
Kiranbir Josan
Clinical Assistant Professor, Medicine - Cardiovascular Medicine
Bio
Dr. Kiranbir Josan is a board certified Cardiologist. She enjoys practicing all areas of cardiology with a special interest in primary and secondary prevention, valvular heart disease, cardiomyopathy, atrial fibrillation and other arrhythmia management. Her current clinical and research focus includes taking a comprehensive approach to managing a patient's cardiometabolic health. She is also interested in digital health technologies and how they can be used to improve healthcare delivery and patient outcomes.
Clinical Focus
- Cardiovascular Disease
Professional Education
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Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2016)
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Board Certification: American Board of Internal Medicine, Internal Medicine (2014)
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Board Certification, Royal College of Physicians and Surgeons of Canada, Cardiology (2011)
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Fellowship, University of British Columbia, Vancouver, Canada, Cardiology (2011)
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Board Certification, Royal College of Physicians and Surgeons of Canada, Internal Medicine (2009)
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Residency, University of Alberta, Edmonton, Canada, Internal Medicine (2008)
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Internship, University of Alberta, Edmonton, Canada (2006)
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Medical Education, Western University, London, Canada (2005)
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BSc, University of Alberta, Edmonton, Canada
Current Research and Scholarly Interests
Cardiovascular Disease
Primary Prevention
Secondary Prevention
Cardiovascular Disease in South Asian Populations
All Publications
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Efficacy of a Telehealth Preventive Cardiology Lifestyle Intervention Program to Treat High-Risk South Asians
AMER DIABETES ASSOC. 2019
View details for DOI 10.2337/db19-885-P
View details for Web of Science ID 000501366902250
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Unique Cardiovascular Risk Stratification Using Prediabetes Metrics in High-Risk South Asian Cohort
AMER DIABETES ASSOC. 2019
View details for DOI 10.2337/db19-903-P
View details for Web of Science ID 000501366902268
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CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians
LIPPINCOTT WILLIAMS & WILKINS. 2019
View details for DOI 10.1161/circ.139.suppl_1.P337
View details for Web of Science ID 000478079000280
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Right Ventricular Dysfunction Should Not Preclude Left Ventricular Assist Device Explantation in Patients Exhibiting Left Ventricular Recovery
ELSEVIER SCIENCE INC. 2012: S90
View details for DOI 10.1016/j.healun.2012.01.255
View details for Web of Science ID 000302207900248
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Right Ventricular Dysfunction Should Not Preclude Left Ventricular Assist Device Explantation in Patients Exhibiting Left Ventricular Recovery
LIPPINCOTT WILLIAMS & WILKINS. 2011
View details for Web of Science ID 000299738707310
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LONG-TERM FOLLOW UP OF LEFT VENTRICULAR SIZE AND FUNCTION IN PATIENTS SUCCESSFULLY BRIDGED TO RECOVERY AFTER LEFT VENTRICULAR ASSIST DEVICE SUPPORT
ELSEVIER SCIENCE INC. 2011: S227
View details for DOI 10.1016/j.cjca.2011.08.105
View details for Web of Science ID 000296656900338
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Successful Weaning and Explantation of the Heartmate II Left Ventricular Assist Device
CANADIAN JOURNAL OF CARDIOLOGY
2011; 27 (3): 358–62
Abstract
Ventricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre.Patients who had a VAD explanted were identified in the mechanical support institutional database and their outcomes were analyzed. Clinical examinations, biochemical markers, and serial echocardiograms were used to demonstrate myocardial recovery.Seventeen patients had a Heartmate II VAD inserted between 2008 and 2010. Four patients underwent successful weaning and subsequent VAD explantation. Etiology of decompensated heart failure was idiopathic dilated cardiomyopathy (n = 1), ischemic (n = 1), or myocarditis (n = 2). Mean age was 35.3 years. Patients were supported for 213 days (range 70-293 days) and were in New York Heart Association class I in the community before explantation. The devices were explanted via a minimally invasive approach, without cardiopulmonary bypass. All patients survived explantation and were discharged alive from hospital after an average of 5.7 ± 1.5 days post pump explantation. No adverse events were reported after explantation. Only one patient required allogenic blood transfusion after the procedure.Patients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.
View details for DOI 10.1016/j.cjca.2011.01.005
View details for Web of Science ID 000291385100010
View details for PubMedID 21601774
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Transatrial Transcatheter Tricuspid Valve-in-Valve Implantation of Balloon Expandable Bioprosthesis
ANNALS OF THORACIC SURGERY
2010; 90 (5): 1696–97
Abstract
Transcatheter valve-in-valve implantation into failing mitral and aortic bioprosthetic valves have been reported. This strategy avoids performing high-risk repeat cardiac surgery in elderly patients with multiple comorbidities. Tricuspid valve-in-valve implantation has not been described. We report a case of failing bioprosthetic tricuspid valve in a 48-year-old woman with carcinoid syndrome. We attempted a transatrial transcatheter approach and we successfully deployed a 26-mm Edwards Sapien balloon expandable bioprosthesis (Edwards Lifesciences, Irvine, CA) into a severely stenotic tricuspid bioprosthesis. This case demonstrates the technical feasibility and safety of this approach. Therefore, tricuspid valve-in-valve implantation may be a viable treatment alternative in carefully selected patients.
View details for DOI 10.1016/j.athoracsur.2010.04.101
View details for Web of Science ID 000283352200065
View details for PubMedID 20971296
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Procedural delay does not explain the circadian variation observed in outcomes of primary PCI for STEMI: Insights from the APEX-AMI trial
ELSEVIER SCIENCE INC. 2008: A201
View details for Web of Science ID 000253997101321
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The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials
CANADIAN MEDICAL ASSOCIATION JOURNAL
2008; 178 (5): 576–84
Abstract
Recent lipid guidelines recommend aggressive low-density lipoprotein (LDL) cholesterol lowering in patients with coronary artery disease. To clarify the evidence for this recommendation, we conducted a meta-analysis of randomized controlled trials that compared different intensities of statin therapy.We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registery of Controlled Trials, Web of Science) for randomized controlled trials published up to July 19, 2007, that compared statin regimens of different intensities in adults with coronary artery disease and that reported cardiovascular events or mortality. Data were pooled using random-effects models to calculate odds ratios (OR).A total of 7 trials (29 395 patients) were included. Compared with less intensive statin regimens, more intensive regimens further reduced LDL levels (0.72 mmol/L reduction, 95% confidence interval [CI] 0.60-0.84 mmol/L), and reduced the risk of myocardial infarction (OR 0.83, 95% CI 0.77-0.91) and stroke (OR 0.82, 95% CI 0.71-0.95). Although there was no effect on mortality among patients with chronic coronary artery disease (OR 0.96, 95% CI 0.80-1.14), all-cause mortality was reduced among patients with acute coronary syndromes treated with more intensive statin regimens (OR 0.75, 95% CI 0.61-0.93). Compared with lower intensity regimens, more intensive regimens were associated with small absolute increases in rates of drug discontinuation (2.5%), elevated levels of aminotransferases (1%) and myopathy (0.5%), and there was no difference in noncardiovascular mortality. All 7 trials reported events by randomization arm rather than by LDL level achieved. About half of the patients treated with more intensive statin therapy did not achieve an LDL level of less than 2.0 mmol/L, and none of the trials tested combination therapies.Our analysis supports the use of more intensive statin regimens in patients with established coronary artery disease. There is insufficient evidence to advocate treating to particular LDL targets, using combination lipid-lowering therapy to achieve these targets or for using more intensive regimens in patients without established coronary artery disease.
View details for DOI 10.1503/cmaj.070675
View details for Web of Science ID 000253136000019
View details for PubMedID 18299547
View details for PubMedCentralID PMC2244680
- Statin therapy: friend or foe? Canadian Journal of Diagnosis Canadian Journal of Diagnosis 2008; 25: 65-67
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Cholesterol lowering for secondary prevention: What statin dose should we use?
VASCULAR HEALTH AND RISK MANAGEMENT
2007; 3 (5): 615–27
Abstract
Over the past decade, 17 large placebo-controlled trials have established that statin therapy lowers LDL cholesterol and prevents cardiovascular events and death in patients with coronary disease or at high risk for atherosclerotic events. Nine trials of higher dose vs. lower dose statins (reporting data from 29,853 patients with coronary artery disease and 486 patients with other indications for statin therapy) have established that higher dose statin therapy is more efficacious than lower dose therapy in reducing myocardial infarctions/coronary death (by 16%) and stroke (by 18%) in patients with coronary disease but only reduces all-cause mortality in patients at high risk for coronary death (such as patients immediately after acute coronary syndrome). Higher dose statins are associated with statistically significantly increased risks of myopathy and elevated transaminases compared to lower dose statins; while relative risks for these outcomes are 1.2 and 4.0, the absolute increases are small (0.5% and 1%). Secondary analyses of these trials using individual patient data and multivariate adjustment will be needed to appropriately examine the incremental benefits of different LDL targets, and trials are needed to determine whether combinations of low dose statins plus other lipid lowering agents may achieve better clinical outcomes than higher dose statin therapy alone.
View details for Web of Science ID 000210211800007
View details for PubMedID 18078013
View details for PubMedCentralID PMC2291306