the main findings of the study?• We found, from an analysis of over 44,000 patients that beta blockers were

not associated with lower risk of CV death, MI or stroke in patients with prior history of MI, those with CAD but without MI and those with risk factors alone. In patients with recent MI (<1 year) there was however a benefit for a softer 'secondary' outcome that included hospitalization but no benefit for primary outcome.

• Angina.com: Were any of the findings unexpected? • The lack of association of beta blocker use with lower events in the prior MI

cohort was somewhat unexpected.

However, a review of the clinical trial data suggests that in patients without heart failure, there is no robust data to support long term use of beta blockers even in this group of patients.





Impact of ESC/ACCF/AHA/WHF universal definition of myocardial infarction on mortality at 10 years

Angina.com Author Interview: Francisco Costa, MD

• Angina.com: What are the main findings of the study?• 1- Our study was the first to demonstrate the impact of the Universal Definition of myocardial

infarction (based on cardiac troponins) in mortality at 10 years.

In a population admitted with the diagnosis of ACS, the use cardiac troponin I allowed the detection of small amounts of myocardial necrosis, increasing the diagnosis of acute MI by 25%, when compared with the old definition based on CK-MB.

AMI by the new definition was associated with a 60% increase in long-term mortality (HR 1.58; 95%CI 1.07-2.04, p= 0.003).

2- In our population, revascularization in the setting of an ACS had a protective role, being associated with 40% lower risk of death.

3- Our study is also the first to validate the impact of the GRACE score in mortality at 10 years. Having a score >148 presented a risk of death 3 times higher.

• Angina.com: Were any of the findings unexpected? • Yes, we expected higher long-term mortality in patients with MI compared with those without MI

using ST-segment elevation criteria, as well as, old definition. • Read the rest of the interview on Angina.com

http://www.angina.com/author_interviews/impact_universal_definition_mi.html



Impact of Chronic Obstructive Pulmonary Diseases on Outcomes and Hospital Days After Percutaneous Coronary Intervention

Angina.com Author Interview: Jian Wei Zhang, MD

• Angina.com: What are the main findings of the study?• COPD is associated with significantly increased Composite

MACE and hospital stay in patients after PCI. Increasing severity of COPD is associated with increased Composite MACE and hospital stay after PCI.

• Angina.com: Were any of the findings unexpected? • Increasing severity of COPD is associated with increased

Composite MACE and hospital stay after PCI.• Angina.com: What should clinicians and patients take away

from this study?• Pay attention to COPD and treat COPD aggressively.• Read the rest of the interview on Angina.com

http://www.angina.com/author_interviews/copd_impact_after_pci.html



Long-term cardiovascular risk of NSAID use according to time passed after first-time myocardial infarction. A nationwide cohort study

Angina.com Author Interview: Anne-Marie Schjerning Olsen MD

• Angina.com: What are the main findings of the study?• The current study addresses the risk of all NSAIDs in a selected population of post-MI patients. • We present a comprehensive analysis on the effect of time passed following first-time MI NSAID treatment

on risk of death or coronary death CHD/recurrent MI (Re-MI) in a nationwide cohort of MI survivors.

Our new findings are that the risk of death and CHD/Re-MI remains elevated in NSAID users for up to five years after first MI.

The results support previous findings suggesting that NSAIDs have no apparent safe treatment window among heart attack patients, and show that coronary risk related to using the drugs remains high, regardless of the time that has passed since the heart attack.

• Angina.com: Were any of the findings unexpected? • Yes. The risks of cardiovascular mort

ality and morbidity are well-known complications after MI. The risk is highest soon after the MI but declines as time passes and eventually corresponds to the risk of the background population after 5–10 years.

It was unexpected that the risk associated with using NSAIDs remained virtually unchanged throughout all 5 years after discharge from hospital after the first MI.


http://www.angina.com/author_interviews/nsaid_risk_after_first_mi.html



Chronic aspirin and statin therapy in patients with impaired renal function and acute coronary syndromes: results from the IN-ACS Outcome Study

Angina.com Author Alessandro Sciahbasi MD

• Angina.com: What are the main findings of the study?• The IN-ACS Outcome Registry is an Italian multi center observational registry of patients with acute coronary syndromes.

In the context of this study we performed a sub-analysis evaluating if a previous chronic aspirin or statin therapy in patients with impaired renal function may affect their outcome after the acute coronary syndrome.

More than 1400 patients with impaired renal function were enrolled in this analysis and these patients were divided in 4 groups according to their previous therapy: aspirin alone, statin alone, combination therapy with aspirin and statin and no therapy.

The main finding of our study was that despite a baseline higher risk profile, the group on chronic aspirin aspirin and statin therapy was associated with better outcome compared to the other groups.

Aspirin alone was ineffective to obtain a significant improvement in outcome, whereas statin alone therapy was effective but in a lower risk population.

Consequently the association of aspirin and statin therapy should be considered a possible therapy in patients with impaired renal function to reduce the cardiovascular risk.

The main limitation of our study is the observational design of the study.

Then to confirm our results, future randomized studies evaluating the possible role of the combination therapy with aspirin and statin in the prevention of cardiovascular risk of patients with impaired renal function are necessary.


http://www.angina.com/author_interviews/chronic_asa_and_statin_in_acs_with_impaired_renal_function.html



Body Composition and Survival in Stable Coronary Heart Disease Impact of Lean Mass Index and Body Fat in the "Obesity Paradox"

Angina.com Author Interview: Carl J. Lavie, M.D.,FACC,FACP,FCCP

• Angina.com: What are the main findings of the study?• The main finding is that both higher lean body mass and body fat were strong independent

predictors of better survival in patients with coronary heart disease.

The best survival was in those with both high lean mass and body fat, and the highest mortality was in those with both low lean mass and body fat, who had a 7-fold higher mortality than did the high lean mass and high body fat group (the group with either high lean mass or high body fat, but not both, had intermediate mortality.)

• Angina.com: Were any of the findings unexpected? • One would expect that having a higher lean mass would be good, but one would also predict that

having a higher body fat would be bad.

The obesity paradox regarding body fat, however, is not a totally new finding , as we demonstrated this with Heart Failure in American Journal of Cardiology about 8 years ago and with Coronary Heart Disease in American Journal of Medicine 2 years ago and in two separate Mayo Clinic Proceedings in the past year.

What is new, however, was that both high lean mass and high body fat were independent of each other and both predicted better survival.


http://www.angina.com/author_interviews/body_composition_and_survival_in_stable_cad.html



Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease

EventsA Systematic Review and Meta-analysisEvangelos C. Rizos, M.D., Ph.D., of the University Hospital of Ioannina, Ioannina, Greece

• Angina.com: What are the main findings of the study?• Analysis indicated no statistically significant association with all-cause

mortality, cardiac death, sudden death, heart attack, and stroke when all supplements tudies were considered across various patient populations.

• Angina.com: Were any of the findings unexpected? • Our analysis is consisted with the results of many of the landmark

trials on this field. • Angina.com: What should clinicians and patients take away from this

study?• In our pooled analysis of the data, we did not find a statistical

significant reduction in "hard" outcomes including all cause mortality. • Read the rest of the interview on Angina.com

http://www.angina.com/author_interviews/omega_3_supplementation_and_risk_of_cv_events.html





Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial InfarctionAngina.com Author Interview:

John G. Canto, MD, MSPH, FACC, FAHA, FACP, FACE

• Angina.com: What are the main findings of the study?• Our study challenges conventional wisdom that patients with more coronary heart disease (CHD)

risk factors have worse outcome.

Our data clearly show that patients with multiple coronary heart disease (CHD) risk factors present much earlier in age than patients with fewer or no risk factors.

However, patients with fewer or no CHD risk factors overall had higher mortality after first heart attack.

• Angina.com: Were any of the findings unexpected? • The reasons for this surprising finding may be attributed to the fact that patients with multiple

CHD risk factors [as compared to those with fewer or no CHD risk factors]: • 1) may also be more likely to be on treatments to modify their risk, such as higher use of aspirin,

statins & other cholesterol lowering meds, blood pressure meds, all treatments known to improve CHD outcome;

• 2) more likely to have closer medical follow-up and care to manage their risk factors in the first place.

• Lastly, the biology of disease may be different in older patients without CHD risk factors. • Read the rest of the interview on Angina.com

http://www.angina.com/author_interviews/number_cad_risk_factors_and_mortality_first_mi.html





Mortality outcome of out-of-hours primary percutaneous coronary intervention in the current eraAngina.com Author Interview:

Dr Mohaned Egred BSc (Hons) MB ChB MD FRCP FESC

• Angina.com: What are the main findings of the study?• The study was conducted in the Freeman Hospital, Newcastle upon Tyne, UK which is a large tertiary

cardiac centre performing more than 3000 angioplasty (PCI)/year of which >850 are for acute myocardial infarction called primary PCI.

Previous publications have indicated that patients, surgical or medical, outcome may be worse if admitted out of working hours or on the weekend in comparison to normal working hours.

Our study looked at patients who underwent primary PCI for acute myocardial infarction and assessed their outcome and in-hospital and long-term mortality in relation to the time of admission, normal working hours or nights and weekends.

Our main finding was that there is no difference in the outcome regardless of the time of admission. The in-hospital and long term mortality were similar in the 2 groups, normal working hours or out of hours and weekends.

• Angina.com: Were any of the findings unexpected? • The findings were to a degree not un-expected given that our centre is well staffed and all operators

are high volume operators and the same team composition covers primary PCI whether during working hours as well as out of hours and weekend. However, this study was performed to affirm this.


http://www.angina.com/author_interviews/mortality_and_out_of_hours_pci.html





Perfluorooctanoic Acid and Cardiovascular Disease in US AdultsAngina.com Author Interview: Anoop Shankar, MD, MPH, PhD

• Angina.com: What is the background for your study?• Perfluorooctanoic acid (PFOA) is a manmade chemical used in the manufacture of common household

consumer products, including surfactants, lubricants, polishes, paper and textile coatings, food packaging, and fire-retarding foams.

PFOA has been detected in the blood of more than 98% of Americans and has a long half life of approximately 3.8 years. We know that Cardiovascular disease (CVD) is the leading cause of death in the United States.

Recent evidence suggests that an association between PFOA exposure and CVD may be biologically plausible as:

-PFOA exposure has been linked to higher cholesterol levels which represent a strong, independent risk factor for CVD development.

-Higher PFOA levels were shown to be related to insulin resistance and metabolic syndrome, both associated with CVD development.

• We have recently shown that higher PFOA levels are associated with serum uric acid levels, a marker associated with an increased risk of developing CVD. Our hypothesis for the study was to determine if exposure to PFCs may be associated with a higher risk of developing CVD.


http://www.angina.com/author_interviews/pfoa_and_cv_disease_in_adults.html



One-Hour Rule-out and Rule-in of Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin TAngina.com Author Interview:

Professor Dr. Christian Müller

• Angina.com: What are the main findings of the study?• Using new hs-cTn assays it is possible to reliably rule out AMI within

1h in 60% of consecutive patients• Angina.com: Were any of the findings unexpected? • Yes, both the high percentage of patients eligible for early rule-out

as well as the very high NPV in both the derivation and validation cohort were surprising

• Angina.com: What should clinicians and patients take away from this study?

• Hs-cTn levels, if used as quantitative variables, significantly improve the management of patients with suspected AMI in the ED


http://www.angina.com/author_interviews/one_hour_rule_and_troponin.html



angina.com heart disease interviews october 2012

Health & Medicine