Podcasts about cardiology congress

Welcome back Rounds Table Listeners!We are back today with a special Rapid Fire Podcast!This week, Drs. Mike Fralick and Justin Boyle discuss top papers from the 2024 European of Society of Cardiology Congress. Here we go!Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease (0:00 – 9:25).Beta-Blocker Interruption or Continuation after Myocardial Infarction (9:25 – 13:52).Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (13:52 – 21:20).Continuation vs. Discontinuation of Renin-Angiotensin System Inhibitors Before Major Non-Cardiac Surgery (21:20 – 28:51).Of note, for prescribers in Ontario, there is now a limited use code for finerenone for patients that have both T2DM and CKD. Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

In this episode, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP,  welcome Muthiah Vaduganathan, MD, MPH, cardiologist and codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women's Hospital, for a discussion around topline data updates from the SUMMIT and FINEARTS-HF trials, the latter of which Vaduganathan served on as a trial investigator. Video Version: https://www.hcplive.com/view/diabetes-dialogue-summit-and-finearts-hf-with-muthiah-vaduganathan-md-mph SUMMIT On August 01, 2024, Eli Lilly and Company announced topline data from the SUMMIT trial, which examined use of tirzepatide (Mounjaro; Zepbound) 5mg, 10 mg, or 15 mg in adults with heart failure with preserved ejection fraction (HFpEF) and obesity. The first primary endpoint of SUMMIT a composite endpoint of time-to-first occurrence of urgent heart failure visit, heart failure hospitalization, oral diuretic intensification and cardiovascular death to study completion and the second primary endpoint was change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) from baseline to week 52. According to the announcement, results of the study indicate use of the dual GIP/GLP-1 receptor agonist was associated with statistically significant improvements in both primary endpoints, with a 38% relative risk reduction in time-to-first occurrence of heart failure outcomes relative to placebo therapy over 104 weeks of follow-up. Results also pointed to a statistically significant benefit on change from baseline in KCCQ-CSS (24.8 vs 15.0). FINEARTS-HF Less than a week later, on August 05, 2024, Bayer announced results from the phase 3 trial of their nonsteroidal mineralocorticoid receptor antagonist, finerenone (Kerendia), among patients with heart failure with mildly reduced or preserved ejection fraction. According to Bayer, FINEARTS-HF met its primary endpoint, with achieving a statistically significant reduction of the composite of cardiovascular death and total heart failure events relative to placebo therapy. The trial is due to be presented in a Hot Line session at the upcoming European Society of Cardiology Congress and Bayer plans to discuss the data and submission for regulatory approval with the US Food and Drug Administration. 

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. The episode discusses several studies presented at the European Society of Cardiology Congress, including one finding that completely opening blocked arteries in older heart attack patients led to better outcomes. Another study surprisingly showed iron infusion did not help heart failure patients as expected. The episode also mentions that ablation seems to be more effective for atrial fibrillation in advanced heart failure cases. Managing weight through drugs like Ozempic was found to benefit those with heart failure and preserved ejection fraction as well. Throughout, Doctor Warrick emphasizes the importance of a multi-disciplinary approach to genetic heart conditions.

Please join author Petr Ostadal and Associate Editor Dharam Kumbhani as they discuss the article "Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Peder Myhre: And I'm Dr. Peder Myhre, social media editor from Akershus University Hospital and University of Oslo in Norway. And today Carolyn will have such an interesting feature discussion. We are going to look into the use of ECMO to treat patients with cardiogenic shock, the results of the ECMO-CS randomized clinical trial. Isn't that interesting? Dr. Carolyn Lam: Awesome. Can't wait. But I suppose you're going to tell us about some papers in the issue first. I'm getting my coffee. Dr. Peder Myhre: Yeah, go ahead. Because first we're going to talk about a very interesting paper that relates to diabetes and the progression of coronary artery disease. So as you know, Carolyn, diabetes remains associated with an increased risk of cardiovascular morbidity and mortality. And although the absolute risk difference between patients with and without diabetes have declined over the past 20 years, we still don't know what is the diabetes associated differences in coronary plaque morphology and lipid content. Dr. Carolyn Lam: It's true. That's a very interesting question. And will you tell us more? Dr. Peder Myhre: Yeah. So the investigators in the prospect two study who enrolled patients exclusively from Denmark, Norway in Sweden who presented with biomarker positive MI and assessed both culprit lesions and untreated non-culprit lesions in these patients. And then they stratified the patients by diabetes status and examined with three vessel quantitative coronary angiography and near infrared spectroscopy and intravascular ultrasound imaging after successful percutaneous coronary intervention. Dr. Carolyn Lam: Okay, that's deep investigation. And what did they find? Dr. Peder Myhre: So diabetes was present in about 12% of patients and during a median or 3.7 year follow up, MACE occurred almost twice as free frequently in patients with versus without diabetes. And that was primarily due to an increased risk of MI related to culprit lesion stenosis and non-culprit relation related spontaneous MI. However, baseline prevalence of high-risk plaque characteristics was similar for patients with versus without diabetes, concerning culprit and the non-culprit lesions and in multi-variable models, diabetes was associated with MACE in lesions but not with prevalence of high-risk plaque characteristics. So Carolyn, the authors conclude that diabetes related plaque characteristics that might underlie the increased risk were not identified by multimodal imaging. Dr. Carolyn Lam: Oh, I just love studies like that so elegant with just a really, really intriguing results that make us ask more important questions. Love it. Thank you. Well, the next paper is also about myocardial infarction, but this time looking at the fibrotic remodeling after myocardial infarction because we know that MI induces a repair response that ultimately generates a stable fibrotic scar. And although the scar is important to prevent cardiac rupture, excessive pro-fibrotic response impairs optimal recovery because it promotes a development of non-contractual fibrotic areas. So would it be possible to regulate the expansion of cardiac fibroblast after MI through a paracrine action on the cardiac stromal cells? So the authors led by corresponding author Dr. Hulot from University of Paris performed a bioinformatic secretome analysis of cardiac stromal PW1 positive cells isolated from normal and post MI mouse hearts to identify novel secreted proteins. And they found that first cardiac PW1 positive stromal cells responded to myocardial infarction by secreting factors that promoted the proliferation and activation of resident fibroblasts and one such factor growth differentiation factor three or GDF3 was highly upregulated in the ischemic hearts and promoted a high induction of fibroblast proliferation via interaction with TGF beta receptors and activation of SMAD1/5 and SMAD2/3 signaling cascades. The upregulation of GDF3 was detected in the plasma of mice and humans following MI and high levels of plasma GDF3 in the days following MI predicted adverse outcomes measured six months later including cardiac dilation and limited recovery of contractile function in humans. Dr. Peder Myhre: Oh, that's so interesting. We already know GDF15 were very well, but now we hear about GDF3 in predicting fibrotic remodeling post myocardial infarction. So Carolyn, what are the clinical implications of these findings? Dr. Carolyn Lam: Exactly, Peder, in fact you said it. So the detection of high circulating GDF3 in plasma may serve as a novel biomarker of adverse fibrotic remodeling in heart tissue. That's one. And next the measurement of GDF3 plasma levels in the early post MI phase may allow for the identification of patients within an increased risk of severe myocardial fibrosis and heart failure and therefore could guide specific disease management. Dr. Peder Myhre: Thank you. That was an excellent summary of the paper, Carolyn. And now I'm going to look into a paper that relates to the important issue of arteriosclerosis following heart transplantation because as you know, transplant arteriosclerosis characterized by concentric and diffuse narrowing of vastly lumen is a major complication in long-term survivors of heart transplant patients. And increased lymph flow from donor heart to host lymph nodes has been reported to play a role in transplant arteriosclerosis. But how lymphangiogenesis affects this process is unknown. The authors of this paper, which comes to us from corresponding author Sue from Sejong University, transplanted vascular allografts between various combinations of mice including mice with severe combined immune deficiency and studied the lymphatic vessels within the grafted arteries. Dr. Carolyn Lam: Wow, that is really cool. Studying lymphatics and lymphangiogenesis in atherosclerosis. Interesting. What did they find, and what are the clinical implications? Dr. Peder Myhre: So Carolyn, lymphangiogenesis within allograft vessels began at the anastomotic sites and extended from preexisting lymphatic vessels in the host. Tertiary lymphatic organs were identified in transplanted arteries at the anastomotic site and lymphatic vessels expressing CCL21 were associated with these immune structures. Fibroblasts in the vascular allografts released VEGFC, which stimulated lymphangiogenesis into the grafts and inhibition of VEGFC signaling inhibited lymphangiogenesis, neointima formation and adventitial fibrosis of vascular allografts. And these studies identified VEGFC released from fibroblasts as signal stimulating lymphangiogenesis extending from the host into the vascular allografts. So, Carolyn, the authors conclude that the formation of lymphatic vessels play a key role in the immune response to vascular transplantation and inhibition of lymphangiogenesis may be a novel approach to prevent transplant atherosclerosis. Dr. Carolyn Lam: Wow, that is super interesting. Thanks, Peder. While also in this issue, there's an exchange of letters between Drs. Tanaka and Schulze regarding SGLT2 inhibitor treatment in acute decompensated heart failure. Why do we initiate it early? There's also a really nice On My Mind paper by Dr. Schiattarella on Cardiometabolic HFpEF. Is it the NASH of the heart? Dr. Peder Myhre: Oh, that's interesting. We also have some cardiology news by our own ‪Bridget Kuehn entitled “No Benefit Seen for Nighttime Dosing Over Morning Dosing for Antihypertensive Medications.” And this is a summary of the time trial, which was presented at European Society of Cardiology Congress in 2022. And finally, Carolyn, we have a Research Letter entitled “Stepwise Generation of Human-Induced Pluripotent Stem Cell Derived Cardiac Parasites to Model Coronary Microvascular Dysfunction” by Dr. Joseph Wu from Stanford University School of Medicine. Dr. Carolyn Lam: While cool, Peder. But now I'm so excited to hear about the ECMO-CS randomized trial. Let's go. Dr. Greg Hundley: Welcome listeners to this February 7th feature discussion and we have with us today Dr. Petr Ostadal from Na Homolce Hospital in Prague in the Czech Republic and our own associate editor, Dr. Dharam Kumbhani from UT Southwestern in Dallas, Texas. Welcome, gentlemen. Well, Petr, we'll start with you. Can you describe for us some of the background information that really led you to perform this study, and what was the hypothesis that you wanted to address? Dr. Petr Ostadal: According to the current guidelines from the management for the management of cariogenic shock, it should be considered administration of inotropes and vasopressor for hemodynamic stabilization, or it may be considered administration of inotropes and vasopressors and it should be considered the use of short-term mechanical circulatory support. And the aim of the ECMO-CS trial was to compare early conservative therapy with inotropes and vasopressors and immediate implementation of ECMO in patients with the rapidly deteriorating or severe cardiogenic shock. The hypothesis of the ECMO-CS trial was that immediate implantation of ECMO in patients with cardiogenic shock and critical hemodynamic condition will be associated with improved outcomes. Dr. Greg Hundley: Very nice. Can you describe for us this study population and then also what study design did you use to address your hypothesis? Dr. Petr Ostadal: We try to select patients who can really profit from the early ECMO implantation, and we define two categories of patients. First category where the patients with rapidly deteriorating cardiogenic shock corresponding to current sky stage D or E. This patient should have evidence of left ventricle pump failure as left ventricle ejection fraction below 35% or ejection fraction 35 to 55 in case of severe mitral regurgitation or aortic stenosis. And this patient also should require a repeated both of vasopressors to maintain mean arterial pressure about 50 millimeters of mercury. The second category where the patients with severe cardiogenic shock corresponding to current sky stage D and this patient should have the criterion of a hemodynamic conditions which was cardiac index less than 2.2 or systemic blood pressure below 100 millimeters of mercury in both situation with higher doses of inotropes and vasopressors. And in case of a low systolic blood pressure, also the evidence of left ventricle pump failure based on ejection fractional below 35 or ejection fraction 35 to 55 in case of severe mitral regurgitation of aortic stenosis. The second criteria for the metabolic criteria, that was the evidence of tissue hypoperfusion and this was defined as a higher lactate above three millimeters per litter or low ScvO2 below 50%. And the third criterion was exclusion of hypovolemia, and this was based on central venous pressure or pulmonary artery wedge pressure. So this was the major inclusion criteria in the ECMO trial. The study population was not defined based on theology of cardiogenic shock, but just on severity of cardiogenic shock. Dr. Greg Hundley: Very nice. And so your design, did you have a one-to-one randomization, or how did that work? And then also how many subjects did you include in this important trial? Dr. Petr Ostadal: The patients were randomized in one-to-one ratio to immediate implementation of ECMO or to early conservative therapy. But it is important to point out that in the early conservative therapy downstream use of ECMO was allowed in case of further hemodynamic worsening defined as increase of what lactate by three millimeters per litter. We enrolled 122 patients, 61 were randomized to early ECMO and 61 to early conservative strategy. Five patients were excluded due to absence of informed consent and finally 58 patients were analyzed in the early ECMO or immediate ECMO arm and 59 patients were analyzed in the early conservative arm. Dr. Greg Hundley: Sounds great Petr. And then tell us and describe your study results. Dr. Petr Ostadal: The primary endpoint was composite of death from any cause, resuscitated circulatory RS and implementation of another mechanical circulatory support including ECMO in the early conservative arm at 30 days. And there was no difference in the primary endpoint with P 0.2221 and has a ratio of 0.72 with a 95% confidence in interval 0.46 to 1.12. There was also no difference in the incidence of death from any cause. 50% in the immediate ECMO arm and 28%, 47.5% in the early conservative arm. There was no difference in the incidence of resuscitated circulatory arrest, 10.3 in the immediate ECMO arm and 13.6 in the early conservative arm. Less patient required another mechanical circulatory support in the early ECMO arm through 17.2 in comparison with 42.4% in the early conservative arm and downstream ECMO was used in 39% of patients in the early conservative arm. Dr. Greg Hundley: Very nice. So similar results both immediately and then 30 days later for both arms. And I think that last point that you make is very interesting. 39% of the individuals randomized to the conservative arm went on to receive VA-ECMO. Well, listeners next, we're going to turn to one of our associate editors and Dharam, you have many papers that you see. How do we put the results that Petr has just described really in the context of management of shock and results that have been published previously? Dr. Dharam Kumbhani: Yeah, Greg, thank you. And Petr, thank you for this important paper and again, I'm really honored to be here on behalf of Circulation on the Run. So again, want to congratulate the authors for really an important study. I think in terms of context, what is really interesting is the use of ECMO, particularly VA-ECMO for patients with shock has really skyrocketed. And it is interesting that this expansion has occurred in the absence despite, I guess high quality clinical trials, this trial certainly fills an important void. Although it is a small patient population, it is randomized, it is a largest randomized trial to date on this important population. And so I think most of the studies that have been done so far have been done using observational data sets which have sort of inherent limitations. So I certainly want to congratulate you on trying to study this very challenging population because in sort of that acute setting, it's frequently very hard to get patients randomized. So just broadly in that context, I think at the same time this study does sort of pose some important questions and sort of perhaps leads, just given the limitations of the sample size does sort of leave a few unanswered questions. So one question I have is, Petr, in addition to the 40% crossover rate is obviously important as Greg pointed out. The other thing is it appears that the use of other mechanical support during the conduct of this trial was also close to 40%, about 42%. So pretty much everybody in the conservative arm ended up with some kind of mechanical support. Now, at least in the last few years, a concept that has gained a lot of traction is a concept of a shock team where a number of providers with particular expertise from different disciplines would get together and sort of decide next steps was a shock team sort of part of the decision-making, especially for the conservative arm. Dr. Petr Ostadal: Thank you for this question. The situation is maybe a little bit more simple in the Czech Republic here, the cardiologist are responsible for the acute cardiac care, usually competent and experience not only for the diagnosis and examinations and monitoring of patients in cardiogenic shock, but also experience in insertion and management of the mechanical circulatory support. So here this attending cardiologist competent to manage this patient from different sites from the manage not only the conservative therapy but also the mechanical circulatory support therapy in these patients. So in this respect, this is more simple situation in the Czech Republic. Dr. Dharam Kumbhani: I just had a very quick question about, and I don't know if you want to include this, but Petr, I was curious, were patients with cardiac arrest, I know you mentioned sky shocks in were patients with cardiac arrest on the field or in the hospital included? Dr. Petr Ostadal: Thank you for this excellent question. And in comparison, with other trials comparing the or focusing on patients with cardiogenic shock in the ECMO-CS trials, cardiac arrest survivors were excluded. And the reason was that the brain damage, which is the major cause of death in these patients cannot be influenced by ECMO insertion. And second, in majority of patients after cardiac arrest, if there is a presence of shock, there is frequently combined shock with important peripheral component. And again, it cannot be assumed that this peripheral component can be reversed by ECMO implantation. So in the ECMO-CS trial, the cardiac arrest survivors were excluded from that enrollment. Dr. Greg Hundley: Well, thank you so much Petr. Petr, what do you think is the next study to be performed really in this area of research? Dr. Petr Ostadal: I think that we are happy because several other clinical trials focusing on the mechanical circulatory support in patients with cardiogenic shock underway. And there are other trials focused on ECMO and trials a bit focused on combination of ECMO with balloon pump and trials focused on Impella. So I think in the very close time we will be able to see the results of these current running trials1. Dr. Greg Hundley: And Dharam, do you have anything to add? Dr. Dharam Kumbhani: No, I agree completely with Petr. I think this is a very exciting field. I know there's a lot of interest in doing well conducted clinical trials in this space. And so certainly, I think the future is bright for investigation in this field. Dr. Greg Hundley: Very nice. Well, listeners, we want to thank Dr. Petr Ostadal from Prague in the Czech Republic and our own associate editor, Dr. Dharam Kumbhani from Dallas, Texas for bringing us this study highlighting that immediate implementation of VA-ECMO in patients with rapidly deteriorating, or severe cardiogenic shock did not improve clinical outcomes compared to an early conservative strategy that permitted downstream use of VA-ECMO in the case when the patient's hemodynamic status worsened. Well, on behalf of Carolyn, and Peder, and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

According to new data, higher concentrations of air pollution were linked to greater heart attack risk in Germany. Reference: de Buhr-Stockburger I, et al. Coronary artery disease – Epidemiology, prognosis, outcome 2. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).VISIT OUR STOREStore: https://www.selfelements.comFOLLOW USwww.selfprinciple.orgwww. youtube.com/selfprinciplewww.youtube.com/plantbasedkidneyhealthwww.instagram.com/seanhashmimd

即刻加入15Mins通勤學英語直播室，每週一9pm等你來說英文 : https://15minsengcafe.pse.is/46hm8k 每日英語跟讀 Ep.K440: How to Get Heart Patients to Take Their Pills? Give Them Just One. Heart disease kills more people than any other condition, but despite advances in treatment and prevention, patients often do not stick to their medication regimens. Now researchers may have found a solution: a so-called polypill that combines three drugs needed to prevent cardiovascular trouble. 死於心臟病的人比死於其他任何疾病的人都多，儘管在治療和預防上取得進展，患者往往不能堅守他們的藥物治療方式。現在，研究人員可能已經找到一個解決方法：一種混合三種預防心血管疾病所需藥物的所謂複方製劑。 In what is apparently the largest and longest randomized controlled trial of this approach, patients who were prescribed a polypill within six months of a heart attack were more likely to keep taking their drugs and had significantly fewer cardiovascular events, compared with those receiving the usual assortment of pills. 在明顯是這種方法規模最大、時間最長的隨機對照試驗中，心臟病發作後6個月內服用複方製劑的患者，跟服用常規藥物患者相比，更有可能繼續服用藥物，心血管事件明顯減少。 The participants also experienced one-third fewer cardiovascular deaths, although their overall risk of death from all causes was not significantly changed. 參與者因心血管疾病死亡人數也減少三分之一，即便他們因為各種原因死亡的總體風險沒有顯著改變。 The study of more than 2,000 heart patients, who were followed for three years, was published Friday morning in The New England Journal of Medicine, as the findings were presented at the European Society of Cardiology Congress in Barcelona, Spain. 這項研究對2000多名心臟病患者進行三年追蹤調查，研究結果周五上午發表在《新英格蘭醫學雜誌》，並在西班牙巴塞隆納舉行的歐洲心臟病學會年會上發表。 The study is the culmination of 15 years of work by researchers led by Dr. Valentin Fuster, director of Mount Sinai Heart at Mount Sinai Hospital in New York City and general director of the National Center for Cardiovascular Research in Spain. 這研究是紐約市西奈山醫院西奈山心臟中心主任、西班牙國立心血管研究中心總監瓦倫丁．福斯特博士帶領研究人員研究15年的結晶。 “Combination pills are easier for the physician and for the patient, and the data are pretty clear — it translates into a benefit,” said Dr. Thomas J. Wang, chair of the department of internal medicine at UT Southwestern Medical Center, who was not involved in the research but wrote an editorial accompanying the study. 未參與研究但為研究報告撰寫社評的德州大學西南醫學中心內科系主任湯瑪斯．王博士說：「複方藥物對醫生和病患來說更簡便，數據非常清楚，它轉化為一種好處。」 The polypill combines a blood-pressure medication, a cholesterol-lowering drug and aspirin, which helps prevent blood clots. 這種複方製劑結合了降壓藥、降膽固醇藥和阿斯匹林，有助防止血栓。 The polypill used in the study has not been approved by the Food and Drug Administration and is not available to patients in the United States right now. Fuster said the results of the new trial would be submitted to the agency shortly in an effort to obtain approval. 這項研究使用的複方製劑還未獲得美國食品藥物管理局批准，目前在美國還不能給患者使用。福斯特 說，這項新試驗結果很快會提交給該機構，以爭取獲得批准。 And since participants became even more likely to keep taking the polypill over time, he said, “The potential results could be even better with more follow-up.” Several studies have shown that only about half of patients, or even less, take all their medications as instructed. 他說，由於參與者會逐漸的更可能繼續服用複方製劑，「若有更多後續研究，潛在結果可能更好」。數項研究顯示，只有大約一半甚至更少患者按照指示服用所有藥物。 The new study, a randomized controlled clinical trial, enrolled just under 2,500 patients at 113 sites in Spain, Italy, France, Germany, Poland, the Czech Republic and Hungary. 這項研究是一項隨機對照臨床試驗，在西班牙、義大利、法國、德國、波蘭、捷克和匈牙利的113個地點招募到近2500名患者。Source article: https://udn.com/news/story/6904/6601708 歡迎留言告訴我們你對這一集的想法： https://open.firstory.me/user/cl81kivnk00dn01wffhwxdg2s/comments Powered by Firstory Hosting

Getting less than 8 hours of sleep each night increases the risk that children and adolescents become obese. In a study presented at the European Society of Cardiology Congress 2022, Spanish researchers grouped participants between 12 and 16 years old into three groups. Those who slept fewer than 7 hours were labeled very short sleepers. […] The post 278. Children who sleep less than eight hours per night have higher risk of obesity appeared first on Dr. David Geier - Feel and Perform Better Than Ever.

In this episode of Don't Miss a Beat, hosts Stephen Greene, MD, and Muthiah Vaduganathan, MD, MPH, provide a recap of the European Society of Cardiology Congress 2022. This recap begins with a discussion on the results of the phase 3 DELIVER trial, in which Vaduganathan served as an investigator, the ADVOR trial, and REVIVED. 

Dear colleagues, we prepared an episode on the latest trials presented in ESC 2022 and we hope you will enjoy this informative episode. You can also download the slides via this link:http://ecardiocast.com/wp-content/uploads/2022/09/ESCBOOK.pdf

Dear folks, the English edition of the ESC 2022 Trials is also ready, we hope you enjoy this episode.you can download the slides via the following link:http://ecardiocast.com/wp-content/uploads/2022/09/ESCBOOK.pdf

If you don't get quality sleep on a regular basis, you might have a higher risk for heart disease and stroke. In a new study presented at the European Society of Cardiology Congress 2022, researchers at the French National Institute of Health and Medical Research studied 7,200 adults, looking at five sleep habits and baseline […] The post 268. Sleeping better linked to lower risk of heart disease and stroke appeared first on Dr. David Geier - Feel and Perform Better Than Ever.

Pomegranate peel has protective effects against enteropathogenic bacteria US Department of Agriculture, August 31, 2021 A recent study by the U.S. Department of Agriculture revealed that pomegranate peel extract contains bioactive compounds that have potential antibacterial activity. The study's findings were published in the journal Nutrition Research. Pomegranate fruit peel is considered an agricultural waste product. However, it is a rich source of polyphenols like punicalins, punicalagins and ellagic acids. Earlier studies have shown that products derived from pomegranates have health benefits, including antibacterial activity, in vitro. There is limited evidence, however, of their antibacterial activity in vivo. For this study, researchers sought to determine the antibacterial properties of pomegranate peel extract in vivo. In particular, they focused on the punicalin, punicalagin and ellagic acid present in the peel extract. The researchers infected C3H/He mice with the bacterial pathogen Citrobacter rodentium, a bacterium that mimics the enteropathogenic bacterium, Escherichia coli. Prior to infection, the mice were orally treated with water or pomegranate peel extract. Twelve days after infection, the researchers examined C. rodentium colonization of the colon and spleen, as well as changes in tissue and gene expression. Fecal excretions were also analyzed for C. rodentium. The results revealed that the pomegranate peel extract reduced weight loss and mortality induced by C. rodentium infection. The extract also reduced C. rodentium colonization of the spleen. Additionally, pomegranate peel extract decreased the extent of damage in the colon caused by C. rodentium infection. In sum, pomegranate fruit peel extract contains bioactive compounds that can help reduce the severity of C. rodentium infection in vivo.   Vitamin D may protect against young-onset colorectal cancer Dana-Farber Cancer Institute and Harvard  School of Public Health, September 1, 2021 Consuming higher amounts of Vitamin D - mainly from dietary sources - may help protect against developing young-onset colorectal cancer or precancerous colon polyps, according to the first study to show such an association. The study, recently published online in the journal Gastroenterology, by scientists from Dana-Farber Cancer Institute, the Harvard T.H. Chan School of Public Health, and other institutions, could potentially lead to recommendations for higher vitamin D intake as an inexpensive complement to screening tests as a colorectal cancer prevention strategy for adults younger than age 50. While the overall incidence of colorectal cancer has been declining, cases have been increasing in younger adults - a worrisome trend that has yet to be explained. The authors of the study, including senior co-authors Kimmie Ng, MD, MPH, of Dana-Farber, and Edward Giovannucci, MD, DSc., of the T.H. Chan School, noted that vitamin D intake from food sources such as fish, mushrooms, eggs, and milk has decreased in the past several decades. There is growing evidence of an association between vitamin D and risk of colorectal cancer mortality. However, prior to the current study, no research has examined whether total vitamin D intake is associated with the risk of young-onset colorectal cancer. “Vitamin D has known activity against colorectal cancer in laboratory studies. Because vitamin D deficiency has been steadily increasing over the past few years, we wondered whether this could be contributing to the rising rates of colorectal cancer in young individuals,” said Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber. “We found that total vitamin D intake of 300 IU per day or more - roughly equivalent to three 8-oz. glasses of milk - was associated with an approximately 50% lower risk of developing young-onset colorectal cancer.” The results of the study were obtained by calculating the total vitamin D intake - both from dietary sources and supplements - of 94,205 women participating in the Nurses' Health Study II (NHS II). This study is a prospective cohort study of nurses aged 25 to 42 years that began in 1989. The women are followed every two years by questionnaires on demographics, diet and lifestyle factors, and medical and other health-related information. The researchers focused on a primary endpoint - young-onset colorectal cancer, diagnosed before 50 years of age. They also asked on a follow-up questionnaire whether they had had a colonoscopy or sigmoidoscopy where colorectal polyps (which may be precursors to colorectal cancer) were found. During the period from 1991 to 2015 the researchers documented 111 cases of young-onset colorectal cancer and 3,317 colorectal polyps. Analysis showed that higher total vitamin D intake was associated with a significantly reduced risk of early-onset colorectal cancer. The same link was found between higher vitamin D intake and risk of colon polyps detected before age 50. The association was stronger for dietary vitamin D - principally from dairy products - than from vitamin D supplements. The study authors said that finding could be due to chance or to unknown factors that are not yet understood. Interestingly, the researchers didn't find a significant association between total vitamin D intake and risk of colorectal cancer diagnosed after age 50. The findings were not able to explain this inconsistency, and the scientists said further research in a larger sample is necessary to determine if the protective effect of vitamin D is actually stronger in young-onset colorectal cancer. In any case, the investigators concluded that higher total vitamin D intake is associated with decreased risks of young-onset colorectal cancer and precursors (polyps). “Our results further support that vitamin D may be important in younger adults for health and possibly colorectal cancer prevention,” said Ng. “It is critical to understand the risk factors that are associated with young-onset colorectal cancer so that we can make informed recommendations about diet and lifestyle, as well as identify high risk individuals to target for earlier screening.”     Choosing personal exercise goals, then tackling them immediately is key to sustaining change University of Pennsylvania, September 1, 2021 When people set their own exercise goals – and then pursue them immediately – it's more likely to result in lasting positive changes, according to a new study at the Perelman School of Medicine at the University of Pennsylvania. The results of this research are especially important because they were found among an underserved population that is at particularly high risk of having or developing heart conditions. The study was published in JAMA Cardiology. “Most behavior change programs involve goal-setting, but the best way to design that process is unknown,” said lead author Mitesh Patel, MD, MBA, an associate professor of Medicine at Penn and vice president for Clinical Transformation at Ascension. “Our clinical trial demonstrated that physical activity increased the most when patients chose their goals rather than being assigned them, and when the goals started immediately rather than starting lower and gradually increasing over time. These findings are particularly important because the patients were from lower-income neighborhoods and may face a number of challenges in achieving health goals.” This study consisted of 500 patients from low-income neighborhoods, mainly in West Philadelphia but also elsewhere in and outside of the city. Participants either had a cardiovascular disease or were assessed to have a near-10 percent risk of developing one within a decade. These high-risk patients stood to greatly gain from increased physical activity. Patel's previous work at the Penn Medicine Nudge Unit often focused on the use of gamification, a concept used to create behavioral change by turning it into a game. The work usually tested whether playing a game attached to physical activity goals could make significant increases against not playing a game, or between different versions of a game. As with past studies, every participant was given a wearable step tracker that recorded their daily step counts through Penn's Way to Health platform. But what set this study apart from many of its predecessors was that the main outcomes of the research were less about participation in the games themselves and more about how goals were established, as well as when participants were encouraged to pursue them. Once every participant got their wearable step counter, they were given a week or two to get used to it. This time period also functioned as a baseline-setting period for everyone's pre-intervention daily step count. After that, participants were randomly assigned to the control group, which didn't have step goals or games attached, or one of the gaming groups with goals. Those in the gamified group also went through two other sets of random assignments. One determined whether they'd have input on their step goal, or whether they'd just be assigned a standard one. The second decided whether each participant would immediately start working toward their goals (for the entire 16-week intervention), or whether they'd ramp up to it, with minor increases in goals, until the full goals kicked in at week nine. After analyzing the results, the researchers saw that the only group of participants who achieved significant increases in activity were those who chose their own goals and started immediately. They had the highest average increase in their steps compared to the group with no goals, roughly 1,384 steps per day. And, in addition to raw step counts, the study also measured periods of sustained, high activity, amounting to an average increase of 4.1 minutes daily. Comparatively, those who were assigned their goals or had full goals delayed for half the intervention only increased their daily steps above the control group's average by between 500 and 600 steps. “Individuals who select their own goals are more likely to be intrinsically motivated to follow through on them,” said Kevin Volpp, MD, PhD, director of the Center for Health Incentives and Behavioral Economics. “They feel like the goal is theirs and this likely enables greater engagement.” The study didn't end when the researchers turned the games off. Participants kept their activity trackers, and in the eight weeks following the intervention, the group that chose their goals and started immediately kept up their progress. In fact, they achieved almost the exact same average in steps – just three less than during the active games. “It is exciting to see that the group that increased their activity levels by the most steps maintained those levels during follow-up,” Patel said. “This indicates that gamification with self-chosen and immediate goals helped these patients form a new habit.” Many programs, whether offered through work or by health insurance companies, offer incentives for boosts in physical activity. But these goals are often fairly static and assigned based on round numbers. Patel, Volpp, and colleagues believe this research suggests that adjusting goal setting in these programs can have a significant impact. And if these adjustments lead to gains among people with lower incomes, whom cardiovascular disease kill at 76 percent higher rates, that could be particularly important.           “Goal-setting is a fundamental element of almost every physical activity program, whether through a smartphone app or in a workplace wellness program,” Volpp said. “Our findings reveal a simple approach that could be used to improve the impact of these programs and the health of their patients.”   Comparing seniors who relocate long-distance shows that where you live affects your longevity Massachusetts Institute of Technology, September 1, 2021 Would you like to live longer? It turns out that where you live, not just how you live, can make a big difference. That's the finding of an innovative study co-authored by an MIT economist, which examines senior citizens across the U.S. and concludes that some locations enhance longevity more than others, potentially for multiple reasons. The results show that when a 65-year-old moves from a metro area in the 10th percentile, in terms of how much those areas enhance longevity, to a metro area the 90th percentile, it increases that person's life expectancy by 1.1 years. That is a notable boost, given that mean life expectancy for 65-year-olds in the U.S. is 83.3 years. "There's a substantively important causal effect of where you live as an elderly adult on mortality and life expectancy across the United States," says Amy Finkelstein, a professor in MIT's Department of Economics and co-author of a newly published paper detailing the findings. Researchers have long observed significant regional variation in life expectancy in the U.S., and often attributed it to "health capital"—tendencies toward obesity, smoking, and related behavioral factors in the regional populations. But by analyzing the impact of moving, the current study can isolate and quantify the effect that the location itself has on residents. As such, the research delivers important new information about large-scale drivers of U.S. health outcomes—and raises the question of what it is about different places that affects the elderly's life expectancy. One clear possibility is the nature of available medical care. Other possible drivers of longevity include climate, pollution, crime, traffic safety, and more. "We wanted to separate out the role of people's prior experiences and behaviors—or health capital—from the role of place or environment," Finkelstein says. The paper, "Place-Based Drivers of Mortality: Evidence of Migration," is published in the August issue of the American Economic Review. The co-authors are Finkelstein, the John and Jennie S. MacDonald Professor of Economics at MIT, and Matthew Gentzkow and Heidi Williams, who are both professors of economics at Stanford University. To conduct the study, Finkelstein, Gentzkow, and Williams analyzed Medicare records from 1999 to 2014, focusing on U.S. residents between the ages of 65 and 99. Ultimately the research team studied 6.3 million Medicare beneficiaries. About 2 million of those moved from one U.S. "commuting zone" to another, and the rest were a random 10 percent sample of people who had not moved over the 15-year study period. (The U.S. Census Bureau defines about 700 commuting zones nationally.) A central element of the study involves seeing how different people who were originally from the same locations fared when moving to different destinations. In effect, says Finkelstein, "The idea is to take two elderly people from a given origin, say, Boston. One moves to low-mortality Minneapolis, one moves to high-mortality Houston. We then compare thow long each lives after they move." Different people have different health profiles before they move, of course. But Medicare records include detailed claims data, so the researchers applied records of 27 different illnesses and conditions—ranging from lung cancer and diabetes to depression—to a standard mortality risk model, to categorize the overall health of seniors when they move. Using these "very, very rich pre-move measures of their health," Finkelstein notes, the researchers tried to account for pre-existing health levels of seniors from the same location who moved to different places. Still, even assessing people by 27 measures does not completely describe their health, so Finkelstein, Gentzkow, and Williams also estimated what fraction of people's health conditions they had not observed—essentially by calibrating the observed health of seniors against health capital levels in places they were moving from. They then consider how observed health varies across individuals from the same location moving to different destinations and, assuming that differences in unobserved health—such as physical mobility—vary in the same way as observed differences in health, they adjust their estimates accordingly. All told, the study found that many urban areas on the East and West Coasts—including New York City, San Francisco, and Miami—have positive effects on longevity for seniors moving there. Some Midwestern metro areas, including Chicago, also score well. By contrast, a large swath of the deep South has negative effects on longevity for seniors moving there, including much of Alabama, Arkansas, Louisiana, and northern Florida. Much of the Southwest, including parts of Texas, Oklahoma, New Mexico, and Arizona, fares similarly poorly. The scholars also estimate that health capital accounts for about 70 percent of the difference in longevity across areas of the U.S., and that location effects account for about 15 percent of the variation. "Yes, health capital is important, but yes, place effects also matter," Finkelstein says. Other leading experts in health economics say they are impressed by the study. Jonathan Skinner, the James O. Freeman Presidential Professor of Economics, Emeritus, at Dartmouth College, says the scholars "have provided a critical insight" into the question of place effects "by considering older people who move from one place to another, thus allowing the researchers to cleanly identify the pure effect of the new location on individual health—an effect that is often different from the health of long-term residents. This is an important study that will surely be cited and will influence health policy in coming years." The Charlotte Effect: What makes a difference? Indeed, the significance of place effects on life expectancy is also evident in another pattern the study found. Some locations—such as Charlotte, North Carolina—have a positive effect on longevity but still have low overall life expectancy, while other places—such as Santa Fe New Mexico—have high overall life expectancy, but a below-average effect on the longevity of seniors who move there. Again, the life expectancy of an area's population is not the same thing as that location's effect on longevity. In places where, say, smoking is highly prevalent, population-wide longevity might be subpar, but other factors might make it a place where people of average health will live longer. The question is why. "Our [hard] evidence is about the role of place," Finkelstein says, while noting that the next logical step in this vein of research is to look for the specific factors at work. "We know something about Charlotte, North Carolina, makes a difference, but we don't yet know what." With that in mind, Finkelstein, Gentzkow, and Williams, along with other colleagues, are working on a pair of new studies about health care practices to see what impact place-based differences may have; one study focuses on doctors, and the other looks at the prescription opioid epidemic. In the background of this research is a high-profile academic and policy discussion about the impact of health care utilization. One perspective, associated with the Dartmouth Atlas of Health Care project, suggests that the large regional differences in health care use it has documented have little impact on mortality. But the current study, by quantifying the variable impact of place, suggest there may be, in turn, a bigger differential impact in health care utilization yet to be identified. For her part, Finkelstein says she would welcome further studies digging into health care use or any other factor that might explain why different places have different effects on life expectancy; the key is uncovering more hard evidence, wherever it leads. "Differences in health care across places are large and potentially important," Finkelstein says. "But there are also differences in pollution, weather, [and] other aspects. … What we need to do now is get inside the black box of 'the place' and figure out what it is about them that matters for longevity."   Gut bacteria influence brain development Researchers discover biomarkers that indicate early brain injury in extreme premature infants University of Vienna (Austria), September 3, 2021 The early development of the gut, the brain and the immune system are closely interrelated. Researchers refer to this as the gut-immune-brain axis. Bacteria in the gut cooperate with the immune system, which in turn monitors gut microbes and develops appropriate responses to them. In addition, the gut is in contact with the brain via the vagus nerve as well as via the immune system. "We investigated the role this axis plays in the brain development of extreme preterm infants," says the first author of the study, David Seki. "The microorganisms of the gut microbiome - which is a vital collection of hundreds of species of bacteria, fungi, viruses and other microbes - are in equilibrium in healthy people. However, especially in premature babies, whose immune system and microbiome have not been able to develop fully, shifts are quite likely to occur. These shifts may result in negative effects on the brain," explains the microbiologist and immunologist. Patterns in the microbiome provide clues to brain damage "In fact, we have been able to identify certain patterns in the microbiome and immune response that are clearly linked to the progression and severity of brain injury," adds David Berry, microbiologist and head of the research group at the Centre for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna as well as Operational Director of the Joint Microbiome Facility of the Medical University of Vienna and University of Vienna. "Crucially, such patterns often show up prior to changes in the brain. This suggests a critical time window during which brain damage of extremely premature infants may be prevented from worsening or even avoided." Comprehensive study of the development of extremely premature infants Starting points for the development of appropriate therapies are provided by the biomarkers that the interdisciplinary team was able to identify. "Our data show that excessive growth of the bacterium Klebsiella and the associated elevated γδ-T-cell levels can apparently exacerbate brain damage," explains Lukas Wisgrill, Neonatologist from the Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the Medical University of Vienna. "We were able to track down these patterns because, for a very specific group of newborns, for the first time we explored in detail how the gut microbiome, the immune system and the brain develop and how they interact in this process," he adds. The study monitored a total of 60 premature infants, born before 28 weeks gestation and weighing less than 1 kilogram, for several weeks or even months. Using state-of-the-art methods - the team examined the microbiome using 16S rRNA gene sequencing, among other methods - the researchers analysed blood and stool samples, brain wave recordings (e.g. aEEG) and MRI images of the infants' brains. Research continues with two studies The study, which is an inter-university clusterproject under the joint leadership by Angelika Berger (Medical University of Vienna) and David Berry (University of Vienna), is the starting point for a research project that will investigate the microbiome and its significance for the neurological development of prematurely born children even more thoroughly. In addition, the researchers will continue to follow the children of the initial study. "How the children's motoric and cognitive skills develop only becomes apparent over several years," explains Angelika Berger. "We aim to understand how this very early development of the gut-immune-brain axis plays out in the long term. " The most important cooperation partners for the project are already on board: "The children's parents have supported us in the study with great interest and openness," says David Seki. "Ultimately, this is the only reason we were able to gain these important insights. We are very grateful for that."     Amino acid supplements may boost vascular endothelial function in older adults: Study University of Alabama, August 28, 2021 A combination of HMB (a metabolite of leucine), glutamine and arginine may improve vascular function and blood flow in older people, says a new study. Scientists from the University of Alabama report that a supplement containing HMB (beta-hydroxy-beta-methylbutyrate), glutamine and arginine (Juven by Abbott Nutrition) increased flow-mediated dilation (FMD - a measure of blood flow and vascular health) by 27%, whereas no changes were observed in the placebo group. However, the researchers did not observe any changes to markers of inflammation, including high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor-alpha (TNF-alpha) “Our results indicate that 6 months of dietary supplementation with HMB, glutamine and arginine had a positive impact on vascular endothelial function in older adults,” wrote the researchers, led by Dr Amy Ellis in the European Journal of Clinical Nutrition . “These results are clinically relevant because reduced endothelial-dependent vasodilation is a known risk factor for cardiovascular diseases. “Further investigation is warranted to elucidate mechanisms and confirm benefits of foods rich in these amino acids on cardiovascular outcomes.” The study supported financially by the National Center for Complementary and Alternative Medicine. Study details Dr Ellis and her co-workers recrtuited 31 community-dwelling men and women aged between 65 and 87 to participate in their randomized, placebo-controlled trial. The participants were randomly assigned to one of two groups: The first group received the active supplements providing 3 g HMB, 14 g glutamine and 14 g arginine per day; while the second group received a placebo. After six months of intervention, the researchers found that FMD increased in the HMB + glutamine + arginine group, but no such increases were observed in the placebo group. While no changes in CRP or TNF-alpha levels were observed in the active supplement group, a trend towards an increase in CRP levels was observed in the placebo group, but this did not reach statistical significance, they noted. “Although no previous studies have examined this combination of amino acids on vascular function, we hypothesized that the active ingredients of the supplement would act synergistically to improve endothelial function by reducing oxidative stress and inflammation,” wrote the researchers. “However, although we observed a trend for increasing hsCRP among the placebo group (P=0.059), no significant changes in hsCRP or TNF-alpha were observed for either group. “Possibly, the effects of the supplement on reducing oxidative stress and inflammation were subclinical, or the high variability in these biomarkers, particularly hsCRP, among our small sample could have precluded visible differences.” The researchers also noted that an alternate mechanism may also be responsible, adding that arginine is a precursor of the potent vasodilator nitric oxide “Although investigation of this mechanism was beyond the scope of this study, it is feasible that the arginine in the supplement improved endothelial-dependent vasodilation by providing additional substrate for nitric oxide synthesis,” they added.     Moderate coffee drinking associated with lower risk of mortality during 11-year median follow-up Semmelweis University (Bulgaria), September 1 2021.  Research presented at ESC (European Society of Cardiology) Congress 2021 revealed a lower risk of dying from any cause during an 11-year median period among light to moderate coffee drinkers in comparison with men and women who had no intake. The study included 468,629 UK Biobank participants of an average age of 56.2 years who had no indications of heart disease upon enrollment. Coffee intake was classified as none, light to moderate at 0.5 to 3 cups per day or high at over 3 cups per day. A subgroup of participants underwent magnetic resonance imaging (MRI) of the heart to assess cardiac structure and function.  Light to moderate coffee intake during the follow-up period was associated with a 12% decrease in the risk of dying from any cause, a 17% lower risk of cardiovascular mortality and a 21% reduction in the incidence of stroke in comparison with the risks associated with not drinking coffee.  “The imaging analysis indicated that, compared with participants who did not drink coffee regularly, daily consumers had healthier sized and better functioning hearts,” reported study author Judit Simon, of Semmelweis University in Budapest. “This was consistent with reversing the detrimental effects of aging on the heart.” “To our knowledge, this is the largest study to systematically assess the cardiovascular effects of regular coffee consumption in a population without diagnosed heart disease,” she announced. “Our results suggest that regular coffee consumption is safe, as even high daily intake was not associated with adverse cardiovascular outcomes and all-cause mortality after a follow-up of 10 to 15 years. Moreover, 0.5 to 3 cups of coffee per day was independently associated with lower risks of stroke, death from cardiovascular disease, and death from any cause.”

In this week's View, guest host Deepak Bhatt, MD, MPH, FACC, offers a preview of some of the hottest trials at the European Society of Cardiology Congress 2021, taking place virtually August 27-30, including IAMI, EMPEROR-Preserved, EMPEROR-Pooled, MASTER DAPT, ENVISAGE-TAVI AF, FIGARO-DKD, FIDELITY, Colchicine in Patients Hospitalized with COVID-19, PREPARE-IT, The Michelle trial, GUIDE-HF, QUARTET, TWILIGHT-HBR, PRONOUNCE, and Amulet IDE.

The Gary Null Show is here to inform you on the best news in health, healing, the environment. Green tea ingredient may ameliorate memory impairment, brain insulin resistance, and obesity Northwest A&F University (China), July 28, 2020 A study published online in The FASEB Journal, involving mice, suggests that EGCG (epigallocatechin-3-gallate), the most abundant catechin and biologically active component in green tea, could alleviate high-fat and high-fructose (HFFD)-induced insulin resistance and cognitive impairment. Previous research pointed to the potential of EGCG to treat a variety of human diseases, yet until now, EGCG's impact on insulin resistance and cognitive deficits triggered in the brain by a Western diet remained unclear. "Green tea is the second most consumed beverage in the world after water, and is grown in at least 30 countries," said Xuebo Liu, Ph.D., a researcher at the College of Food Science and Engineering, Northwest A&F University, in Yangling, China. "The ancient habit of drinking green tea may be a more acceptable alternative to medicine when it comes to combatting obesity, insulin resistance, and memory impairment." Liu and colleagues divided 3-month-old male C57BL/6J mice into three groups based on diet: 1) a control group fed with a standard diet, 2) a group fed with an HFFD diet, and 3) a group fed with an HFFD diet and 2 grams of EGCG per liter of drinking water. For 16 weeks, researchers monitored the mice and found that those fed with HFFD had a higher final body weight than the control mice, and a significantly higher final body weight than the HFFD+EGCG mice. In performing a Morris water maze test, researchers found that mice in the HFFD group took longer to find the platform compared to mice in the control group. The HFFD+EGCG group had a significantly lower escape latency and escape distance than the HFFD group on each test day. When the hidden platform was removed to perform a probe trial, HFFD-treated mice spent less time in the target quadrant when compared with control mice, with fewer platform crossings. The HFFD+EGCG group exhibited a significant increase in the average time spent in the target quadrant and had greater numbers of platform crossings, showing that EGCG could improve HFFD-induced memory impairment. "Many reports, anecdotal and to some extent research-based, are now greatly strengthened by this more penetrating study," said Thoru Pederson, Ph.D., Editor-in-Chief of The FASEB Journal.       Medieval medicine remedy could provide new treatment for modern day infections University of Warwick UK, July 28, 2020 Antibiotic resistance is an increasing battle for scientists to overcome, as more antimicrobials are urgently needed to treat biofilm-associated infections. However scientists from the School of Life Sciences at the University of Warwick say research into natural antimicrobials could provide candidates to fill the antibiotic discovery gap. Bacteria can live in two ways, as individual planktonic cells or as a multicellular biofilm. Biofilm helps protect bacteria from antibiotics, making them much harder to treat, one such biofilm that is particularly hard to treat is those that infect diabetic foot ulcers. Researchers at the University of Warwick, Dr Freya Harrison, Jessica Furner-Pardoe, and Dr Blessing Anonye, have looked at natural remedies for the gap in the antibiotic market, and in the paper, 'Anti-biofilm efficacy of a medieval treatment for bacterial infection requires the combination of multiple ingredients' published in the journal Scientific Reports today the 28 July, researchers say medieval methods using natural antimicrobials from every day ingredients could help find new answers. The Ancientbiotics research team was established in 2015 and is an interdisciplinary group of researchers including microbiologists, chemists, pharmacists, data analysts and medievalists at Warwick, Nottingham and in the United States. Building on previous research done by the University of Nottingham on using medieval remedies to treat MRSA, the researchers from the School of Life Sciences at University of Warwick reconstructed a 1,000-year-old medieval remedy containing onion, garlic, wine, and bile salts, which is known as 'Bald's eyesalve', and showed it to have promising antibacterial activity. The team also showed that the mixture caused low levels of damage to human cells. They found the Bald's eyesalve remedy was effective against a range of Gram-negative and Gram-positive wound pathogens in planktonic culture. This activity is maintained against the following pathogens grown as biofilms:   1. Acinetobacter baumanii- commonly associated with infected wounds in combat troops returning from conflict zones. 2. Stenotrophomonas maltophilia- commonly associated with respiratory infections in humans 3. Staphylococcus aureus- a common cause of skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning. 4. Staphylococcus epidermidis- a common cause of infections involving indwelling foreign devices such as a catheter, surgical wound infections, and bacteremia in immunocompromised patients. 5. Streptococcus pyogenes - causes numerous infections in humans including pharyngitis, tonsillitis, scarlet fever, cellulitis, rheumatic fever and post-streptococcal glomerulonephritis.   All of these bacteria can be found in the biofilms that infect diabetic foot ulcers and which can be resistant to antibiotic treatment. These debilitating infections can lead to amputation to avoid the risk of the bacteria spreading to the blood to cause lethal bacteremia. The Bald's eyesalve mixtures use of garlic, which contains allicin, can explain activity against planktonic cultures, however garlic alone has no activity against biofilms, and therefore the anti-biofilm activity of Bald's eyesalve cannot be attributed to a single ingredient and requires the combination of all ingredients to achieve full activity. Dr Freya Harrison, from the School of Life Sciences at the University of Warwick comments: "We have shown that a medieval remedy made from onion, garlic, wine, and bile can kill a range of problematic bacteria grown both planktonically and as biofilms. Because the mixture did not cause much damage to human cells in the lab, or to mice, we could potentially develop a safe and effective antibacterial treatment from the remedy. "Most antibiotics that we use today are derived from natural compounds, but our work highlights the need to explore not only single compounds but mixtures of natural products for treating biofilm infections. We think that future discovery of antibiotics from natural products could be enhanced by studying combinations of ingredients, rather than single plants or compounds. In this first instance, we think this combination could suggest new treatments for infected wounds, such as diabetic foot and leg ulcers. " Jessica Furner-Pardoe, from the Medical School at the University of Warwick comments: "Our work demonstrates just how important it is to use realistic models in the lab when looking for new antibiotics from plants. Although a single component is enough to kill planktonic cultures, it fails against more realistic infection models, where the full remedy succeeds." In previous research Christina Lee, from the School of English at the University of Nottingham, had examined the Bald's Leechbook, an Old English leatherbound volume in the British Library, to see if it really works as an antibacterial remedy. The Leechbook is widely thought of as one of the earliest known medical textbooks and contains Anglo-Saxon medical advice and recipes for medicines, salves and treatments. Christina adds: "Bald's eyesalve underlines the significance of medical treatment throughout the ages. It shows that people in Early Medieval England had at least some effective remedies. The collaboration which has informed this project shows the importance of the arts in interdisciplinary research."   First clinical trial of its kind studies whether cannabidiol could help treat cannabis use disorder, compared to placebo University of Bath (UK), July 28, 2020   Prescription medication of cannabis extract cannabidiol, or CBD, is safe for daily use in treating cannabis use disorder, and could help people to cut down on cannabis use, according to an initial randomised controlled trial published in The Lancet Psychiatry journal. The study is the first to report that daily prescribed medical-use CBD use can cause reduction in cannabis use among people with cannabis use disorder, but the four-week study was not designed to provide robust estimates of the magnitude or duration of efficacy and further studies are needed. Researchers found an optimal daily dose of between 400mg and 800mg of CBD, which is considerably higher than concentrations found in CBD products that are available without prescription (which typically contain around 25mg CBD). They warn that such products should not be used for medicinal purposes. The authors say that these findings are important in light of major policy changes surrounding the production and sale of cannabis products, increases in the number of people entering treatment for cannabis use disorders worldwide, and the current absence of recommended treatments for cannabis use disorder. Dr Tom Freeman, the study's lead author and Director of the Addiction and Mental Health Group at the University of Bath, UK, said: "Our study provides the first causal evidence to support cannabidiol, or CBD, as a treatment for cannabis use disorders. This is encouraging, as there are currently no drug treatments for cannabis addiction. CBD products are widely available in many countries but we would not advise people to self-medicate with these products. People with concerns about their cannabis use should always speak to a healthcare professional in the first instance." [1] Cannabis addiction affects an estimated 22 million people worldwide - similar to the prevalence of opioid use disorders - and the proportion of people seeking help for cannabis use disorders has risen in all world regions apart from Africa. However, there are currently no medications recommended for the treatment of cannabis use disorders. Cannabidiol, also known as CBD, is one of more than 80 chemicals present in cannabis. By itself, CBD has been reported to induce feelings of relaxation and calm, but it does not cause the "high" associated with cannabis use, which is caused by a different chemical called tetrahydrocannabinol, or THC. As a result, CBD is sold legally in many countries in oils, capsules, creams, tea and other products. Previous studies have suggested that taking CBD products could help to reduce withdrawal symptoms in people who are actively trying to quit cannabis use. However, it hasn't been possible to determine whether these effects were due to CBD, because the studies either used an open-label design (where the participants knew what medications they were taking and so the results could have been biased), or CBD was given together with THC so it wasn't possible to say to which chemical the effects were attributable. In this latest study, researchers carried out the first randomised clinical trial of cannabidiol for the treatment of cannabis addiction. All 82 people who took part in the study had been diagnosed with a cannabis use disorder of at least moderate severity, which means they experienced at least four out of 11 possible symptoms of addiction. They had all expressed a desire to quit within the next month, and had tried to quit on at least one occasion before. Participants were randomly assigned to treatment groups and asked to take two capsules of CBD twice daily for four weeks. The placebo group were given sham capsules containing no CBD, while the others received a daily dose of either 200mg, 400mg or 800mg CBD. All of the participants received six counselling sessions designed to help them quit using cannabis, which took place before and during the study period. Weekly urine samples were tested for levels of THC to assess how much cannabis had been consumed in the past week. Participants were also asked to report how many days they had abstained from using cannabis that week. The trial used an adaptive design to identify which doses of CBD were effective or ineffective compared to placebo. In the first stage of the trial, 12 people per group were assigned to either placebo, 200mg, 400mg or 800mg CBD (48 total). After the first phase of the study, the 200mg dose was found to be ineffective and these participants were removed from the trial. A further 34 people were recruited to the second stage of the study and randomly assigned to receive daily doses of either the placebo (11 people), 400mg CBD (12 people) or 800mg CBD (11 people). Daily CBD doses of 400mg and 800mg were both found to reduce participants' cannabis intake (reducing THC levels in the urine by -94.21ng/mL and -72.02ng/mL, respectively). In addition, abstinence from cannabis use increased by an average of 0.5 days per week in the group who received the 400mg daily dose of CBD and 0.3 days per week in the group who received 800mg CBD daily. The researchers observed no difference in side effects experienced by the placebo group and those receiving any dose of CBD. 77 of 82 participants completed the treatment and those who dropped out did so because of missing study visits, being lost to follow up, not taking the study medication, or taking additional medications, and not because of the CBD treatment. There were no serious adverse events during the study, suggesting that CBD is safe and well tolerated at the doses tested. Professor Valerie Curran, senior author and Director of the Clinical Psychopharmacology Unit at University College London, UK, said: "Our findings indicate that CBD doses ranging from 400mg to 800mg daily have the potential to reduce cannabis use in clinical settings, but higher doses are unlikely to bring any additional benefit. Larger studies are needed to determine the magnitude of the benefits of daily CBD for reducing cannabis use." [1] The study was carried out over a four week treatment period with follow up extending to six months. The researchers say additional research is needed to investigate the extent to which their findings translate to different durations of treatment. Studies are also needed to investigate whether CBD directly reduces cannabis use or if it reduces other mental health symptoms which might indirectly affect cannabis use, such as anxiety.   Pessimistic outlook on life linked to life expectancy QIMR Berghofer Medical Research Institute (Australia). July 28, 2020   A new QIMR Berghofer Medical Research Institute study has found people who are strongly pessimistic about the future are at greater risk of dying earlier than those who are not pessimists. The researchers also found, however, that being an optimist did not extend life expectancy. The lead researcher, Dr. John Whitfield from QIMR Berghofer's Genetic Epidemiology group, said study participants who scored higher on pessimism in a questionnaire were likely to die on average two years earlier than those with low scores. "We found people who were strongly pessimistic about the future were more likely to die earlier from cardiovascular diseases and other causes of death, but not from cancer," Dr. Whitfield said. "Optimism scores on the other hand did not show a significant relationship with death, either positive or negative. "Less than nine percent of respondents identified as being strongly pessimistic. There were no significant differences in optimism or pessimism between men and women. On average, an individual's level of either optimism or pessimism increased with age. "We also found depression did not appear to account for the association between pessimism and mortality." The researchers used data collected from almost 3,000 participants who completed the Life Orientation Test as part of a broader questionnaire that looked at the health of Australians aged over 50 between 1993 and 1995. The participants were invited to agree or disagree with a number of statements including positive statements such as, 'I'm always optimistic about my future' or negative statements such as, 'If something can go wrong for me, it will'. The participants' details were then cross checked with the Australian National Death Index in October 2017 to find out how many people had died and their cause of death. (More than 1,000 participants had died.) Previous studies have shown a correlation between optimism and pessimism and specific diseases such as cardiovascular disease or stroke, but most previous studies also put optimism and pessimism on one scale. This resulted in people who received low scores on the pessimism questions being classed as optimists, but Dr. Whitfield said that was not always an accurate reflection of people's outlooks. "Optimism and pessimism are not direct opposites," Dr. Whitfield said. "The key feature of our results is that we used two separate scales to measure pessimism and optimism and their association with all causes of death. "That is how we discovered that while strong pessimism was linked with earlier death, those who scored highly on the optimism scale did not have a greater than average life expectancy. "We think it's unlikely that the disease caused the pessimism because we did not find that people who died from cancer had registered a strong pessimism score in their tests. If illness was leading to higher pessimism scores, it should have applied to cancers as well as to cardiovascular disease." Dr. Whitfield said the research findings raised questions about the practical health benefits of training people out of pessimism. "Understanding that our long term health can be influenced by whether we're a cup-half-full or cup-half-empty kind of person might be the prompt we need to try to change the way we face the world, and try to reduce negativity, even in really difficult circumstances." The study findings have been published this week in the journal Scientific Reports.   Wealthier men are more likely to develop high blood pressure Hokkaido University Graduate School of Medicine (Japan), 26 July 2020:    Working men with higher incomes are more likely to develop high blood pressure, reports a study presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society (JCS 2020). JCS 2020 takes place online from 27 July to 2 August in conjunction with the Asian Pacific Society of Cardiology Congress 2020 (APSC 2020). Joint scientific sessions are being held by the European Society of Cardiology (ESC) and JCS as part of the ESC Global Activities programme.1 "Men with higher incomes need to improve their lifestyles to prevent high blood pressure," said study author Dr. Shingo Yanagiya of the Hokkaido University Graduate School of Medicine, Sapporo, Japan. "Steps include eating healthily, exercising, and controlling weight. Alcohol should be kept to moderate levels and binge drinking avoided." More than one billion people have high blood pressure worldwide.2 Around 30-45% of adults are affected, rising to more than 60% of people over 60 years of age. High blood pressure is the leading global cause of premature death, accounting for almost 10 million deaths in 2015. Of those, 4.9 million were due to ischaemic heart disease and 3.5 million were due to stroke. Japan alone has more than 10 million people with high blood pressure, and the number continues to rise. Dr. Yanagiya said: "High blood pressure is a lifestyle-related disease. As a physician seeing these patients I wanted to know if risk varies with socioeconomic class, to help us focus our prevention efforts." This analysis of the J-HOPE3 study examined the relationship between household income and high blood pressure in Japanese employees. A total of 4,314 staff (3,153 men and 1,161 women) with daytime jobs and normal blood pressure were enrolled in 2012 from 12 workplaces. Workers were divided into four groups according to annual household income: less than 5 million, 5 to 7.9 million, 8 to 9.9 million, and 10 million or more Japanese yen per year. The researchers investigated the association between income and developing high blood pressure over a two-year period. Compared to men in the lowest income category, men in the highest income group were nearly twice as likely to develop high blood pressure. Men in the 5 to 7.9 million and 8 to 9.9 million groups had a 50% higher risk of developing high blood pressure compared to men with the lowest incomes, although the positive association did not reach statistical significance in the 8 to 9.9 million group. The findings were consistent regardless of age, and were independent of baseline blood pressure, worksite, occupation, number of family members, and smoking. The relationships were slightly weakened after accounting for alcohol consumption and body mass index (BMI; kg/m2), both of which were higher for men in the higher income groups. In women, there was no significant link between income and blood pressure. However, women with higher household income tended to have a lower risk of developing high blood pressure. "Some previous Japanese surveys have reported that higher household income is associated with more undesirable lifestyles in men, but not in women," said Dr. Yanagiya. "Our study supports this: men, but not women, with higher household incomes were more likely to be obese and drink alcohol every day. Both behaviours are major risk factors for hypertension." He concluded: "Men with high-paying daytime jobs are at particular risk of high blood pressure. This applies to men of all ages, who can greatly decrease their chance of a heart attack or stroke by improving their health behaviours." Dr. Yusuke Yoshikawa, public relations coordinator for JCS 2020, said: "Hypertension is one of the most important risk factors of cardiovascular disease in Japan, because the average daily salt intake in Japan (approx. 10 g/day) is much higher than desired. As the current guidelines2 strongly recommend healthy lifestyle to control high blood pressure, this study suggests a potential key to successful intervention for those who are at risk of heart disease and stroke." Professor Michel Komajda, a Past President of the ESC and course director of the ESC programme at JCS 2020, said: "The ESC is delighted to be part of JCS 2020 in Kyoto. We value our special partnership with JCS and the high quality of Japanese research. Japan is among the top submitters of abstracts to ESC Congress."   Acute exercise has beneficial effects on the immune system during prostate cancer Victoria University (Australia), July 28, 2020   New research published this week in Experimental Physiology found that in prostate cancer survivors, a moderate bout of exercise kept the cell count of certain type of immune cells at a normal level, suggesting the exercise is safe for prostate cancer survivors. After 24 hours after a moderate bout of cycling, the immune cell count of natural killer (NK) cells, part of the body's first line of defence, had returned to resting levels. Prostate cancer treatments, including androgen deprivation therapy (ADT), have numerous adverse effects that reduce physical function and quality of life. Exercise is recommended for cancer survivors to reduce the side effects of treatment and has shown to have many benefits. However, the effects of prostate cancer treatment and acute exercise on the immune system have only been briefly examined. Exercise oncology guidelines were initially based on the responses seen in healthy, older adults. But individuals with cancer have different physiological responses to exercise, many of which we are only just beginning to understand. Exercise helps the immune system mobilise by causing NK cells to move into the blood and be transported them to areas of need, such as sites of infection or tumours. At the tissues, these cells move out of circulation and in cancer patients they can the infiltrate the tumour and potentially slow the tumour's rate of growth. This has been shown very elegantly in animal models but the exercise and immune response in cancer survivors is limited, with only a few studies in prostate cancer. The researchers, based at Victoria University in Australia, had volunteers (11 cancer survivors currently receiving ADT treatment, and 14 men with prostate cancer not on ADT, and 8 healthy controls) completed a cycling task to determine their maximal aerobic fitness. The researchers chose to use a moderate intensity exercise session that was consistent with current exercise oncology guidelines but was also a bout that would be practical for prostate cancer survivors to perform on their own. To ensure that the exercise bout used to stimulate the immune system was the same degree of difficulty for everyone, they standardised based on their maximal effort. To determine immune function, they obtained blood samples before exercise, immediately after and 2h after they finished cycling. The participants then came back the next day (24h) after exercise, and immune function was assessed again after one night of recovery. They also measured several key hormone levels, including adrenaline and noradrenaline, as they play a role in activating and mobilising the NK immune cells. The researchers found that 24 hours after a moderate bout of cycling, the immune cell count of natural killer (NK) cells, part of the body's first line of defence, had returned to resting levels. They also showed that the immune cell mobilisation with exercise does not appear to be significantly altered during prostate cancer treatment, which provides direct evidence that acute exercise that falls within current oncology guidelines also appears to be beneficial for the immune system. A limitation of the study is the modest sample size, and also that they examined cytokines and proteins that are related to NK cell function but did not directly assess the killing capacity of the NK cells. Erik D Hanson, first author on the study said, "One of the most enjoyable aspects of working with these men is how willing these men are to help their fellow prostate cancer survivors. Many of them realise that these studies are not likely to benefit them directly. However, they do not hesitate to volunteer and are willing to do just about whatever is asked of them for the collective good."   Study shows mango consumption has positive impact on inflammatory bowel disease Texas A&M University, July 29, 2020  Initial results of a study by researchers in the department of nutrition and food science at Texas A&M University in College Station show mango consumption has a positive impact on people with inflammatory bowel disease. Dr. Susanne Talcott, Texas A&M AgriLife Research scientist, and others recently investigated the use of fresh mangoes as an adjuvant to conventional therapy in mild to moderate inflammatory bowel disease. "Inflammatory bowel disease presents a major risk factor for colon cancer with the most common forms of this disorder being Crohn's disease and ulcerative colitis," Talcott said. "Previous studies indicate that IBD affects about 1.5 million individuals in the U.S., about 2.2 million in Europe and many more in other countries." "Colorectal cancer can develop from precursor lesions that can be caused by inflammatory bowel disease over periods of 10 to 15 years, which provides an extended time for preventive measures," she said. Talcott said multiple studies have demonstrated the health benefits of secondary plant compounds in fruits and vegetables including pomegranate, citrus and curcuminoids, and polyphenolics have been found to reduce inflammatory processes in chronic diseases such as cardiovascular disease, cancer and inflammatory bowel diseases. "However, few human clinical studies using polyphenolics in the treatment of inflammatory bowel disease have been conducted," she said. Mangos are rich in gallotannins, a group of large molecular polyphenols that can be broken down to small, absorbable, bioactive molecules by certain intestinal bacteria. To investigate the impact of mango polyphenolics on humans, Talcott's team, which included husband Dr. Stephen Alcott, also an AgriLife Research scientist, designed a clinical trial conducted at Texas A&M. Trial subjects were recruited in the College Station area and at the Ertan Digestive Disease Center at the Memorial Hermann Hospital in Houston under the direction of Dr. Andrew Dupont, MD. The study was designed as a controlled clinical pilot trial in subjects with mild-to-moderate active Crohn's disease or mild-to-moderate ulcerative colitis. Subjects ate mango as an adjunct to their common drug treatment for mild-to-moderate IBD. Male and female individuals from 18 to 79 years old with Crohn's disease or ulcerative colitis were enrolled in the study. Those included were individuals undergoing current or previous IBD drug treatment within the past six months and those on a stable drug regimen for at least three weeks before the start of the treatment phase of the study. Excluded from the study were those with chronic health conditions or recurrent hospitalizations, as well as those who smoked more than one pack of cigarettes per week, had a current liver or renal dysfunction, were pregnant or lactating or had a known lactose intolerance, gluten sensitivity or celiac disease. Also excluded were those with planned or scheduled IBD-related surgery, current IBD-related intestinal stricture, current infection with C. difficile or a previous bowel resection. Medical personnel evaluated more than 300 subjects for the study based on medical records or surveys. Twenty subjects participated in some aspect of the study, including the screening, with 14 completing the study. Subjects were provided with and asked to include 200-400 grams of commercially available frozen mangos of the Keitt variety in their daily diet. They were asked to increase their mango consumption slowly over the first week. "Since the tolerability of large amounts of fiber-rich fruit varies between subjects and for each patient over time, this study allowed subjects to consume mango within a range rather than a fixed amount," Talcott said. "This range was from 200 grams twice daily to 400 grams three times a day." She said subjects could skip their mango consumption or reduce it to accommodate any possible digestive issues, but were required to document their daily mango intake. Subjects who underwent an endoscopy before the beginning of this study were asked to wait at least one week before the study treatment could be started. The treatment phase of the study was eight weeks. "Despite a relatively small subject number, this study yielded significant findings and several biomarkers would have been significantly reduced with a higher number of subjects," Talcott said. She said symptoms of ulcerative colitis were significantly reduced in the test subjects and several biomarkers associated with inflammation were decreased after eight weeks of mango consumption. Additionally, the presence of GRO, a molecule associated with colon cancer growth, was significantly reduced. "Intestinal Lactobacilli and other beneficial probiotic bacteria were significantly increased after the consumption of mango as were certain short-chain fatty acids essential for a healthy intact intestinal tract," she said. Talcott said high endotoxin levels are not only associated with intestinal inflammation but also with other chronic inflammatory diseases, but after eight weeks of mango consumption, high endotoxin levels in blood plasma were significantly decreased. "Taken together, our results indicate mango intake exerted beneficial effects in the progression and severity of the IBD after eight weeks of nutritional intervention," she said. She noted mango consumption might also mitigate inflammation in part by improving the composition of the intestinal microbiota and decreasing the serum endotoxin level. "All subjects who completed the study stated they would continue to consume mangoes regularly and will recommend this to others who suffer from IBD and also tell their physicians," Talcott said. She said if mango or any other polyphenolic-rich food can be identified as helpful in shortening or reducing severity of episodes of inflammatory bowel disease, the addition of mango polyphenolics to conventional IBD drug treatment could have a significant positive impact on public health.   Meta-analysis supports potential of omega-3s for ADHD Kings College London, July 28, 2020 Omega-3s fatty acid supplements may improve symptoms and cognitive performance in children and adolescents with attention deficit hyperactivity disorder (ADHD), according to a meta-analysis of gold standard clinical trials. Data from seven clinical trials involving over 500 children and adolescents indicated that omega-3s were associated with improvements in clinical symptoms of ADHD, while data from three clinical trials involving over 200 children and adolescents indicated a positive impact on cognitive measures associated with attention. “[W]e provide strong evidence supporting a role for n3-PUFAs deficiency in ADHD, and for advocating n-3 PUFAs supplementation as a clinically relevant intervention in this group, especially if guided by a biomarker-based personalization approach,” wrote the authors, led by Jane Pei-Chen Chang from King's College London, in Neuropsychopharmacology . Boosting EPA/DHA intakes Commenting independently on the meta-analysis, Harry Rice, PhD, VP of regulatory & scientific affairs for the Global Organization for EPA and DHA Omega-3s (GOED): “In the past, I've been lukewarm on whether or not increasing EPA/DHA intake benefits children with ADHD. Results from this meta-analysis put me a little closer to believing. “Minimally, given the low side effect profile of omega-3s versus the drugs of choice to treat ADHD, I would highly recommend first increasing intake of EPA/DHA. This is particularly true if a child doesn't eat at least two servings of fatty fish a week or doesn't take an omega-3 supplement on a regular basis.” Meta-analysis details The new meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and used established scientific literature databases to identify appropriate studies for inclusion. Data from seven randomized controlled trials (RCTs) with 534 young people indicated that that omega-s3 supplementation significantly improved inattention and hyperactivity symptoms, according to parental reports. Additional analysis revealed that the improvements in hyperactivity were only observed when doses of EPA (eicosapentaenoic acid) of 500 mg/day or more were used. Interesting, the researchers did not find improvements in hyperactivity and inattention when they looked at teacher's reports, unlike what was reported by parents. Omega-3 supplements were associated with improvements in select measures of cognitive performance, said the researchers. “N-3 PUFAs are crucial for optimal neurotransmitter function: for example, incorporating more EPA and DHA in the cell membrane can increase cholesterol efflux, modulate lipid raft clustering and disruption, and affect the function of the dopamine transporter (DAT), which in turn may affect attention and executive function by regulating synaptic dopamine levels,” wrote the researchers. Omega-3 levels Data from case-control studies were also collected to assess if omega-3 levels were also associated with ADHD, with results indicating that children and adolescents with ADHD had lower levels of EPA, DHA (docosahexaenoic acid),and total omega-3s. “In the context of ‘personalised medicine', it is tempting to speculate that a subpopulation of youth with ADHD and with low levels of n-3 PUFAs may respond better to n-3 PUFAs supplementation, but there are no studies to date attempting this stratification approach,” wrote the researchers. “However, we have [previously] shown that individuals at genetic risk of developing depression in the context of the immune challenge, interferon-alpha (IFN-alpha), have lower levels of RBCs n3-PUFAs, and that n-3 PUFAs supplementation prevents the onset of IFN-alpha-induced depression, arguably by replenishing the endogenously low anti-inflammatory PUFAs in the ‘at risk' individuals.”

Dr. Steve Nissen, Chairman of Cardiovascular Medicine at Cleveland Clinic shares what you need to know from five impactful trials: ATTR, ARRIVE, ASCEND, AIMS and MITRA, presented at the European Society of Cardiology Congress in Munich.

Wednesday, September 5th - European Society of Cardiology Congress, 2007, 1-5 September, Vienna, Austria 1. Better Criteria For Cardiac Resynchronisation Needed in Heart Failure: PROSPECT Trial Results STEFANO GHIO, San Matteo University Hospital, Italy COMMENT: CECILIA LINDE, Karolinska University Hospital, Stockholm REFERENCE: Hotline III, 3222 page 315 The standard echocardiographic criteria for selecting patients to receive cardiac resynchronisation are not adequate according to Stefano Ghio. During the ESC Congress in Vienna he presented results from the PROSPECT trial and afterwards he talked with Sarah Maxwell. Cecilia Linde gave Nicola Solomon her comments on the findings. 2. Selective Invasive Treatment Best for Women with Non-ST Elevation Acute Coronary Syndromes EVA SWAHN, University Hospital Linköping, Sweden COMMENT: ECKART FLECK, Deutsches Herzzentrum, Berlin REFERENCE: HOTLINE II, Monday 8am Women who undergo selective invasive treatment for non-ST elevation acute coronary syndromes do better than those who receive routine early invasive treatment. This is according to the OASIS 5 study from Sweden that randomised women to either of the two approaches. The findings suggest that females with non-ST elevation ACS should be approached differently from their male counterparts. Sarah Maxwell interviewed OASIS investigator Eva Swahn at the ESC meeting in Vienna. Eckart Fleck of the Deutsches Herzzentrum in Berlin gave his comments on her comments to Derek Thorne. 3Patients with High Restenosis Risk Benefit More from Drug Eluting Stents RAUL MORENO, University Hospital La Paz, Madrid REFERENCE: Abstract 3103 Results from a large meta analysis suggest that drug eluting stents have a greater benefit when the risk of restenosis increases. This could affect the “off label” use of these stents. Raul Moreno, of the University Hospital La Paz, Madrid, discussed his findings with Derek Thorne.

Tuesday, September 4th - European Society of Cardiology Congress, 2007, 1-5 September, Vienna, Austria 1. Drug Eluting Stents: Higher Late Mortality in STEMI Patients Than Bare Metal: GRACE Registry Findings GABRIEL STEG, Hôpital Bichat, Paris COMMENT: FREEK VERHEUGT, Radboud University Nijmegen Medical Centre, Nijmegen REFERENCE: Hotline III, number 709 The GRACE registry looking at over 60 000 patients with ST elevation myocardial infarction has shown that patients live longer if they receive bare metal stents than if they get drug eluting stents. Gabriel Steg presented these latest data at the ESC meeting in Vienna. Sarah Maxwell discussed the findings with him. 2. Looking for Atherosclerosis in the Legs Could Save Lives CURT DIEHM, University of Heidelberg COMMENT: FREEK VERHEUGT, Radboud University Nijmegen Medical Centre, Nijmegen Peripheral arterial disease (PAD) can be diagnosed easily by a test using the ankle brachial index (ABI) and its presence can indicate a high risk of myocardial infarction. Curt Diehm explained his findings to Derek Thorne, while Peter Goodwin got expert comment from Freek Verheugt. 2. Heart Attacks Drop After Smoking Ban in Ireland EDMOND CRONIN, Cork University Hospital REFERENCE: Abstract 3506, European Society of Cardiology Congress, 2007, 1-5 September, Vienna, Austria Study data that support banning smoking in public places were unveiled at the ESC congress by a team from Ireland. After the smoking ban in 2004, admissions for acute coronary syndromes dropped, and lead author Edmond Cronin explained the significance of his findings to Derek Thorne.

Monday, September 3rd - European Society of Cardiology Congress, 2007, 1-5 September, Vienna, Austria 1. Chronic Stable Angina: Should ESC Guidelines on Clopidogrel as Pre-Treatment to Planned Coronary Angiography be Changed? PETR WIDIMSKY, Charles University, Prague COMMENT: ECKART FLECK, Deutsches Herzzentrum Berlin REFERENCE: Hot Line II Monday 3rd Sept The ESC guideline suggesting all patients with chronic stable angina having coronary angiography should have clopidogrel pre-treatment is now being questioned following findings of the PRAGUE-8 Study, which randomized patients to receive the anti-platelet agent either non selectively before angiography, or selectively after angiography in those considered to need PCI. The PRAGUE investigators concluded that the ESC guideline was unjustified for the treatment of elective angiography in chronic stable angina, and that the previous practice of selective administration of clopidogrel should be resumed. Nicola Solomon talked with Petr Widimsky at the ESC Congress in Vienna. Derek Thorne heard comments on the findings from Eckart Fleck. 2. Enoxaparin Superior to Unfractionated Heparin for STEMI at 12 months Follow Up: ExTRACT-TIMI 25 Trial DAVID MORROW, Brigham and Women’s Hospital, Boston REFERENCE: 1027, Clinical Trial Update I Further data to support the use of enoxaparin has come out of the latest update from the ExTRACT-TIMI 25 study. It shows at 12 months follow up, that the benefits of enoxaparin are durable and still superior to unfractionated heparin for patients with ST elevation myocardial infarction undergoing fibrinolytic therapy. Sarah Maxwell interviewed David Morrow at the Vienna meeting. 3. Drug Eluting Stent Shows Great Benefit in Chronic Total Occlusions GERALD WERNER, Klinikum Darmstadt, Germany REFERENCE: Abstract 925 The ESC congress in Vienna heard that drug eluting stents are highly effective in chronically occluded arteries, when compared with bare metal stents. Derek Thorne got more on this German study from Gerald Werner, of Klinikum Darmstadt in Germany.

Sunday, September 2nd - European Society of Cardiology Congress, 2007, 1-5 September, Vienna, Austria 1. Blood Pressure Drugs Reduce Mortality in Patients with Diabetes: The ADVANCE Study REFERENCE: Abstract 312 Hot Line 1 Sunday STEPHEN MACMAHON, The George Institute, University of Sydney COMMENT: RAYMOND GIBBONS, Mayo Clinic, Rochester MN The randomised placebo controlled ADVANCE study of 11000 patients with diabetes has demonstrated that a combination of the ACE inhibitor, perindopril, with the diuretic indapamide can lower blood pressure and mortality. The investigators saw an impact even in patients who did not have high blood pressure. Lead study author Stephen MacMahon said this approach should be included in current practise guidelines. Sarah Maxwell spoke with him at the meeting in Vienna. Commented on Stephen McMahon's presentation of the ADVANCE study looking at the use of perindopril plus indapamide among patients with diabetes: a study with 11 000 patients divided between active and placebo in which a 14 per cent improvement in all-cause mortality, an 18 per cent reduction of cardiovascular deaths, was achieved together with reductions of the incidence of both renal and coronary disease. 2. Lifestyle and Heart Disease in Europe: A Growing Problem REFERENCE: Abstract 316 DAVID WOOD, Charing Cross Hospital, London Among 8000 coronary patients in 9 European countries, smoking prevalence hasn’t changed over the last 12 years, and obesity is going up – that’s according to the combined EUROASPIRE surveys, which were presented at the ESC congress. Derek Thorne got more from David Wood, of Charing Cross Hospital in London. 3. Drug Eluting Stents, Bare Metal Stents: No Survival Difference REFERENCE: Hot Line 1 Sunday 11:00 2 Sept/ESC Congress 2007 Vienna 1-5 September STEFAN JAMES, Uppsala Clinical Research Centre, Sweden COMMENT: RAYMOND GIBBONS, Mayo Clinic, Rochester MN Another year’s results of the long term outcome of using drug-eluting stents as compared with bare-metal stents from Sweden reveal that there is no longer an increased risk of late mortality when using drug-eluting stents according to Stefan James of Uppsala Clinical Research Centre. He suggested that improvements in technique have helped reduce the risk of death or myocardial infarction associated with using drug-eluting stents nevertheless the risk of blood clots still remains. Overall survival of patients was found to be the similar for both categories of stent.