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Tag: Cardiovascular Health

  • What to know about melatonin use and heart failure

    (CNN) — Long-term use of melatonin supplements may be linked with a higher risk of heart failure, according to new research — but does that mean people taking it as a sleep aid should stop using it now?

    In a review of electronic medical records, thousands of adults who had chronic insomnia and took melatonin for a year or longer had a 90% higher chance of heart failure over the next five years, compared with participants who had the same health factors but didn’t take melatonin. Melatonin users were also more than three times as likely to be hospitalized for heart failure and about twice as likely to die from any cause.

    But experts suggest holding off on seeing melatonin as a definite danger. The research had significant limitations, was not designed to be able to prove cause and effect, and contradicts previous studies that indicated positives for heart health.

    The research also hasn’t yet been peer-reviewed or published in a journal but will be presented at the American Heart Association’s Scientific Sessions 2025 meeting taking place November 7-10.

    “Melatonin supplements are widely thought of as a safe and ‘natural’ option to support better sleep, so it was striking to see such consistent and significant increases in serious health outcomes, even after balancing for many factors,” Dr. Ekenedilichukwu Nnadi, lead research author and chief resident in internal medicine at SUNY Downstate/Kings County Primary Care in Brooklyn, said in a news release.

    However, “while the association we found raises safety concerns about the widely used supplement, our study cannot prove a direct cause-and-effect relationship,” Nnadi said. “This means more research is needed to test melatonin’s safety for the heart.”

    Naturally occurring melatonin in the brain is a hormone produced by the pineal gland in response to darkness, to help the body wind down for sleep.

    The melatonin in supplements can be extracted from the pineal glands of animals or synthetically produced via a chemical process.

    In the United States, because melatonin is sold as a dietary supplement, manufacturers aren’t subject to the level of scrutiny involved in the US Food and Drug Administration’s safety measures and approval processes for drugs. This means melatonin supplements can contain significantly more of the active ingredient than advertised or necessary, as well as harmful hidden additives.

    Chronic insomnia, experienced by 10% of the global population, is defined by taking more than 30 minutes to fall asleep or fall back to sleep up to three times weekly for more than three months. It can lead to problems with memory, daytime energy, mood, thinking and concentration, work or school performance, and one’s social life.

    A doctor can help one determine whether insomnia is occurring on its own or because of an underlying factor, such as a medical condition or stressful life circumstance, and therefore determine the best ways to treat it — whether that’s adjusting your sleep routine, undergoing therapy for mental or emotional distress or cognitive behavioral therapy for insomnia, taking medication, or treating a medical condition.

    Melatonin use and heart health

    Melatonin supplements are often marketed as a safe sleep aid, but there hasn’t been sufficient data on long-term safety for cardiovascular health, the authors said.

    The research team assessed more than 130,000 adults with health records in the TriNetX Global Research Network, a large international electronic database. They were about 55 years old on average, and 61.4% were women. Participants with melatonin use documented in medication entries in their health records for more than a year were classified as the melatonin group, whereas those without any record of melatonin use were in the “non-melatonin group.”

    These factors lend themselves to a few important limitations, the authors and independent experts pointed out.

    The database includes patients in countries that require a prescription for melatonin, such as the United Kingdom, and those that don’t, including the United States — so the control group may unknowingly include adults who take melatonin without a prescription, which wouldn’t be reflected in their medical records, Dr. Carlos Egea, who wasn’t involved in the research, said in a statement provided by the Science Media Centre. Egea is president of the Spanish Federation of Sleep Medicine Societies.

    The researchers also didn’t have details on the severity of participants’ insomnia or whether they had any mental health issues, both of which can influence melatonin use and heart health risks, Nnadi said.

    Insomnia has been associated with a higher risk of having a heart attack or stroke. Disrupted circadian rhythms — our body clocks in which melatonin plays a role — and insufficient sleep have been linked with greater odds of cardiovascular issues including heart failure.

    Other limitations include a lack of information on dosage, the Council for Responsible Nutrition, a trade association for the dietary supplement and functional food industry, said in a statement. “Decades of consumer experience and multiple clinical studies indicate that low-dose, short-term supplementation is safe for healthy adults when used as directed,” the association added.

    The research challenges previous studies, including a March analysis of four studies that found melatonin supplementation improved heart failure patients’ quality of life and cardiac function, Egea said.

    Melatonin is also an antioxidant, and antioxidants help protect against damage to DNA by oxidative stress, an imbalance between free radicals and antioxidants in the body.

    Before you take sleep aids

    Many people turn to melatonin as a short- or long-term solution to sleep woes. But for some people, the supplement has been linked to various side effects including headaches, nausea, dizziness, drowsiness, stomach aches, confusion or disorientation, tremors, low blood pressure, irritability, mild anxiety and depression.

    Before resorting to supplements, “speak to your doctor first about, for one, getting a proper diagnosis for your sleep difficulty and then discussing the appropriate course of treatment,” Dr. Marie-Pierre St-Onge, director of the Center of Excellence for Sleep & Circadian Research in the department of medicine at Columbia University Irving Medical Center, said in the American Heart Association news release. “People should be aware that (melatonin) should not be taken chronically without a proper indication.”

    Healthy sleep hygiene involves limiting light exposure, screen time and consumption of food and alcohol in the few hours before bed. Your bedroom should be dark, cool and quiet.

    If you still choose to supplement melatonin, pharmaceutical grade melatonin is best, experts told CNN in a 2022 report — look for a stamp showing that the independent nonprofit US Pharmacopoeia’s Dietary Supplement Verification Program has tested the product.

    Kristen Rogers and CNN

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  • There may soon be a new approach to treat hard-to-control high blood pressure

    Doctors may soon have a new way to treat high blood pressure, even among people for whom medicines haven’t worked well in the past.Baxdrostat, an experimental medicine made by AstraZeneca, showed promise in treating people with uncontrolled or resistant high blood pressure in a recent trial. If the medicine gets approved by regulatory authorities, it will be one of the first new approaches to treating high blood pressure in decades, researchers say.Scientists presented the trial results Saturday at the European Society of Cardiology Congress 2025 in Madrid and simultaneously published them in the New England Journal of Medicine.For the study, researchers enrolled 800 adults who still had high blood pressure after taking two or more medications for at least four weeks. To qualify for the study, patients’ systolic blood pressure had to be between 140 and 170.Blood pressure is measured in millimeters of mercury, which is abbreviated as mm Hg. The measurement has an upper number, or systolic reading, and a lower number, a diastolic reading. Systolic pressure measures the force of blood as it pumps out of the heart into the arteries; diastolic is the pressure created as the heart rests between beats.Normal blood pressure is less than 120/80 mm Hg, and elevated blood pressure is considered to be from 120 to 129/80 mm Hg. At 130/80 mmHg or higher, according to new U.S. guidelines, a person’s medical provider will want them to take a blood pressure medication if lifestyle changes — including eating healthier, reducing salt in the diet and exercising more — don’t work first.The researchers on the new trial placed the participants into three groups. One received 1 milligram of baxdrostat, another got 2 mg, and another got a placebo, which does nothing. Participants took their dose in addition to medicines they were already taking.At 12 weeks, about 4 in 10 patients taking baxdrostat reached healthy blood pressure levels, compared with less than 2 in 10 who got a placebo.Specifically, participants who got 1 or 2 mg of baxdrostat daily saw their systolic blood pressure – the upper number in the reading – fall around 9 to 10 mm Hg more than those taking a placebo. This reduction, studies show, is large enough to cut cardiovascular risk.When blood pressure is high, the force of the blood pushes against the walls of their blood vessels, making the heart less efficient: Both the vessels and the heart must work harder, and it’s more difficult to get blood to essential organs and cells. Without treatment, high blood pressure will eventually damage the arteries, raising the risk of conditions like a heart attack, stroke, coronary disease, vascular dementia and cognitive problems.Heart disease is the No. 1 killer in the world. Lowering blood pressure is the most modifiable way to avoid such a death.Nearly half of all adults in the U.S. have higher than normal blood pressure, and 1 in 10 people have what doctors call resistant hypertension: Despite being on three or more medications, they are not meeting the goal for blood pressure control.When a patient has high blood pressure, doctors may need to try a variety of medications to see what works best.Adding baxdrostat to the list of options could be a big help for patients, according to Dr. Stacey E. Rosen, volunteer president of the American Heart Association, who was not involved with the new research.“What’s interesting about this medication is that they can really be a wonderful partner, so to speak, with some of the more classically recommended anti-hypertensive medications,” said Rosen, who is also a senior vice president of women’s health and executive director of the Katz Institute for Women’s Health of Northwell Health in New York City.Medication options now on the market control blood pressure in a variety of ways. Some, such as vasodilators, relax and widen arteries and veins to allow blood to get through easier and increase flow. Diuretics primarily work by removing excess fluid and salt from the body by increasing urine production. Centrally acting alpha agonists help prevent the nervous system from responding to stress. ACE inhibitors keep the body from producing angiotensin II, a hormone that makes blood vessels constrict. ARBs, or angiotensin II receptor blockers, help reduce the production of aldosterone, a hormone that promotes salt and water retention. Calcium channel blockers can keep calcium away from the cells of the heart and arteries so they don’t have to work as hard.Each can have different side effects, including dizziness, rapid or slower heart rate, exhaustion, upset stomach and swelling in the legs.Baxdrostat’s side effects, the study showed, were mild overall. The most common problem was abnormalities in potassium and sodium levels, but this was rare.Baxdrostat takes a new approach to managing high blood pressure. It focuses on blocking aldosterone, a hormone created by the adrenal glands that helps kidneys regulate salt and maintain the body’s water balance. Some people produce too much aldosterone, leading their body to retain too much water and salt, pushing up blood pressure.“We’ve also known for a while now that most of us eat too much salt and in doing that, it raises blood pressure. But we’re also increasingly recognizing that aldosterone may have a direct impact on causing damage to the blood vessels, to the heart, to the kidneys,” said Dr. Jenifer Brown, one of the lead investigators and co-author of the published study.Brown said she often sees cardiology patients at Brigham and Women’s who may have had a heart event, so she needs to be aggressive in getting their blood pressure under control to prevent another. Some patients may have trouble tolerating other blood pressure medications. For others, the standard medicines just don’t work well. Baxdrostat could be a good complement, she said.“We really have had the same tools as clinicians for many years,” Brown said. “I would be excited to have an option like this.”In an editorial accompanying the publication, Dr. Tomasz Guzik, a cardiovascular scientist at the University of Edinburgh, and Dr. Maciej Tomaszewski, a cardiovascular expert at the University of Manchester, write that next steps should be to figure out which patients would best respond to this new medicine and provide longer-term data. If the medication works long-term, they wrote, it could become a “central piller of therapy for difficult-to-control hypertension.”AstraZeneca said it plans to submit its data to regulatory agencies before the end of 2025.

    Doctors may soon have a new way to treat high blood pressure, even among people for whom medicines haven’t worked well in the past.

    Baxdrostat, an experimental medicine made by AstraZeneca, showed promise in treating people with uncontrolled or resistant high blood pressure in a recent trial. If the medicine gets approved by regulatory authorities, it will be one of the first new approaches to treating high blood pressure in decades, researchers say.

    Scientists presented the trial results Saturday at the European Society of Cardiology Congress 2025 in Madrid and simultaneously published them in the New England Journal of Medicine.

    For the study, researchers enrolled 800 adults who still had high blood pressure after taking two or more medications for at least four weeks. To qualify for the study, patients’ systolic blood pressure had to be between 140 and 170.

    Blood pressure is measured in millimeters of mercury, which is abbreviated as mm Hg. The measurement has an upper number, or systolic reading, and a lower number, a diastolic reading. Systolic pressure measures the force of blood as it pumps out of the heart into the arteries; diastolic is the pressure created as the heart rests between beats.

    Normal blood pressure is less than 120/80 mm Hg, and elevated blood pressure is considered to be from 120 to 129/80 mm Hg. At 130/80 mmHg or higher, according to new U.S. guidelines, a person’s medical provider will want them to take a blood pressure medication if lifestyle changes — including eating healthier, reducing salt in the diet and exercising more — don’t work first.

    The researchers on the new trial placed the participants into three groups. One received 1 milligram of baxdrostat, another got 2 mg, and another got a placebo, which does nothing. Participants took their dose in addition to medicines they were already taking.

    At 12 weeks, about 4 in 10 patients taking baxdrostat reached healthy blood pressure levels, compared with less than 2 in 10 who got a placebo.

    Specifically, participants who got 1 or 2 mg of baxdrostat daily saw their systolic blood pressure – the upper number in the reading – fall around 9 to 10 mm Hg more than those taking a placebo. This reduction, studies show, is large enough to cut cardiovascular risk.

    When blood pressure is high, the force of the blood pushes against the walls of their blood vessels, making the heart less efficient: Both the vessels and the heart must work harder, and it’s more difficult to get blood to essential organs and cells. Without treatment, high blood pressure will eventually damage the arteries, raising the risk of conditions like a heart attack, stroke, coronary disease, vascular dementia and cognitive problems.

    Heart disease is the No. 1 killer in the world. Lowering blood pressure is the most modifiable way to avoid such a death.

    Nearly half of all adults in the U.S. have higher than normal blood pressure, and 1 in 10 people have what doctors call resistant hypertension: Despite being on three or more medications, they are not meeting the goal for blood pressure control.

    When a patient has high blood pressure, doctors may need to try a variety of medications to see what works best.

    Adding baxdrostat to the list of options could be a big help for patients, according to Dr. Stacey E. Rosen, volunteer president of the American Heart Association, who was not involved with the new research.

    “What’s interesting about this medication is that they can really be a wonderful partner, so to speak, with some of the more classically recommended anti-hypertensive medications,” said Rosen, who is also a senior vice president of women’s health and executive director of the Katz Institute for Women’s Health of Northwell Health in New York City.

    Medication options now on the market control blood pressure in a variety of ways. Some, such as vasodilators, relax and widen arteries and veins to allow blood to get through easier and increase flow. Diuretics primarily work by removing excess fluid and salt from the body by increasing urine production. Centrally acting alpha agonists help prevent the nervous system from responding to stress. ACE inhibitors keep the body from producing angiotensin II, a hormone that makes blood vessels constrict. ARBs, or angiotensin II receptor blockers, help reduce the production of aldosterone, a hormone that promotes salt and water retention. Calcium channel blockers can keep calcium away from the cells of the heart and arteries so they don’t have to work as hard.

    Each can have different side effects, including dizziness, rapid or slower heart rate, exhaustion, upset stomach and swelling in the legs.

    Baxdrostat’s side effects, the study showed, were mild overall. The most common problem was abnormalities in potassium and sodium levels, but this was rare.

    Baxdrostat takes a new approach to managing high blood pressure. It focuses on blocking aldosterone, a hormone created by the adrenal glands that helps kidneys regulate salt and maintain the body’s water balance. Some people produce too much aldosterone, leading their body to retain too much water and salt, pushing up blood pressure.

    “We’ve also known for a while now that most of us eat too much salt and in doing that, it raises blood pressure. But we’re also increasingly recognizing that aldosterone may have a direct impact on causing damage to the blood vessels, to the heart, to the kidneys,” said Dr. Jenifer Brown, one of the lead investigators and co-author of the published study.

    Brown said she often sees cardiology patients at Brigham and Women’s who may have had a heart event, so she needs to be aggressive in getting their blood pressure under control to prevent another. Some patients may have trouble tolerating other blood pressure medications. For others, the standard medicines just don’t work well. Baxdrostat could be a good complement, she said.

    “We really have had the same tools as clinicians for many years,” Brown said. “I would be excited to have an option like this.”

    In an editorial accompanying the publication, Dr. Tomasz Guzik, a cardiovascular scientist at the University of Edinburgh, and Dr. Maciej Tomaszewski, a cardiovascular expert at the University of Manchester, write that next steps should be to figure out which patients would best respond to this new medicine and provide longer-term data. If the medication works long-term, they wrote, it could become a “central piller of therapy for difficult-to-control hypertension.”

    AstraZeneca said it plans to submit its data to regulatory agencies before the end of 2025.

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  • How Jogging Slows Aging (The Effects of Running on the Aging Process) – Southwest Journal

    How Jogging Slows Aging (The Effects of Running on the Aging Process) – Southwest Journal

    Jogging offers several health benefits, such as better cardiovascular health, effective weight management, and a lower risk of metabolic syndrome.

    It’s defined as running at a pace slower than 6 miles per hour.

    Some studies suggest that jogging might also slow aging and contribute to a longer, healthier life.

    In this article, we’ll explore the science behind how jogging can decelerate aging.

    We’ll also discuss a few additional strategies that can help older adults maintain their health.

    The Effects of Running on The Aging Process

    New research highlights the incredible benefits of jogging in the combat of the aging process. In fact, scientists revealed a fascinating correlation between high activity levels and the reversal of biological age.

    A study from Brigham Young University by Larry A. Tucker, shed light on the deep impact of running on our cells. More specifically, the impact of running on telomeres. If you’re not familiar with biochemistry, telomeres are protective sheaths at the end of chromosomes that shrink with age. As a result, their ability to shield our chromosomes diminishes, which leaves our cells vulnerable to dysfunction and demise.[1]

    Surprisingly, the study concluded that 30 to 40 minutes of running, five days a week, could be enough to turn back the cellular clock by a whopping nine years!

    But why does running greatly impact the cellular clock? The answer may lie in its ability to combat oxidative stress. You see, oxidative stress is notorious for accelerating the shortening of telomeres. Therefore, it significantly accelerates the aging process.

    The study’s findings serve as a reminder that when it comes to slowing down aging, bouts of irregular exercise will not be enough. Instead, you need to have sustained and dedicated effort. It’s those 30 to 40 minutes of rhythmic activity that’s repeated over the course of five days that truly hold the key to making your cells younger.

    More research

    According to a recent study published in the International Journal of Environmental Research & Public Health by the same Larry A. Tucker, 75 minutes of running a week can potentially extend your lifespan by as much as 12 years. The study also focused on telomeres.

    The study examined 4,458 participants, which revealed a notable difference in the biological age of runners who clocked at least 75 minutes of running per week compared to those who ran less than 10 minutes. Although the study did not directly measure mortality rates, it highlighted the significance of cellular aging since reduced telomere length has been linked to higher mortality and increased risk of chronic diseases.

    Study also focused on the concept of “healthspan.” This refers to the duration of one’s life lived without disabling chronic diseases. Numerous studies showed that cardio exercise significantly improves healthspan by reducing the chances of Alzheimer’s disease, cancer, and an array of other diseases. [2]

    Indirect Ways that Running Can Help with The Aging Process

    Better weight management

    Paul T. Williams say that as we age, it is very challenging to maintain a healthy weight. However, a healthy body mass index becomes even more critical for your well-being and longevity. Although various forms of exercise contribute to weight management, research highlights the effectiveness of running in this regard.[3]

    The transition from low-intensity activities, such as walking, to jogging will help you maintain a healthy weight and slow down the aging process, as excess weight is a key factor in accelerated aging and age-related diseases.

    Stronger immune system

    Immunosuppression is one of the hallmarks of the aging process. This is why we see more infections in elderly adults. Furthermore, the severity of the infection is also proportional to the age of the patient. In other words, the older the patient, the more likely they are to experience severe or life-threatening infections.

    John P Campbell indicates that moderate exercise can optimize the function of the immune cells and mitigate the risk related to their dysfunction. This is indispensable to maintain your vitality and resilience against illnesses that commonly afflict older adults. [4]

    Lower risk of metabolic syndrome

    indicates that regular jogging can reduce insulin resistance, which could slow down the aging process. The improvement of insulin sensitivity and metabolic health places running as the cheapest and most effective way to fight against age-related metabolic disorders.

    Note that many elderly adults deal with metabolic syndrome, including type 2 diabetes. The hallmark of the latter is insulin resistance.

    What’s more, chronically elevated blood sugar levels damage capillaries and nerves in the brain, which can considerably accelerate the aging process. [5] [6]

    Improved cognitive abilities

    Cognitive decline is a common feature of aging that affects memory, decision-making, and mental acuity. Running can be a potent intervention to preserve cognitive function as we age.

    Jogging can protect you from age-related cognitive decline through the following mechanisms:

    • Promotion of neuroplasticity.
    • Enhancement of executive function.
    • Protection against the effects of stress on the brain.

    Although these processes may not have a direct impact on telomeres, they surely address one critical aspect of the aging process – Cognitive Decline.

    Lower risk of mood disorders

    Regular jogging exerts potent antidepressant effects and provides a holistic approach to combat age-related mental health challenges. The reduction of stress hormones (e.g., cortisol) and the promotion of endorphin release are prevalent mechanisms.

    You might wonder how the antidepressant effects of running can slow down aging. Well, we have science to back us up. According to a study from 2019, of Alessio Squassina found that mood disorders, including depression, are associated with increased biological age of the cells. [7]

    Bottom Line

    Running is a fantastic physical activity that offers an array of health benefits. T

    he exciting research about running and the aging process should get us all to go out for a jog or at least hop on the treadmill.

    We hope that this article managed to explain how running can slow down the aging process and help older individuals to be healthier.

    REFERENCES:

    1. Larry A. Tucker,
      Physical activity and telomere length in U.S. men and women: An NHANES investigation,
      Preventive Medicine, Pages 145-151, ISSN 0091-7435, https://doi.org/10.1016/j.ypmed.2017.04.027.
    2. Blackmon CM, Tucker LA, Bailey BW, Davidson LE. Time Spent Jogging/Running and Biological Aging in 4458 U.S. Adults: An NHANES Investigation. International Journal of Environmental Research and Public Health. 2023; 20(19):6872. https://doi.org/10.3390/ijerph20196872
    3. Williams PT. Greater weight loss from running than walking during a 6.2-yr prospective follow-up. Med Sci Sports Exerc. 2013 Apr;45(4):706-13. doi: 10.1249/MSS.0b013e31827b0d0a. PMID: 23190592; PMCID: PMC4067491.
    4. Campbell JP, Turner JE. Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Front Immunol. 2018 Apr 16;9:648. doi: 10.3389/fimmu.2018.00648. PMID: 29713319; PMCID: PMC5911985.
    5. Lin X, Zhang X, Guo J, Roberts CK, McKenzie S, Wu WC, Liu S, Song Y. Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2015 Jun 26;4(7):e002014. doi: 10.1161/JAHA.115.002014. PMID: 26116691; PMCID: PMC4608087.
    6. https://www.cdc.gov/diabetes/library/features/diabetes-and-your-brain.html
    7. Squassina A, Pisanu C, Vanni R. Mood Disorders, Accelerated Aging, and Inflammation: Is the Link Hidden in Telomeres? Cells. 2019 Jan 15;8(1):52. doi: 10.3390/cells8010052. PMID: 30650526; PMCID: PMC6356466.

     

    Srdjan Ilic

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  • Bernadette Boden-Albala to be honored for contributions in addressing stroke inequities

    Bernadette Boden-Albala to be honored for contributions in addressing stroke inequities


    Newswise — Irvine, Calif., Jan. 30, 2024 — Bernadette Boden-Albala, M.P.H., Dr.P.H., director of the University of California, Irvine Program in Public Health and founding dean of the planned School of Population and Public Health, has been selected to receive the prestigious Edgar J. Kenton III Lecture Award from the American Stroke Association, a division of the American Heart Association, just prior to its annual International Stroke Conference. She is being recognized for her lifetime achievement of contributions to investigation, management, mentorship and community service in the field of stroke inequities or related disciplines.

    “It’s a great honor to be acknowledged by the American Heart Association’s leadership at such an important event,” Boden-Albala said. “Stroke exhibits significant racial and ethnic inequalities, encompassing differences in incidence, prevalence, treatment and outcomes. This award and lecture provide me with a valuable platform to highlight the crucial role of community-based research, particularly in addressing stroke disparities among diverse communities.”

    An internationally renowned expert in the social epidemiology of stroke and cardiovascular disease, Boden-Albala has authored or co-authored 170 publications that have become a blueprint for community-based stroke and heart disease prevention. Her robust research portfolio spans more than 25 years, with a focus on the roles of sex, race/ethnicity, socioeconomic status, social support, social networks and stress. Her work has significantly contributed to the understanding of inequalities and patterns of disparity across the U.S. and globally.

    The American Heart Association will host its 2024 International Stroke Conference on Feb. 7 to 9 at the Phoenix Convention Center. Boden-Albala will present her lecture Feb. 6 at a pre-conference symposium called Health Equity and Actionable Disparities in Stroke: Understanding and Problem Solving. Held at the same site, HEADS-UP is recognized internationally as the premier meeting dedicated to the science and treatment of cerebrovascular disease and brain health. This annual gathering brings together a vast network of professionals to gain insights into the physiological processes associated with stroke, explore more effective therapies for brain health and stroke recovery, and collectively strive to reduce the burden of stroke worldwide.

    About the University of California, Irvine: Founded in 1965, UCI is a member of the prestigious Association of American Universities and is ranked among the nation’s top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UCI has more than 36,000 students and offers 224 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. For more on UCI, visit www.uci.edu.

    Media access: Radio programs/stations may, for a fee, use an on-campus ISDN line to interview UCI faculty and experts, subject to availability and university approval. For more UCI news, visit news.uci.edu. Additional resources for journalists may be found at https://news.uci.edu/media-resources.

    NOTE TO EDITORS: PHOTO AVAILABLE AT
    https://news.uci.edu/2024/01/30/bernadette-boden-albala-to-be-honored-for-contributions-in-addressing-stroke-inequities/





    University of California, Irvine

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  • New Research Finds Volume Alone Does Not Predict Quality Outcomes in Pediatric Cardiac Surgery

    New Research Finds Volume Alone Does Not Predict Quality Outcomes in Pediatric Cardiac Surgery


    Newswise — SAN ANTONIO (January 28, 2024) — A study of pediatric heart surgery centers across the United States has demonstrated that, when it comes to successful surgery, it’s not just the size of the program that matters in determining quality outcomes. 

    Historically, hospitals with a “low volume” of pediatric heart operations—in this case, those that perform 103 surgeries or fewer a year—have been associated with worse outcomes for patients. However, a team led by D. Chauhan, MD, from WVU Medicine Children’s Heart Center found that “overperformers” and “underperformers” exist in all volume categories. 

    “Contrary to conventional wisdom regarding the relationship between institutional volume and quality outcomes, there are high-performing low-volume centers in pediatric cardiac surgery, for even the most complex operations,” said senior author Christopher Mascio, MD, a pediatric cardiothoracic surgeon, professor, and executive director at WVU Medicine Children’s Heart Center. “There are also underperforming high-volume programs. Judging program quality is more complex than a single volume number.”

    The team examined a total of 25,749 heart operations performed by 235 pediatric hospitals across the country. They divided the centers into three volume categories: low-volume (103 or fewer cases per year), mid-volume (104 to 194 cases per year), and high-volume (more than 194 cases per year). They included only “on-pump” procedures—meaning, those that used a cardiopulmonary bypass machine, which takes over temporarily for the heart and lungs while the operation is performed. 

     

    According to coauthor J. Hunter Mehaffey, MD, an assistant professor and director of cardiac surgery research at WVU, the study included variables commonly used and validated in evaluating risk in pediatric cardiac surgery including age, race, birth weight, genetic diagnosis, history of re-operation, the urgency of the procedure, the patient’s length of hospital stay before the surgery, and the presence of heterotaxy (an abnormal arrangement of the internal organs).

    Looking at hospital mortality rates, the researchers found that all three volume groups had both “overperforming” and “underperforming” hospitals. For six “benchmark” operations as defined by The Society of Thoracic Surgeons, they found no statistically significant difference in hospital mortality when comparing low- and mid-volume centers to high-volume centers.  

    The benchmark operations included tetralogy of Fallot repair, arterial switch with ventricular septal defect (VSD), arterial switch without VSD, Glenn and Fontan procedures, and truncus arteriosus repair.

    This new research study will be presented at The Society of Thoracic Surgeons’ 2024 Annual Meeting in San Antonio, Texas. The Society selected the presentation as its 2024 James S. Tweddell Memorial Paper in Congenital Surgery.

    Underscoring the study’s importance, Dr. Mascio added, “When parents consider which center is best for their child, there are many other factors at play, including care team coordination, proximity, surgical team, and personal interactions. The time is ripe for the congenital community to develop better methods for evaluating program quality. We hope this contribution provides a nidus for continued discussion around this issue, providing a voice to programs of all sizes.” 

     

    # # #

    Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,700 cardiothoracic surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

     





    The Society of Thoracic Surgeons

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  • New Research Highlights Superior Long-Term Survival with Multi-Arterial Coronary Artery Bypass Grafting Over Single Arterial Grafting

    New Research Highlights Superior Long-Term Survival with Multi-Arterial Coronary Artery Bypass Grafting Over Single Arterial Grafting


    Newswise — SAN ANTONIO (January 27, 2024) ─ A new study presented at The Society of Thoracic Surgeons’ 2024 Annual Meeting in San Antonio, Texas, examines the ongoing controversy surrounding the choice between multi-arterial grafting (MAG) and single arterial grafting (SAG) in coronary artery bypass grafting (CABG) for multivessel coronary revascularization.

    The research, spanning from 2008 to 2019 and involving over one million patients undergoing isolated CABG with more than two bypass grafts, found that multi-arterial grafting CABG is associated with superior long-term survival compared to single arterial grafting, establishing it as the preferred surgical strategy for multivessel revascularization. 

    “Multiple small studies have demonstrated a survival benefit of multi-arterial grafting. We wanted to know if this survival benefit of multi-arterial grafting observed in single-center studies would translate to a large national cohort,” said the study’s lead author, Joseph Sabik III, MD, University Hospitals.  “Using the STS Adult Cardiac Surgery Database, we were able to demonstrate that it does.”

     At 10 years, MAG demonstrated improved unadjusted (HR 0.59, 95% CI 0.58-0.61) and adjusted (HR 0.86, 95% CI 0.85-0.88) survival rates compared to SAG. A center volume of 10 or more MAG cases per year was associated with survival benefits. 

    MAG’s survival advantage over SAG was found in various subgroups, including stable coronary disease, acute coronary syndrome, and acute infarction. Notably, MAG showed superior survival for patients with a BMI less than 40, whereas patients with a BMI of 40 or higher had superior survival with SAG. Survival outcomes were equivalent between MAG and SAG for patients aged 80 years or older, and those with severe heart failure, renal failure, peripheral vascular disease, or obesity.

    Patient data was collected from the STS Adult Cardiac Surgery Database and linked to the National Death Index for comprehensive longitudinal survival analysis. Risk-adjustment measures, including inverse probability weighting and multivariable modeling, were implemented to ensure accurate comparisons.

    These findings have significant implications for clinicians and cardiac surgeons when deciding on the most appropriate multivessel revascularization approach.

    “The survival benefit of multi-arterial grafting was observed in nearly all patients, except in those 80 or older and in those with co-morbidities graded as severe, where multi and single-arterial grafting resulted in similar survival. The only patients where single arterial grafting resulted in better survival were severely obese,” said Dr. Sabik. 

     

    This research not only contributes valuable insights to the ongoing debate but also provides evidence-based guidance for healthcare professionals in optimizing patient outcomes during CABG procedures.

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    Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,700 cardiothoracic surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.





    The Society of Thoracic Surgeons

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  • ¿Quiénes se benefician de la administración de estatinas?

    ¿Quiénes se benefician de la administración de estatinas?

    Newswise — ROCHESTER, Minnesota—Si usted corre el riesgo de enfermedad cardíaca, el equipo de atención médica podría utilizar la herramienta de la ecuación de cohorte agrupada para determinar su riesgo a largo plazo y si la administración de estatinas (medicamentos para reducir el colesterol) es una buena opción.

    El Dr. Francisco Lopez-Jimenez, cardiólogo de Mayo Clinic de Rochester, Minnesota, afirma que es importante saber quiénes se benefician más de la administración de estatinas.

    Las estatinas son medicamentos que reducen la cantidad de colesterol que produce el hígado.

    “El colesterol se forma en las placas que se acumulan y crecen en el interior de las arterias, a veces hasta el punto de que esas arterias se obstruyen”, explica el Dr. López-Jiménez.

    Y esa obstrucción puede derivar en una enfermedad cardíaca. Sin embargo, ¿se pueden administrar las estatinas a todas las personas? 

    “Los pacientes que más se beneficiarán de la administración de estatinas serán las personas con antecedentes de ataques cardíacos, accidentes cerebrovasculares y otras afecciones que se sabe que se producen por las placas de colesterol”, afirma.

    La alimentación también desempeña un papel importante. El Dr. Lopez-Jimenez recomienda comer menos carne procesada y más cereales, frutas y verduras.

    “Los cambios de mayor impacto que las personas pueden hacer para reducir el colesterol incluyen consumir menos productos de origen animal que no sean pescado y consumir menos grasas saturadas”, afirma.

    ¿Qué ocurre si el equipo de atención médica recomienda medicamentos además de cambios en el estilo de vida?

    “Tome los medicamentos indicados, verifique las cantidades, asegúrese de que todos esos factores estén bien controlados”, afirma el Dr. Lopez-Jimenez.

    ###

    Información sobre Mayo Clinic

    Mayo Clinic es una organización sin fines de lucro, dedicada a innovar la práctica clínica, la educación y la investigación, así como a ofrecer pericia, compasión y respuestas a todos los que necesitan recobrar la salud. Visite la Red Informativa de Mayo Clinic para leer más noticias sobre Mayo Clinic.

    Mayo Clinic

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  • من الذي يستفيد من تناول أدوية خافِضة للكوليسترول؟

    من الذي يستفيد من تناول أدوية خافِضة للكوليسترول؟

    Newswise — مدينة روتشستر، ولاية مينيسوتا—إذا كنت مهددًا بخطرالإصابة بمرض القلب فقد يستخدم فريق الرعاية الصحية أداة معادلة تقييم المخاطر المُشتركة بين الفئات العمرية(PCE)  لتحديد خطر إصابتك على المدى الطويل وما إذا كان تناول أدوية خافِضة للكوليسترول — أدوية خفض الكوليستيرول، خيار مناسب لك أم لا.

    يقول الدكتور فرانسيسكو لوبيز جيمينيز،طبيب القلب لدى مايو كلينك في مدينة روتشستر، ولاية مينيسوتا إنه من المهم أن نفهم من هم الأكثر استفادةً من تناول أدوية خافِضة للكوليسترول.

    أدوية خافِضة للكوليسترول هي أدوية تعمل على خفض مقدار الكوليستيرول الذي يصنعه الكبد.

    يقول الدكتور لوبيز جيمينيز: “الكوليستيرول يتراكم في اللويحات التي تتجمع وتنمو داخل الشرايين، ويصل الأمر أحيانًا إلى انسداد هذه الشرايين.”

    والشرايين المسدودة تؤدي إلى مرض القلب التاجي. ولكن هل تناول أدوية خافِضة للكوليسترول مناسبة للجميع؟ 

    يقول الدكتور جيمينيز: “المرضى الأكثر استفادةً من تناول أدوية خافِضة للكوليسترول هم الأشخاص الذين لديهم تاريخ الإصابة بالنوبات القلبية والسكتات الدماغية وغير ذلك من الحالات المعروف أنها تنشأ عن لويحات الكوليستيرول.”

    كما أن الحمية الغذائية لها دور مهم. يقول الدكتور لوبيز جيمينيز إنه يجب الإقلال من أكل اللحوم المُصنَّعة والإكثار من الحبوب والفاكهة والخضروات.

    ويقول أيضًا: “التغييرات الأكثر تأثيرًا التي يجب على الناس إجراؤها للحد من الكوليستيرول تشمل الإقلال من أكل المُنتجات الحيوانية بخلاف الأسماك والإقلال من تناول الدهون المُشبَّعة.

    وماذا إذا أوصاك فريق الرعاية الصحية بالأدوية إلى جانب تغييرات نمط الحياة؟

    يقول الدكتور لوبيز جيمينيز: “خُذ الأدوية، وافحص مستويات الكوليسترول لديك، وتأكد أن كل العوامل تحت السيطرة.”

    ###

    نبذة عن مايو كلينك

    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.

    Mayo Clinic

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  • Quem se beneficia com a administração de estatinas?

    Quem se beneficia com a administração de estatinas?

    Newswise — ROCHESTER, Minnesota—Se você está sob o risco de ter uma doença cardíaca, a equipe de cuidados médicos pode usar a ferramenta de equação de coorte agrupada (PCE) para determinar o seu risco de longo prazo, e se a administração de estatinas (medicamentos para reduzir o colesterol) é uma boa opção.

    O Dr. Francisco Lopez-Jimenez, cardiologista da Mayo Clinic em Rochester, Minnesota, explica que é importante entender quem mais se beneficia com a administração de estatinas.

    As estatinas são medicamentos que reduzem a quantidade de colesterol produzida pelo fígado.

    “O colesterol se forma nas placas que acumulam e crescem dentro das artérias. Às vezes, o acúmulo chega ao ponto de as artérias ficarem bloqueadas”, explica o Dr. Lopez-Jimenez.

    E artérias bloqueadas podem ocasionar o surgimento de doença cardíaca. Mas, as estatinas podem ser usadas por todas as pessoas? 

    “Os pacientes que mais serão beneficiados com a administração de estatinas são aqueles com um histórico de ataques cardíacos, acidentes vasculares cerebrais e outras condições conhecidas decorrentes das placas de colesterol”, ele explica.

    A dieta também tem um papel importante. O Dr. Lopez-Jimenez recomenda consumir menos carne processada e mais grãos, frutas e vegetais.

    “As mudanças mais impactantes que as pessoas podem fazer para reduzir o colesterol incluem consumir menos produtos de origem animal, exceto peixes, e menos gordura saturada”, explica o Dr. Lopez-Jimenez.

    E se a equipe de cuidados médicos recomendar o uso de medicamentos além das mudanças do estilo de vida?

    “Tome os medicamentos, verifique as suas taxas e tenha a certeza de que todos os fatores estarão sob controle”, ele explica.

    ###

    Sobre a Mayo Clinic

    A Mayo Clinic é uma organização sem fins lucrativos comprometida com a inovação na prática clínica, educação e pesquisa, fornecendo compaixão, conhecimento e respostas para todos que precisam de cura. Visite a Rede de Notícias da Mayo Clinic para obter outras notícias da Mayo Clinic.

    Mayo Clinic

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  • Adolescent fitness may not provide as much future cardiovascular health benefit as believed.

    Adolescent fitness may not provide as much future cardiovascular health benefit as believed.

    Newswise — There is a well-known relationship between good physical fitness at a young age and a lower risk of cardiovascular disease later in life. However, when researchers adjusted for familial factors by means of sibling analysis, they found a weaker association, although the link between high body mass index (BMI) and cardiovascular disease remained strong. The study, which was conducted by researchers from Karolinska Institutet and other universities, is published in JAMA Network Open.

    “This does not mean that fitness is irrelevant,” says the study’s last author Viktor Ahlqvist, doctoral student at the Department of Global Public Health, Karolinska Institutet. “We could still see an association, although it was weaker after taking into account factors shared by full siblings. We also think that adolescence is an important time in life for establishing good habits such as exercising and having a healthy diet.”

    Challenging to prove causal associations

    Many observational studies have previously demonstrated links between various risk factors at a young age and cardiovascular disease in adulthood. However, whether the associations are causal is challenging to prove because of the potential influence of unaccounted genetic and environmental factors. A collaborative team including researchers from Karolinska Institutet in Sweden has therefore tried to examine if a large proportion of cardiovascular diseases in adulthood could indeed be prevented with a lower BMI, lower blood pressure, improved physical fitness or improved muscle strength in adolescence.

    Sourcing data from the Swedish Military Conscription Register and other Swedish registries, the researchers identified over a million 18-year-old males and followed them for 60 years. Almost half of them were full brothers.

    “The strength of our study, which makes it more reliable than many other conventional observational studies, is that we have used sibling analyses,” says the study’s first author Marcel Ballin, researcher at Uppsala University and analyst at Region Stockholm’s Centre for Epidemiology and Community Medicine. “By doing so we could examine how the relationship changes when controlling for all shared sibling factors. This includes environmental factors such as childhood environment and half of the genetics.”

    High BMI is a strong risk factor

    The results show that a high BMI in late adolescence was strongly associated with future cardiovascular disease, even after the researchers had controlled for shared familial factors. However, the association between physical fitness and cardiovascular disease was considerably weaker in the sibling analysis, suggesting that many previous observational studies might have overestimated the relevance of adolescent fitness to cardiovascular health later in life.

    “Our conclusion is that of the risk factors studied, high BMI is the strongest individual risk factor for cardiovascular disease, and that efforts to tackle the obesity epidemic should continue to be given high priority,” says co-author Daniel Berglind, docent at the Department of Global Public Health, Karolinska Institutet. “A good level of fitness and muscle strength in adolescence doesn’t seem as crucial, but physical activity still remains important for public health, as it can bring other health benefits.”

    Several limitations

    The study examined the association between risk factors at a young age and future cardiovascular disease; other disease outcomes were not investigated. The researchers had no data on whether the participants’ risk factors varied later in life, and they only studied men, which makes it difficult to extend their findings to women. The Military Conscription Register also lacks details on certain risk factors for future cardiovascular disease, such as diet, alcohol consumption, smoking, blood lipids and blood glucose.

    The researchers received no specific grant for this study. Co-author Martin Neovius is on the advisory panels for Ethicon, Johnson & Johnson and Itrim and has been a consultant for the Swedish armed forces outside the scope of this study. No other conflicts of interest have been reported.

    Publication: “Genetic and environmental factors and cardiovascular disease risk in adolescents”, Marcel Ballin, Martin Neovius, Francisco B. Ortega, Pontus Henriksson, Anna Nordström, Daniel Berglind, Peter Nordström, Viktor H. Ahlqvist, JAMA Network Open, online 17 November 2023, doi: 10.1001/jamanetworkopen.2023.43947.

    Karolinska Institute

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  • UTHealth Houston researchers awarded $2.6M NIH grant to study molecular pathways and potential strategies for treatment of myocardial ischemia and reperfusion injury

    UTHealth Houston researchers awarded $2.6M NIH grant to study molecular pathways and potential strategies for treatment of myocardial ischemia and reperfusion injury

    Newswise — A four-year, $2.6 million grant to study circadian rhythm and novel therapies to protect the heart during a heart attack or cardiac surgery has been awarded to UTHealth Houston by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

    Principal investigator Holger Eltzschig, MD, PhD, professor, and co-investigator Wei Ruan, MD, PhD, assistant professor, from the Department of Anesthesiology, Critical Care and Pain Medicine at McGovern Medical School at UTHealth Houston, are studying translational, pharmacologic, and interventional strategies targeting circadian rhythm and hypoxia signaling that could help patients who are experiencing a heart attack or undergoing open-heart surgery.

    Previously published research in 2012 and 2021 by Eltzschig and Ruan showed that biological rhythms affect myocardial ischemia and reperfusion injury (IRI) severity. IRI can occur in the setting of a heart attack, open-heart surgery, or during circulatory arrest, where blood flow is temporarily cut off (ischemia). During this period, the affected heart tissues suffer from inadequate oxygen supply (hypoxia). Once the obstruction is removed and blood flow resumes (reperfusion), rather than bringing immediate relief, this sudden influx of blood can lead to additional stress and damage to the heart.  

    The previous research further indicated that larger infarctions or higher incidences of heart failure happen in patients with morning onset heart attacks rather than later in the day. This daytime variation of myocardial injury hints at a potential interaction between circadian rhythm and hypoxia signaling.

    “My laboratory has been very interested in studying IRI for over two decades,” said Eltzschig, the John P. and Kathrine G. McGovern Distinguished University Chair and the director of the Center for Perioperative Medicine at McGovern Medical School. “We undertook an unbiased look to understand the molecular mechanisms of why there are differences in heart attacks in the early morning versus the late afternoon.”

    In studies that led up to the current grant application, the team of scientists analyzed heart tissue samples from circadian rhythm-trained mice following heart attacks at different time points of the day. In addition, they analyzed samples derived from the left heart ventricle of patients undergoing cardiac surgery at different times of the day. They identified a highly differentially expressed gene, BMAL1, a core circadian transcription factor. The genetic deletion of BMAL1 in mouse hearts eliminates daytime variations in cardiac injury.

    Natural protective molecules called hypoxia-inducible factors (HIFs) are activated due to a lack of oxygen and promote the adaptation to limited oxygen availability. In addition, HIFs limit excessive tissue inflammation in order to prevent further tissue damage. Specifically, researchers uncovered that HIF2A works together with BMAL1 in heart tissues to provide circadian-dependent heart protection.

    With this grant, researchers will aim to understand how BMAL1 and HIF2A interact and their functional roles in modulating daytime variation of cardiac injury. High-resolution imaging techniques will be employed to study the molecular interactions between BMAL1 and HIF2A by Kuang-Lei Tsai, PhD, co-principal investigator and assistant professor, and postdoctoral researcher Tao Li, PhD, from the Department of Biochemistry and Molecular Biology at McGovern Medical School. They will further explore the possibility of targeting the BMAL1 and HIF2A pathways as therapeutic strategies to protect the heart from injuries during surgery.

    “We are using data to see if the pathways and transcriptional regulations are occurring in patients undergoing cardiac surgery in the morning or the afternoon,” Eltzschig said.

    The other co-principal investigator of the study is Jochen Daniel Muehlschlegel, MD, MMSc, MBA, professor and chair of the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University. NIH Grant R01HL165748 funds this research.

    University of Texas Health Science Center at Houston

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  • Cardiologists Dr. Carlos Ince and Dr. Kate Elfrey of The Heart Center at Mercy are Featured Guests for the November 2023 edition of “Medoscopy”

    Cardiologists Dr. Carlos Ince and Dr. Kate Elfrey of The Heart Center at Mercy are Featured Guests for the November 2023 edition of “Medoscopy”

    Newswise — (Baltimore, MD) – Carlos Ince, M.D., FACC, board certified in Adult Cardiovascular Disease, and M. Kate Elfrey, D.O., board certified by the American Osteopathic Board in Cardiology and Internal Medicine, are the featured guests on Mercy Medical Center’s monthly talk show, “Medoscopy,” airing Wednesday and Thursday, Nov. 15th and 16th at 5:30 p.m. EST (www.facebook.com/MercyMedicalCenter).

    Both Drs. Ince and Elfrey see patients at The Heart Center at Mercy, which specializes in the diagnosis, treatment and prevention of heart disease including coronary artery disease (CAD), heart attack and high blood pressure.

    A 30-minute pre-taped program exploring the background and lives of Mercy clinicians, patients and others, Medoscopy was launched in spring 2021 and airs in two 15-minute segments. To view past episodes, visit the Medoscopy playlist on the Mercy Medical Center YOUTUBE channel.

    Dr. Ince explained his work with the Association of Black Cardiologists and efforts to address the ongoing issue of racial disparity in medicine. Dr. Elfrey noted how medicine for her is a family affairs, as her father, Stephen J. Plantholt, M.D., FACC, is not only a cardiologist as well, but is her colleague at The Heart Center at Mercy.

    Medoscopy is filmed on the campus of Mercy Medical Center in downtown Baltimore with video, sound, and lighting by Zinnia Film. 

    Founded in 1874 by the Sisters of Mercy, Mercy Medical Center is located in downtown Baltimore City, about six blocks from Baltimore’s famed Inner Harbor. A university-affiliated teaching facility, Mercy is a Catholic hospital with a national reputation for women’s health care, orthopedics, and other specialties. Mercy is home to the renowned Weinberg Center for Women’s Health & Medicine, and the $400+ million Mary Catherine Bunting Center. For more information, visit www.mdmercy.com, and MDMercyMedia on Facebook and Twitter, or call 1-800-M.D.-Mercy.

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    Mercy Medical Center

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  • Antibodies to Cow’s Milk Linked to Increased Risk of Cardiovascular Death

    Antibodies to Cow’s Milk Linked to Increased Risk of Cardiovascular Death

    BYLINE: Analyses led by Corinne Keet, MD, PhD, at the University of North Carolina School of Medicine, of two longitudinal studies reveal how an increased level of an antibody called immunoglobin (IgE) to cow’s milk is associated to cardiovascular-related death.

    Newswise — CHAPEL HILL, NC – Sensitivity to common food allergens such as cow’s milk and peanuts could be an important and previously unappreciated cause of heart disease, new research suggests – and the increased risk for cardiovascular death includes people without obvious food allergies.

    In a paper published in The Journal of Allergy and Clinical Immunology that describes analyses led by Corinne Keet, MD, PhD, pediatric allergy and immunology professor in the UNC Department of Pediatrics of two longitudinal studies, the authors show that the people who produced IgE antibodies to cow’s milk and other foods were at significantly increased risk of cardiovascular mortality. This was true even when traditional risk factors for heart disease, such as smoking, high blood pressure, and diabetes were accounted for. The strongest link was for cow’s milk, but IgE to other allergens such as peanut and shrimp were also significant among those who eat the foods.

    This troubling finding represents the first time that IgE antibodies to common foods have been linked to increased risk of cardiovascular mortality, the researchers report. The findings do not conclusively prove that food antibodies are causing the increased risk, but the work builds on previous studies connecting allergic inflammation and heart disease.

    “People who had an antibody called IgE to foods that they regularly eat seemed to be at increased risk for dying from heart disease,” said Keet, who is the corresponding author of the paper. “We were surprised by these findings because it is very common to have IgE to foods (about 15% of American adults have IgE to common food allergens), and most people don’t have any symptoms when they eat the food. As allergists, our thinking has been that it is not important if people have IgE to foods, as long as they don’t have symptoms when they eat the food,” she said.

    Funded by the National Institute of Allergy and Infectious Disease and an AAAAI Faculty Development Award to her collaborator Jeff Wilson at the University of Virginia, this research used two methods to examine the association between IgE sensitization to foods and cardiovascular mortality. Data from 4,414 adults who participated in The National Health and Examination Survey (NHANES) and 960 participants in the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort were used. Participants were enrolled in MESA from 2000-2002 and followed for up to 19 years. Participants were enrolled in NHANES from 2005 to 2006 and data on mortality up to 14 years were tracked. Total and specific IgE was measured to cow’s milk, egg, peanut, shrimp, and a panel of aeroallergens for the NHANES group. IgE to cow’s milk, alpha-gal, peanut, dust mite and timothy grass were measured in the MESA group. In NHANES, 229 cardiovascular deaths were recorded and 960 deaths from MESA were also reported. Milk sensitization was particularly associated in both NHANES & MESA. Researchers also discovered that food sensitization to shrimp and peanut were both additional risk factors for heart disease.

    It is also important to note that associations in the findings related to food sensitization rather than clinical allergy. Although researchers did not have access to information about clinical food allergy in either cohort, they expect that individuals who report regularly eating a food allergen on food frequency questionnaires were not showing symptoms of a food allergy. Thus, the findings that showed how associations were strengthened when researchers excluded those who avoided the food suggest that these findings were most relevant to those who have not been diagnosed with food allergy. Keet says the results raise questions about whether these apparently non-allergic individuals may have long-term consequences from consuming foods to which they are sensitized.

    The study states that aside from two recent reports linking IgE to the unusual carbohydrate allergen alpha-gal to coronary artery disease, cardiovascular disease had not previously been identified as a long-term complication of food sensitization. However, there is now substantial evidence for the importance of allergic-type immune pathways in normal cardiac physiology and heart disease. Because discovering the link between milk sensitization with cardiovascular mortality is new, Keet says there’s more to explore as far as the relevance of food sensitization and diet in cardiovascular disease development.

    “More research needs to be done about how sensitization to common food allergens is related to cardiovascular disease,” she said. “While this study provides good evidence of an association between sensitization to these allergens and death from cardiovascular disease, there is much work to be done to understand if this is a causal relationship.”

    Media contact: Brittany T. Phillips, Communications Specialist, UNC Health | UNC School of Medicine

     

    University of North Carolina Health Care System

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  • Older adults from distressed communities attend less cardiac rehab after heart procedures

    Older adults from distressed communities attend less cardiac rehab after heart procedures

    BYLINE: Noah Fromson

    Newswise — Older adults who live in disadvantaged communities are less likely to attend cardiac rehabilitation after common heart procedures, a Michigan Medicine-led study finds.

    The study aimed to calculate how many Medicare beneficiaries attended cardiac rehabilitation, a medically supervised program exercise and education program, after coronary revascularization between mid-2016 and 2018.

    Patient communities were categorized using the Distressed Community Index, which analyzes economic well-being and social determinants of health, such as educational disparities and poverty rate, of United States zip codes.

    Only 26% of patients from distressed communities use cardiac rehab, compared to 46% of patients from areas deemed prosperous. Any patient who attended cardiac rehab, no matter where they lived, had a reduced risk of death, hospitalization and heart attack, according to results published in Circulation: Cardiovascular Quality and Outcomes.

    “Addressing barriers to participation in cardiac rehabilitation in distressed communities may improve outcomes for these patients and reduce longstanding disparities in such outcomes,” said first author Michael P. Thompson, Ph.D., assistant professor of cardiac surgery at University of Michigan Medical School.

    “While some individuals who face geographic barriers to participation may benefit from transportation services or virtual options for cardiac rehab, there is a critical need to address socioeconomic barriers that prevent so many patients from attending this lifesaving therapy.”

    Additional authors include, Hechuan Hou, Francis D. Pagani, M.D., Ph.D., Robert B. Hawkins, M.D., Devraj Sukul, M.D., and Donald S. Likosky, Ph.D., all of University of Michigan, James W. Stewart II, M.D., of Yale School of Medicine, and Steven J. Keteyian, Ph.D., of Henry Ford Health.

    This study was funded as part of a career development award Thompson received from the Agency for Healthcare Research and Quality (AHRQ, Grant no. 1K01HS027830).

    Paper cited: “Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization,” Circulation: Cardiovascular Quality and Outcomes. DOI: 10.1161/CIRCOUTCOMES.123.010148

    Michigan Medicine – University of Michigan

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  • Brain Immune Cell to Neuron Conversion Aids Post-Stroke Mouse Recovery.

    Brain Immune Cell to Neuron Conversion Aids Post-Stroke Mouse Recovery.

    Newswise — Fukuoka, Japan – Researchers at Kyushu University have discovered that turning brain immune cells into neurons successfully restores brain function after stroke-like injury in mice. These findings, published on October 10 in PNAS, suggest that replenishing neurons from immune cells could be a promising avenue for treating stroke in humans.

    Stroke, and other cerebrovascular diseases, occur when blood flow to the brain is affected, causing damage to neurons. Recovery is often poor, with patients suffering from severe physical disabilities and cognitive problems. Worldwide, it’s one of the most common causes for needing long-term care.

    “When we get a cut or break a bone, our skin and bone cells can replicate to heal our body. But the neurons in our brain cannot easily regenerate, so the damage is often permanent,” says Professor Kinichi Nakashima, from Kyushu University’s Graduate School of Medical Sciences. “We therefore need to find new ways to replace lost neurons.”

    One possible strategy is to convert other cells in the brain into neurons. Here, the researchers focused on microglia, the main immune cells in the central nervous system. Microglia are tasked with removing damaged or dead cells in the brain, so after a stroke, they move towards the site of injury and replicate quickly.

    “Microglia are abundant and exactly in the place we need them, so they are an ideal target for conversion,” says first author, Dr. Takashi Irie from Kyushu University Hospital.

    In prior research, the team demonstrated that they could induce microglia to develop into neurons in the brains of healthy mice. Now, Dr. Irie and Professor Nakashima, along with Lecturer Taito Matsuda and Professor Noriko Isobe from Kyushu University Graduate School of Medical Sciences, showed that this strategy of replacing neurons also works in injured brains and contributes to brain recovery.

    To conduct the study, the researchers caused a stroke-like injury in mice by temporarily blocking the right middle cerebral artery – a major blood vessel in the brain that is commonly associated with stroke in humans. A week later, the researchers examined the mice and found that they had difficulties in motor function and had a marked loss of neurons in a brain region known as the striatum. This part of the brain is involved in decision making, action planning and motor coordination.

    The researchers then used a lentivirus to insert DNA into microglial cells at the site of the injury. The DNA held instructions for producing NeuroD1, a protein that induces neuronal conversion. Over the subsequent weeks, the infected cells began developing into neurons and the areas of the brain with neuron loss decreased. By eight weeks, the new induced neurons had successfully integrated into the brain’s circuits.

    At only three weeks post-infection, the mice showed improved motor function in behavioral tests. These improvements were lost when the researchers removed the new induced neurons, providing strong evidence that the newly converted neurons directly contributed to recovery.

    “These results are very promising. The next step is to test whether NeuroD1 is also effective at converting human microglia into neurons and confirm that our method of inserting genes into the microglial cells is safe,” says Professor Nakashima.

    Furthermore, the treatment was conducted in mice in the acute phase after stroke, when microglia were migrating to and replicating at the site of injury. Therefore, the researchers also plan to see if recovery is also possible in mice at a later, chronic phase.

    Kyushu University

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  • New insights into heart disease risk, prevention, and management

    New insights into heart disease risk, prevention, and management

     

    Newswise — DALLAS, Oct. 9, 2023 — Health experts are redefining cardiovascular disease (CVD) risk, prevention and management, according to a new American Heart Association presidential advisory published today in the Association’s flagship journal Circulation.

    Various aspects of cardiovascular disease that overlap with kidney disease, Type 2 diabetes and obesity support the new approach. For the first time, the American Heart Association defines the overlap in these conditions as cardiovascular-kidney-metabolic (CKM) syndrome. People who have or are at risk for cardiovascular disease may have CKM syndrome.

    The new approach detailed in the presidential advisory includes:

    • CKM syndrome stages ranging from 0, or no risk factors and an entirely preventive focus, to Stage 4, the highest-risk stage with established cardiovascular disease. Stage 4 may also include kidney failure. Each stage correlates to specific screenings and therapies.
    • Screening for and addressing social factors that impact health.
    • Collaborative care approaches among multiple specialties to treat the whole patient.
    • Suggested updates to the algorithm, or risk calculator, that helps health care professionals predict a person’s likelihood of having a heart attack or stroke. The update adds a risk prediction for heart failure, which estimates risk for “total cardiovascular disease” — heart attack, stroke and/or heart failure.
    • The writing group suggest the updated algorithm provide both 10- and 30-year cardiovascular disease risk estimates.

    According to the American Heart Association’s 2023 Statistical Update, 1 in 3 U.S. adults have three or more risk factors that contribute to cardiovascular disease, metabolic disorders and/or kidney disease. CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver. However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more.

    “The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Chiadi E. Ndumele, M.D., Ph.D., M.H.S., FAHA, writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore. “Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”

    CKM syndrome is a consequence of the historically high prevalence of obesity and Type 2 diabetes in both adults and youth, according to the advisory. Type 2 diabetes and obesity are metabolic conditions — the “M” in CKM — that are also risk factors for cardiovascular disease. Moreover, the most common cause of death for people with Type 2 diabetes and chronic kidney disease is cardiovascular disease.

    “We now have several therapies that prevent both worsening kidney disease and heart disease,” Ndumele said. “The advisory provides guidance for health care professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome.”

    With multiple conditions to manage, Ndumele noted fragmented care is a concern in treating patients with CKM syndrome, particularly for those with barriers to care. “The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient.” Additionally, the advisory emphasizes the importance of systematically screening for and addressing social factors that act as determinants, or drivers, of health, such as nutrition insecurity and opportunities for exercise,  as key aspects of optimal CKM syndrome care.”

    A companion article published with the presidential advisory, a new American Heart Association scientific statement, “A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome,”, documents the evidence for the writing committee’s proposed approach. The scientific statement brings together evidence from current guidelines and large research studies and describes where gaps remain in knowledge needed to further improve CKM health.

    CKM screening, stages and treatment

    CKM-related screening is intended to detect cardiovascular, metabolic and kidney health changes early; identify social and structural barriers to care; and prevent progression to the next stage of CKM syndrome.

    The advisory addresses care for adults. However, studies suggest CKM syndrome is progressive and begins early in life. Therefore, the advisory aligns with the American Academy of Pediatrics’ recommendations for children and youth to have annual assessments of weight, blood pressure, and mental and behavioral health, starting at age 3.

    Stage 0 – No CKM risk factors. The goal at this stage is preventing CKM syndrome by achieving and maintaining ideal health based on the American Heart Association’s Life’s Essential 8 recommendations. The recommendations include healthy eating, physical activity and sleep habits; avoiding nicotine; and maintaining optimal weight, blood pressure, blood sugar and cholesterol levels. The advisory suggests screening adults in Stage 0 every three to five years to assess blood pressure, triglycerides, HDL (good) cholesterol and blood sugar.

    Preventing unhealthy weight gain is important for CKM syndrome prevention because of the connection of obesity to Type 2 diabetes, high blood pressure and high triglycerides. At all stages, the advisory proposes yearly measurement of waist circumference and body mass index. Healthy lifestyle behaviors are also encouraged at every stage.

    Stage 1 – Excess body fat and/or an unhealthy distribution of body fat, such as abdominal obesity, and/or impaired glucose tolerance or prediabetes. Support for healthy lifestyle changes (healthy eating and regular physical activity) and a goal of at least 5% weight loss in people with Stage 1 are suggested, with treatment for glucose intolerance if needed. Screening every two to three years is advised to assess blood pressure, triglycerides, cholesterol and blood sugar.

    Stage 2 – Metabolic risk factors and kidney disease. Stage 2 includes people with Type 2 diabetes, high blood pressure, high triglycerides or kidney disease, and indicates a higher risk for worsening kidney disease and heart disease. The goal of care at this stage is to address risk factors to prevent progression to cardiovascular disease and kidney failure. Treatment may include medications to control blood pressure, blood sugar and cholesterol. In those with chronic kidney disease and in some people with Type 2 diabetes, SGLT2 inhibitors are advised to protect kidney function and reduce the risk of heart failure. SGLT2 inhibitors are a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with Type 2 diabetes. Glucagon-like peptide 1 (GLP-1) receptor agonists are also suggested for consideration in people with Type 2 diabetes to help reduce high glucose, facilitate weight loss and reduce risk for CVD. Other therapies to prevent worsening kidney function are also advised. Screening suggestions for Stage 2 CKM syndrome align with AHA/ACC guidelines, which include yearly assessment of blood pressure, triglycerides, cholesterol, blood sugar and kidney function.

    For those with increased risk of kidney failure based on kidney function assessments, more frequent kidney screening is recommended.

    Stage 3 – Early cardiovascular disease without symptoms in people with metabolic risk factors or kidney disease or those at high predicted risk for cardiovascular disease. The goal of care in Stage 3 is to intensify efforts to prevent people who are at high risk of progressing to symptomatic cardiovascular disease and kidney failure. This may involve increasing or changing medications, and additional focus on lifestyle changes. The writing committee advises coronary artery calcium (CAC) measurement in some adults to assess narrowing of the arteries when treatment decisions are unclear. CAC screening is used to guide decisions about cholesterol-lowering statin therapy. Test results indicating asymptomatic heart failure should lead to intensified therapy to prevent heart failure symptoms.

    The advisory also describes CKM syndrome regression, an important concept and public health message in which people making healthy lifestyle changes and achieving weight loss may regress to lower CKM syndrome stages and a better state of health. The best opportunity for patients to experience regression is in Stages 1, 2 and 3. Some may see improvements in glucose control, cholesterol and blood pressure levels, weight, kidney function and types of heart dysfunction.

    Stage 4 – Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors or kidney disease. Stage 4 CKM syndrome is divided into two subcategories: (4a) for those without kidney failure or (4b) for those with it. In this stage, people may have already had a heart attack or stroke or may already have heart failure. They also may have additional cardiovascular conditions such as peripheral artery disease or atrial fibrillation. The goal of care is individualized treatment for cardiovascular disease with consideration for CKM syndrome conditions.

    Predicting Risk

    A critical step in assessing risk and managing CKM syndrome is updating the risk prediction algorithm to help health care professionals predict cardiovascular disease in a way that includes CKM components: cardiovascular disease, chronic kidney disease and metabolic disorders.

    The Pooled Cohort Equation, the current risk calculator for atherosclerotic cardiovascular disease, established in 2013, estimates the risk of a heart attack or stroke in the next 10 years for people ages 40-75. It includes health and demographic factors about a person and is used to guide lifestyle recommendations and treatment decisions for people at risk for cardiovascular disease. The risk factors are age, sex and race (as white, Black and other); cholesterol levels; and systolic blood pressure. The equation also includes yes/no responses to whether a person is receiving treatment for high blood pressure Type 2 diabetes, or smokes cigarettes.

    The advisory proposes updating the risk calculator to include measures of kidney function, Type 2 diabetes control (using blood test results instead of a yes/no response) and social determinants of health for a more comprehensive risk estimate. Kidney function assessments include a measure of how well the kidneys filter waste from the blood and urine albumin levels, a measure of how well the kidneys reabsorb protein. Individual health measures in addition to demographic information will allow the calculator to produce an individual’s total CVD risk estimate.

    The writing group recommends the risk calculator updates be expanded to assess risk in people as young as age 30 and to calculate both 10- and 30-year CVD risk. More comprehensive CVD risk assessment at younger ages will allow for earlier preventive strategies to mitigate progression to advanced stages of CKM syndrome. In the long term, this will help to reduce gaps in treatment and health equity and improve outcomes.

    Calls to Action

    The advisory calls for systemic changes to optimize CKM health.

    “There is a need for fundamental changes in how we educate health care professionals and the public, how we organize care and how we reimburse care related to CKM syndrome,” Ndumele said. “Key partnerships among stakeholders are needed to improve access to therapies, to support new care models and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health.”

    Investing in research is important for advancing CKM care. Key research gaps include:

    1. better understanding the pathways leading to heart disease in CKM syndrome;
    2. better understanding of why some people may advance more quickly along CKM stages, while others may progress more slowly; and
    3. understanding the best way to use newer therapies with multiple effects on CKM syndrome, including to improve metabolic factors such as obesity and Type 2 diabetes, and to reduce worsening kidney disease and prevent heart disease.

    Co-authors and their disclosures are listed in the manuscript.

    This presidential advisory was prepared by the volunteer writing group on behalf of the American Heart Association. Presidential advisories and scientific statements promote greater awareness about cardiovascular diseases and stroke and help facilitate informed health care decisions. They outline what is known about a topic and what areas need additional research. While scientific statements and advisories inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide official clinical practice recommendations.

    The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

    Additional Resources:

    American Heart Association (AHA)

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  • Baylor Scott & White Presents Research At The Heart Failure Society of America Annual Scientific Meeting 2023

    Baylor Scott & White Presents Research At The Heart Failure Society of America Annual Scientific Meeting 2023

    BYLINE: Baylor Scott & White Presents Research At The Heart Failure Society of America Annual Scientific Meeting 2023

    The Heart Failure Society of America (HFSA) is a multidisciplinary organization working to improve and expand heart failure care through collaboration, education, research, innovation and advocacy. Its annual scientific meeting held Oct. 6-9, in Cleveland offers the best heart failure science, research, practical management and networking opportunities for HFSA members to learn about their peers’ latest research.

    Researchers with Baylor Scott & White Research Institute and clinicians on the medical staff with Baylor University Medical Center at Dallas and Baylor Scott & White The Heart Hospital – Plano will present the following research at the meeting.  For more information visit our page:  Baylor Scott & White Research

    Baylor Scott and White Health

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  • UM Medicine Faculty-Scientists and Clinicians Perform Second Historic Transplant of Pig Heart into Patient with End-Stage Cardiovascular Disease

    UM Medicine Faculty-Scientists and Clinicians Perform Second Historic Transplant of Pig Heart into Patient with End-Stage Cardiovascular Disease

    Newswise — After world’s first successful transplant in 2022, also performed at the University of Maryland Medical Center (UMMC), this groundbreaking transplant team performed second pig heart transplant on patient deemed ineligible for traditional heart transplant.

    A 58-year-old patient with terminal heart disease became the second patient in the world to receive a historic transplant of a genetically-modified pig heart on September 20. He is recovering and communicating with his loved ones. This is only the second time in the world that a genetically modified pig heart has been transplanted into a living patient.  Both historic surgeries were performed by University of Maryland School of Medicine (UMSOM) faculty at the University of Maryland Medical Center (UMMC).

    The first historic surgery, performed in January, 2022, was conducted on David Bennett by University of Maryland Medicine surgeons (comprising UMSOM and UMMC), who are recognized as the leaders in cardiac xenotransplantation. This new patient, Lawrence Faucette, had end-stage heart disease. He was deemed ineligible for a traditional transplant with a human heart, by UMMC and several other leading transplant hospitals, due to his pre-existing peripheral vascular disease and complications with internal bleeding.

    This transplant was the only option available for Mr. Faucette who was facing near-certain death from heart failure. The patient, who lives in Frederick, MD, is a married father of two and a 20-year Navy veteran and most recently worked as a lab technician at the National Institutes of Health before his retirement. He is currently breathing on his own, and his heart is functioning well without any assistance from supportive devices.

    “My only real hope left is to go with the pig heart, the xenotransplant,” said Mr. Faucette during an interview from his hospital room a few days before his surgery. “Dr. Griffith, Dr. Mohiuddin and their entire staff have been incredible, but nobody knows from this point forward. At least now I have hope, and I have a chance.”

    Added his wife, Ann Faucette: “We have no expectations other than hoping for more time together. That could be as simple as sitting on the front porch and having coffee together.”

    The U.S. Food and Drug Administration granted emergency approval for the surgery on Friday September 15 through its single patient investigational new drug (IND) “compassionate use” pathway. This approval process is used when an experimental medical product, in this case the genetically-modified pig’s heart, is the only option available for a patient faced with a serious or life-threatening medical condition. The approval was granted in the hope of saving the patient’s life.

    “We are once again offering a dying patient a shot at a longer life, and we are incredibly grateful to Mr. Faucette for his bravery and willingness to help advance our knowledge of this field,” said Bartley P. Griffith, MD, who surgically transplanted the pig heart into both the first and second patient at UMMC. Dr. Griffith is the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery and Clinical Director of the Cardiac Xenotransplantation Program at UMSOM. “We are hopeful that he will get home soon to enjoy more time with his wife and the rest of his loving family.”

    Considered one of the world’s foremost experts on xenotransplantation, Muhammad M. Mohiuddin, MD, Professor of Surgery at UMSOM, joined the UMSOM faculty seven years ago and established the Cardiac Xenotransplantation Program. Dr. Mohiuddin serves as the program’s Program/Scientific Director. Dr Mohiuddin co-led this procedure with Dr Griffith.

     “We are continuing to pursue the pathway to clinical trials by providing important new data on pre-clinical research that has been requested by the FDA,” said Dr. Mohiuddin. “The FDA used our data from these new studies, as well as our experience with the first patient, to determine that we were ready to attempt a second transplant in an end-stage heart disease patient who had no other treatment options.”

    About 110,000 Americans are currently waiting for an organ transplant, and more than 6,000 patients die each year before getting one, according to the federal government’s organdonor.gov. Transplanting animal organs (known as xenotransplantation) could potentially save thousands of lives but carries a unique set of risks. Besides the fear of transmitting an unknown pathogen from the animal to human, xenotransplants are more likely to trigger a dangerous immune response. These responses can trigger an immediate rejection of the organ with a potentially deadly outcome to the patient.

    “As a cardiothoracic surgeon who does lung transplants, I am so grateful to our team of surgeons who are working to help solve the organ shortage crisis,” said Christine Lau, MD, MBA the Dr. Robert W. Buxton Professor and Chair of the Department of Surgery at UMSOM and Surgeon-in-Chief at UMMC. “Once again, we are at the forefront of a historic accomplishment that brings us one step closer to making xenotransplantation a life-saving reality for patients in need.”

    United Therapeutics Corporation, through its xenotransplantation subsidiary Revivicor, based in Blacksburg, VA, provided the genetically-modified pig to the xenotransplantation laboratory at UMSOM. On the morning of the transplant surgery, the surgical team, led by Dr. Griffith and Dr. Mohiuddin, removed the pig’s heart and placed it in the XVIVO Heart Box, a machine perfusion device, to keep the heart preserved until surgery.

    The physician-scientists are also treating the patient with a novel antibody therapy along with conventional anti-rejection drugs, which are designed to suppress the immune system and prevent the body from damaging or rejecting the foreign organ. The novel therapy being developed by Eledon Pharmaceuticals is an experimental antibody, called tegoprubart; it blocks CD154, a protein involved in immune system activation.

    Before consenting to receive the transplant, Mr. Faucette was fully informed of the procedure’s risks, and that the procedure was experimental with unknown risks and benefits. He was admitted to UMMC on Thursday, September 14 after experiencing complications from his heart failure and peripheral vascular disease. Mr. Faucette underwent a psychiatric evaluation and met with a medical ethicist, social workers and other members of the UMMC care team to discuss the procedure’s risks and benefits and to obtain his informed consent.

    “This innovative program embodies the future of molecular medicine in surgery and speaks to a possible future where organs may be available to all patients,” said UMSOM Dean Mark Gladwin MD, who is also Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor at UMSOM. “We recognize a heroic partnership with Mr. Faucette and his family, as we partner to advance the field of transplantation medicine into the next era.  I appreciate the hard work of so many of our clinical, research and administrative teams at the University of Maryland Medicine. They have worked so hard over the last year to prepare for this day, doing everything possible to optimize the outcome of this historic surgery.”

    “This transplant is another remarkable achievement for medicine and humanity that would not have been possible without the close relationship between University of Maryland Medical Center and our University of Maryland School of Medicine partners,” said Bert W. O’Malley, MD, President and CEO of the University of Maryland Medical Center. “The Faucettes and thousands of families like them are the reason we are pressing onward to propel the xenotransplantation field forward. We are immensely proud to have taken another significant leap toward a day when more people who need a lifesaving organ transplant can get one.”

    “This is an exciting time for everyone in the xenotransplantation field,” said Mohan Suntha, MD, MBA, University of Maryland Medical System President and CEO. “We’ve seen an astonishing amount of progress in a short period of time and our System is proud to be part of this incredible milestone. This is the result of the resolve and tenacity of researchers who have held fast to the vision over decades. Those team members who have been directly involved in this work as well as those who have watched in hopeful interest are each part of a medical community that can feel the magnitude of this moment.”

    Organs from genetically modified pigs have been the focus of much of the research in xenotransplantation, in part because of physiologic similarities between pigs and human and nonhuman primates. United Therapeutics has funded a $22 million research program to test their genetically-modified pig hearts from Revivicor in baboon studies conducted at UMSOM.

    Three genes–responsible for a rapid antibody-mediated rejection of pig organs by humans—were “knocked out” in the donor pig. Six human genes responsible for immune acceptance of the pig heart were inserted into the genome. One additional gene in the pig was knocked out to prevent excessive growth of the pig heart tissue, for a total of 10 unique gene edits made in the donor pig. 

    “This procedure is another significant step forward in bringing our vision of lifesaving xenotransplantation to those patients in desperate need,” said David Ayares, PhD, President and Chief Scientific Officer of United Therapeutics Corporation’s Revivicor subsidiary. “This second successful transplantation of United Therapeutics’ UHeart™ is a product of decades of gene editing, animal husbandry, and creative thinking by the team of scientists at United Therapeutics and Revivicor, and at the University of Maryland—especially Drs. Mohiuddin and Griffith. All of us at United Therapeutics recognize the bravery and unconditional willingness by Mr. Faucette to advance the cause of science and medical treatment in this remarkable way.”

    During the nearly two years since the first surgery, UMSOM faculty-scientists have extensively investigated Mr. Bennett’s experience with the world’s first genetically modified cardiac xenotransplant. They published their initial findings in the New England Journal of Medicine and then published their follow-up findings from an extensive investigation in The Lancet. They demonstrated that the pig heart functioned well in the patient for several weeks with no signs of acute rejection. Mr. Bennett’s death from heart failure was likely caused by a multitude of factors including his poor state of health that left him hospitalized on a heart-lung bypass machine for six weeks prior to the transplant.

    Prior to performing the first surgery in Mr. Bennett in 2022, Dr. Mohiuddin, Dr. Griffith, and their research team spent five years perfecting the surgical technique on non-human primates. Dr. Mohiuddin’s xenotransplant research experience spans over 30 years, during which time he demonstrated in peer-reviewed research that a genetically-modified pig’s heart can function when placed in the abdomen for as long as three years.

     

    About the University of Maryland School of Medicine

    Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $500 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2023, the UM School of Medicine is ranked #10 among the 92 public medical schools in the U.S., and in the top 16 percent (#32) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

    About the University of Maryland Medical Center

    The University of Maryland Medical Center (UMMC) is comprised of two hospital campuses in Baltimore: the 800-bed flagship institution of the 11-hospital University of Maryland Medical System (UMMS) and the 200-bed UMMC Midtown Campus. Both campuses are academic medical centers for training physicians and health professionals and for pursuing research and innovation to improve health. UMMC’s downtown campus is a national and regional referral center for trauma, cancer care, neurosciences, advanced cardiovascular care, and women’s and children’s health, and has one of the largest solid organ transplant programs in the country. All physicians on staff at the downtown campus are clinical faculty physicians of the University of Maryland School of Medicine. The UMMC Midtown Campus medical staff is predominately faculty physicians specializing in a wide spectrum of medical and surgical subspecialties, primary care for adults and children and behavioral health. UMMC Midtown has been a teaching hospital for 140 years and is located one mile away from the downtown campus. For more information, visit www.umm.edu.

    About the University of Maryland Medical System

    The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine and University of Maryland, Baltimore who educate the state’s future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System’s anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

    University of Maryland School of Medicine

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  • Diabetes Treatments Less Studied in Black Patients

    Diabetes Treatments Less Studied in Black Patients

    Newswise — New research analysing the effects of two drugs used to treat type 2 diabetes indicates a consistent lack of cardiovascular and renal benefits in Black populations. Cardiovascular disease is the leading cause of severe illness and death associated with type 2 diabetes. Renal disease is also a common complication of type 2 diabetes.

    The drugs, called sodium-glucose co-transporter 2 inhibitors (SGLT2-Is) and glucogen-like peptide 1 receptor agonists (GLP1-RAs), are some of the newer treatments prescribed to lower blood sugar levels in people with type 2 diabetes.

    The research findings, published in the Journal of the Royal Society of Medicine, show that for White and Asian populations, SGLT2-Is and GLP1-RAs have beneficial effects on blood pressure, weight control and renal function, and significantly reduce the risk of severe heart problems and kidney disease. However, the research shows no evidence of these beneficial effects in Black populations.

    Researchers at the Diabetes Research Centre at the University of Leicester analysed the results of 14 randomised controlled trials of SGLT2-Is and GLP1-RAs reporting cardiovascular and renal outcomes by race, ethnicity and region.

    Lead researcher Professor Samuel Seidu, Professor in Primary Care Diabetes and Cardio-metabolic Medicine at the University of Leicester, said: “Given the well-documented evidence that Black and other ethnic minority populations are more likely to develop type 2 diabetes and at a younger age, the consistent lack of benefits we observed among Black populations is concerning.

    “Minimising racial and ethnic variations in the cardiovascular and renal complications of type 2 diabetes requires targeted improved access to care and treatment for those most at risk.”

    The researchers suggest there are many factors that could have contributed to the lack of evidence of beneficial effects for Black and other non-White populations. Low statistical power due to small sample sizes of these populations may be partly responsible.

    “It is quite clear from the current data that some racial/ethnic groups such as Black populations were underrepresented in all the included trials,” pointed out Professor Seidu.

    Enrolment in the trials ranged from 66.6% to 93.2% for White populations, 1.2% and 21.6% for Asian populations, and 2.4% to 8.3% for Black populations.

    However, the researchers suggest that, given the consistent nature of the significant lack of beneficial effects across the majority of outcomes for Black populations, other factors may also be at play.

    “”Whether the differences are due to issues with under-representation of Black populations and low statistical power, or to racial/ethnic variations in the way the body and these drugs interact with each other needs further investigation,” said Professor Seidu. “It is therefore important that prescribers don’t hasten to deny these newer treatments to Black populations on the back of this research.”

    SAGE Publications UK

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  • Por qué las personas adultas de la comunidad LGBTQ+ deben prestar atención a la salud cardíaca

    Por qué las personas adultas de la comunidad LGBTQ+ deben prestar atención a la salud cardíaca

    Newswise — ROCHESTER, Minnesota — En estudios recientes se ha observado una tendencia preocupante en la salud cardiovascular de las personas adultas de la comunidad LGBTQ+. Tienen una peor salud cardíaca en comparación con las personas cisgénero heterosexuales. Las personas LGBTQ+ también tienden a tener una mayor prevalencia de factores de riesgo de enfermedad cardiovascular.

    La Dra. Rekha Mankad, cardióloga de Mayo Clinic, explica lo que puede aumentar el riesgo de enfermedad cardiovascular en las personas adultas LGBTQ+ y lo que se puede hacer para disminuirlo.

    “La comunidad LGBTQ+ es un grupo de personas marginalizado”, dice la Dra. Mankad. “Uno de los primeros problemas es que quizás no acudan a realizarse exámenes médicos periódicos”.

    Cuando se trata de prevenir enfermedades cardiovasculares, es fundamental conocer los factores de riesgo.

    Estos son los factores de riesgo comunes de las enfermedades cardíacas:

    • Presión arterial alta
    • Colesterol alto
    • Consumo de tabaco
    • Diabetes
    • Falta de actividad física
    • Obesidad

    “Son cosas de las que hablamos con todos, pero se debe consultar con un proveedor de atención médica para hablar acerca de esos factores de riesgo”, explica la Dra. Mankad.

    Alrededor de la mitad de las personas LGBTQ+ dicen que han sufrido discriminación en el entorno sanitario, lo cual es un factor que hace que sea menos probable que vean a un médico en comparación con las personas cisgénero heterosexuales.

    “Si a una persona le preocupa ir al médico, seguramente no va a hablar de los aspectos que la ponen en riesgo de presentar enfermedades cardíacas”, aclara la doctora.

    La Dra. Mankad dice que otro factor puede ser la presencia de factores estresantes particulares de los grupos marginalizados.

    “Existen tensiones interpersonales, tales como la autoestigmatización y cuestiones relacionadas con el ocultamiento. Además, lidian con problemas como los prejuicios que han sufrido y, posiblemente, la violencia”, aclara.

    El estrés puede derivar en otros problemas

    “Si una persona se expone a mayor estrés, es más probable que presente ansiedad o depresión”, dice la Dra. Mankad. “Además, es menos probable que salga y haga ejercicio porque siente incomodidad en un vestidor o vestuario. Estos son algunos de los muchos factores que luego pueden generar una mayor probabilidad de desarrollar esos factores de riesgo de enfermedades cardíacas”.

    Ante estas circunstancias, es fundamental que las personas de la comunidad LGBTQ+ sean proactivas con respecto a su salud cardíaca.

    “Les diría a las personas de la comunidad que no duden en ver a un proveedor de atención médica y que le hablen con honestidad”, agrega la Dra. Mankad. “Háganle saber sus preocupaciones en relación con la salud en general, en especial la salud cardiovascular, y elaboren un plan sobre lo que pueden hacer para proteger el corazón a largo plazo”.

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