September 3rd, 2013

A Transatlantic Taste

Several Cardiology Fellows who are attending ESC.13 in Amsterdam this week are blogging for CardioExchange. The Fellows include Paddy BarrettLouis Handoko, and  Amanda Vest. For more of our ESC.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our Coverage Headquarters.

As a British cardiology fellow at a U.S. institution, I’m often asked on patient care rounds, “Would this condition be managed differently in Europe?” I’m embarrassed to admit that I have minimal knowledge of European cardiology practice — I’ve been in the U.S. for the past 7 years of training, and my British cardiology experience is limited to a 4-week medical student rotation in 2004.

In an effort to address this deficit, I submitted an abstract to ESC Congress 2013 and was delighted to have my work accepted as a poster presentation. I was slightly less delighted to discover that the lowest registration fee for this 5-day convention was 600 euros (US$790), leaving me wondering whether it was my scientific or my financial contribution that the ESC was most interested in attracting! The absence of a trainee’s registration fee is disappointing in comparison to the heavily subsidized registration offered to fellows-in-training at the American Heart Association and American College of Cardiology scientific sessions (US$110 for ACC 2013). With the costs of transatlantic flight (US$1500) and accommodation — international conferences are not reimbursed by my department — I began questioning the value of my first European medical conference attendance.

However, I am glad to report that the investment has proven worthwhile thus far. My initial perception is that the ESC is more willing to explore controversial areas; American cardiology conferences might have shied away from the Rapid Fire session “Obesity: Problem or Paradox.” Although obesity continues to be considered as a major modifiable risk factor for cardiovascular disease, there is increasing evidence that excess adiposity may promote survival in some populations with coronary artery disease or heart failure. Aziza Azimi presented data from a cohort of women with coronary artery disease in whom weight gain was associated with a reduced mortality risk, regardless of baseline BMI. Lower BMI was associated with worse outcomes in a Japanese cohort with cardiovascular risk factors (Takanori Nagahiro), and the survival paradox also held true in a post-PCI Japanese cohort (Hidehiro Kaneko). Discussion of a possible mortality benefit conferred by adipokines – cell-signaling proteins secreted by adipose tissue – was balanced by two presentations outlining the positive cardiovascular effects of surgical weight loss. Data presented by Pio Cialdella were particularly compelling in building on existing reports of reductions in left ventricular mass and end-systolic volumes after bariatric surgery.

Although the answer to the ultimate clinical question — should we still encourage cardiovascular patients to lose weight? — proved elusive, I was impressed that the ESC and abstract presenters had tackled this controversial area that sits uncomfortably alongside the weight-loss message central to American cardiovascular public health efforts.

This first taste of European cardiology had left me hungry to learn more about international clinical and research perspectives.

What do you see as the most salient differences in cardiology research between the U.S. and the rest of the world?


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