Tag Archives: New England Journal of Medicine

UMKC researcher helped lead studies published in New England Journal of Medicine

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UMKC School of Medicine researcher John Spertus, M.D., M.P.H., is part of two large NIH-funded clinical studies published in the New England Journal of Medicine, Monday, March 30. The studies indicate eliminating unnecessary revascularization treatments for cardiac patients could save the United States hundreds of millions of dollars annually.

Spertus serves as professor of medicine and Daniel J. Lauer, M.D., Endowed Chair in Metabolism and Vascular Disease Research at the School of Medicine, and Clinical Director of Outcomes Research at Saint Luke’s Hospital.

The studies looked specifically at coronary artery disease patients who had high-risk blockages with least 10 percent or more of the heart muscle being at risk. One focused on patients with preserved kidney function and the other targeted patients with end-stage kidney failure. That latter group has largely been excluded from almost all cardiovascular trials, despite having a high prevalence of coronary artery disease and death, Spertus said.

Both studies, conducted in unison, examined the most important outcomes for patients, clinical events (e.g. heart attacks, death) and patients’ symptoms, function and quality of life. Participants were randomized to undergo invasive angiography and revascularization with aggressive medical therapy or aggressive medical therapy alone. The goals of the medical treatment were cholesterol reduction, blood pressure control, aspirin and medications to treat chest pain.

The studies in patients with preserved kidney function showed that invasive medical procedures provided no reduction in clinical events, but did improve patients’ symptoms and quality of life, if they had chest pain within a month of entering the trial. These health status benefits were evident within three months and sustained out to four years.

“Importantly, this benefit was only observed in patients who had angina, chest pain, and not in asymptomatic patients,” Spertus said. “There is no indication for these procedures in patients whose symptoms are well-controlled with medications alone. If we avoided revascularization in asymptomatic patients, we could potentially save about $500 million to $750 million a year in the United States alone.”

Among patients with very severe kidney disease, there was no significant difference in clinical events or in patients’ symptoms and quality of life.

“While disappointing, this is a very ill patient population for whom an aggressive, invasive treatment strategy does not seem to offer much benefit,” Spertus said.

The NEJM is publishing four papers from these studies on March 30, one for each trial focusing on the clinical events and another for each trial focusing on the quality of life outcomes. Spertus was involved in writing all four and is the lead author on the two quality of life papers. He and his team designed, analyzed and led the health status, quality of life components of both trials.

Spertus is the author of the Seattle Angina Questionnaire (SAQ) that used in the studies. It is widely recognized throughout the world as the gold standard for quality of life measurement in cardiac medicine.

“Our group has led its use and analyses in multiple studies and quality improvement efforts,” Spertus said. “In light of these findings, the SAQ may start becoming a routine part of clinical care in cardiology.”

New England Journal of Medicine publishes med school faculty member report on e-cigarettes

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The New England Journal of Medicine has published a report by Chitra Dinakar, M.D., professor of pediatrics  at the UMKC School of Medicine. The report examines the health effects of electronic cigarettes.

In the article published on Oct. 6, Dinakar and co-author George O’Connor, M.D., of the Boston University School of Medicine, state that while e-cigarettes might be safer than smoking conventional cigarettes according to some studies, it is impossible to reach a consensus on their overall safety.

More study is necessary, their report says, to better understand the effectiveness of e-cigarettes as a tool for smoking cessation, to identify their health risks, and to make them as safe as possible.

Dinakar, a specialist in allergy and immunology, and O’Connor conclude that using e-cigarettes does have biologic effects and that there are also possible health-related effects for users who do not smoke conventional tobacco products. Epidemiologic data, they say, indicate e-cigarettes may promote nicotine addiction in minors and young adults who would otherwise be nonsmokers.

A significant public health concern is the increased use among middle- and high-school students who have never smoked conventional cigarettes. As cigarette smoking reportedly decreased and leveled off among youths in 2014 and 2015, 16 percent of high-school students reported using e-cigarettes in 2015.

The use of e-cigarettes among adults showed a dramatic rise from 1.8 percent to 13 percent between 2010 and 2013. Reports of overall use of e-cigarettes jumped from 0.3 to 6.8 percent during the same time period.

The full article on the New England Journal of Medicine web site can be found here.

Dinakar’s journal article was also highlighted in a health article on the Consumer Reports web site, in which she states, “There are many unexplored potential toxic effects that need further study.”