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Tag: Heart Disease

  • 82-year-old Korean man has heart attack after choking on ‘live octopus’ dish | CNN

    82-year-old Korean man has heart attack after choking on ‘live octopus’ dish | CNN

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    Seoul, South Korea
    CNN
     — 

    An 82-year-old man in South Korea had a heart attack after choking on a piece of “live octopus,” or san-nakji, a local delicacy comprised of freshly severed – and still wriggling – tentacles.

    Fire station authorities in Gwangju, a city near the country’s southern tip, received a report on Monday morning that a piece of san-nakji had become stuck in a man’s throat, according to a fire station official.

    When first responders arrived on site, the man had a cardiac arrest, and they conducted CPR, the official said.

    The official did not say whether the man survived.

    San-nakji refers to a small octopus that is sliced and served raw, often eaten in South Korea’s coastal areas or seafood markets.

    Though the dish’s name translates to “live octopus,” this is slightly misleading – the octopus is killed before serving, with its tentacles cut into portions.

    However, it is served immediately after slicing, and is so fresh that the tentacles’ nerves are still active – causing the octopus to appear “live” as it continues moving on the plate.

    San-nakji is often served with sesame oil, sesame seeds, and sometimes ginger, and has a chewy texture.

    It made an appearance on a 2015 episode of Anthony Bourdain’s CNN series “Parts Unknown,” when the famed chef and television host traveled to South Korea to sample everything from soju to Korean fried chicken – and san-nakji, with Bourdain using his chopsticks to peel a sticky tentacle off the plate.

    The dish has also previously made headlines, with local media reporting multiple cases over the years of diners dying after choking or asphyxiating on “live octopus.”

    In perhaps the best-known case, dubbed the “octopus murder,” a South Korean man was sentenced to life imprisonment in 2012 for allegedly killing his girlfriend and claiming it was a san-nakji accident – before he was acquitted by the Supreme Court in 2013 for insufficient evidence.

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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

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    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

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    Michigan Medicine – University of Michigan

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  • Diabetes Associations Recognize Plant-Based Diets  | NutritionFacts.org

    Diabetes Associations Recognize Plant-Based Diets  | NutritionFacts.org

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    Plant-based diets are the single most important—yet underutilized—opportunity to reverse the pending obesity and diabetes-induced epidemic of disease and death. 

    Dr. Kim Williams, immediate past president of the American College of Cardiology, started out an editorial on plant-based diets with the classic Schopenhauer quote: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” In 2013, plant-based diets for diabetes were in the “ridiculed” stage in the official endocrinology practice guidelines and placed in the “Fad Diets” section. The guidelines acknowledged that strictly plant-based diets “have been shown to reduce the risk for T2DM [type 2 diabetes] and improve management of T2DM” better than the American Diabetes Association recommendations, then inexplicably went on to say that it “does not support the use of one type of diet over another” with respect to diabetes or in general. “The best approach for a healthy lifestyle is simply the ‘amelioration of unhealthy choices’”—whatever that means. 

    But, by 2015, the clinical practice guidelines from the same professional associations explicitly endorsed a plant-based diet as its general recommendation for diabetic patients. The times they are a-changin’! 

    As I discuss in my video Plant-Based Diets Recognized by Diabetes Associations, the American Diabetes Association itself is also now on board, listing plant-based eating as one of the dietary patterns acceptable for the management of the condition. The Canadian Diabetes Association, however, has really taken the lead. “Type 2 diabetes mellitus is considered one of the fastest growing diseases in Canada, representing a serious public health concern,” so it isn’t messing around and recommends plant-based diets for disease management “because of their potential to improve body weight and A1C [blood sugar control], LDL-cholesterol, total cholesterol and non-HDL-cholesterol levels, in addition to reducing the need for diabetes medications.” The Canadian Diabetes Association uses the Kaiser Permanente definition for that eating pattern: “a regimen that encourages whole, plant-based foods and discourages meats, dairy products and eggs, as well as all refined and processed foods,” that is, junk. 

    It recommends that diabetes education centers in Canada “improve patients’ perceptions of PBDs [plant-based diets] by developing PBD-focused educational and support as well as providing individualized counseling sessions addressing barriers to change.” The biggest obstacle identified to eating plant-based was ignorance. Nearly nine out of ten patients interviewed “had not heard of using a plant-based diet to treat or manage T2DM.” Why is that? “Patient awareness of (and interest in) the benefits of a plant-based diet for the management of diabetes…may be “influenced by the perception of diabetes educators and clinicians.” Indeed, most of the staff were aware of the benefits of plant-based eating for treating diabetes, yet only about one in three were recommending it to their patients.  

    Why? One of the common reasons given was they didn’t think their patients would eat plant-based, so they didn’t even bring it up, but “[t]his notion is contrary to the patient survey results that almost two-thirds of patients were willing” to at least give it a try. The researchers cite the PCRM Geico studies I’ve covered in other videos, in which strictly plant-based diets were “well accepted with over 95% adherence rate,” presumably because the study participants just felt so much better, reporting “increased energy level, better digestion, better sleep, and increased satisfaction when compared with the control group.” 

    A number of staff members also expressed they were unclear about the supportive scientific evidence as their second reason for not recommending this diet, but it’s been shown to be more effective than an American Diabetes Association–recommended diet at reducing the use of diabetes medications, long-term blood sugar control, and cholesterol. It’s therefore possible that the diabetes educators were simply behind the times, as there is “a lag-time” in the dissemination of new scientific findings from the literature to the clinician and finally to the patient. Speeding up this process is one of the reasons I started NutritionFacts.org. 

    As Dr. Williams put it, “the ‘truth’ (i.e., evidence) for the benefits of plant-based nutrition continues to mount. This now includes lower rates of stroke, hypertension, diabetes mellitus, obesity, myocardial infarction, and mortality [heart attacks and cardiac death], as well as many non-cardiac issues that affect our patients in cardiology, ranging from cancer to a variety of inflammatory conditions.” We’ve got the science. The bigger challenge is overcoming the “inertia, culture, habit, and widespread marketing of unhealthy foods.” He concludes, “Reading the existing literature and evaluating the impact of plant-based nutrition, it clearly represents the single most important yet underutilized opportunity to reverse the pending obesity and diabetes-induced epidemic of morbidity and mortality,” disease and death. 

    I highlighted the PCRM Geico studies in my videos Slimming the Gecko and Plant-Based Workplace Intervention. 

    Aren’t plant-based diets high in carbs? Get the “skinny” by checking out my video Flashback Friday: Benefits of a Macrobiotic Diet for Diabetes. 

    To learn more about diet’s effect on type 2 diabetes, see the related videos below. 

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    Michael Greger M.D. FACLM

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

    New insights into heart disease risk, prevention, and management

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    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:

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    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

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    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

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    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

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    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.

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  • New Study Confirms HeartFlow FFRCT Leads to Improved Patient Outcomes

    New Study Confirms HeartFlow FFRCT Leads to Improved Patient Outcomes

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    Newswise — CLEVELAND – A diagnostic test, first offered in the United States at University Hospitals (UH) Harrington Heart & Vascular Institute, has now shown through a clinical study to significantly decrease cardiovascular mortality, reduce additional non-invasive heart testing, and increase cath lab efficiency. These results show a promising, new approach that benefits not only patients’ health, but their pocketbooks.

    Developed by HeartFlow Inc., FFRCT (Fractional Flow Reserve – Computed Tomography) is the first and only non-invasive integrated heart care solution that creates a 3D model of the coronary arteries used to help physicians detect blockages, as well as identify their extent and impact on heart function. It aims to be a new standard of care for the diagnosis and management of coronary artery disease (CAD) – the number one killer worldwide. CAD affects an estimated 16.8 million American adults and is one of the most expensive medical conditions to the U.S. health care system.

    UH Harrington & Heart Vascular Institute’s Daniel Simon, MD, and Hiram Bezerra, MD, PhD were the first to use the FFRCT test in the U.S. on Jan. 16, 2015.

    “This is another example of UH Harrington Heart & Vascular Institute’s commitment to research and defining the future of medicine,” said Mehdi Shishehbor, DO, MPH, PhD, President of UH Harrington Heart & Vascular Institute, and Angela and James Hambrick Chair in Innovation. “Every day, our teams work to find new treatments and approaches to reduce cardiovascular morbidity and mortality. Eight years later, our early adoption of HeartFlow’s FFRCT technology has proven incredibly beneficial to our patients.”

    Now, promising results from a real world, multi-center, retrospective clinical study have been  released. The National Health Service England conducted the two-year FISH&CHIPS study and presented its findings at the 2023 European Society of Cardiology Congress meeting in Amsterdam.

    The study, involving more than 90,000 patients, was designed to assess at a national level the incremental impact of adding FFRCT to a CCTA-first (Coronary Computed Tomography Angiography) diagnostic pathway to evaluate and manage CAD.

    FISH&CHIPS key outcomes associated with availability of FFRCT include:

    • A significant 14% relative reduction in cardiovascular mortality and a significant 8% relative reduction in all-cause mortality.
    • An increase in cath lab efficiency, driven by a 5% relative reduction in invasive cardiac angiography (ICA) and an 8% relative increase in Percutaneous Coronary Intervention (PCI).
    • A 14% relative reduction in additional non-invasive heart testing following CCTA.
    • High prognostic value for FFRCT whereby patients with severely abnormal FFRCT values (≤0.50) had a 2x risk of all-cause death and a 3x risk of non-fatal MI compared to patients with normal FFRCT values.

    After performing the first American FFRCT case in 2015, Dr. Simon, then president of UH Harrington Heart & Vascular Institute, said he believed FFRCT had the potential to completely change the way CAD was managed globally.

    “FFRCT is indeed a game changer,” said Dr. Simon, now President of Academic & External Affairs and Chief Scientific Officer, and Ernie and Patti Novak Distinguished Chair in Health Care Leadership at University Hospitals, as well as Professor of Medicine and Senior Associate Dean for Academic Affairs at Case Western Reserve University School of Medicine. “This technology has changed our approach to the diagnosis of coronary artery disease. We have embraced FFRCT as the first line, preferred test because it saves lives, reduces unnecessary invasive procedures, and increases cardiac cath lab efficiency.”

    Non-invasive tests are widely used to diagnose CAD, but studies have shown a need to improve their accuracy. Most other diagnostic tests provide information regarding a patient’s overall risk of CAD, but they cannot help the clinician determine the extent to which a specific blockage is impeding blood flow to the heart. This missing piece leads to more testing and potentially more cost to the patient. HeartFlow’s FFRCT technology is designed to address this unmet need.

    “The nationwide CCTA-first approach for evaluating patients with possible cardiovascular disease has become the model of both clinical efficacy and efficiency, which is why clinical guidelines across the globe have adopted it,” said Campbell Rogers, Chief Medical Officer, HeartFlow. “FISH&CHIPS demonstrates that the decision to incorporate the HeartFlow FFRCT Analysis into patient care extended the lives of many patients and ensured efficient and effective use of noninvasive and invasive testing and treatment.”

    The recent Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization (PRECISE) trial, which compared a non-invasive precision pathway to traditional testing, proved the CCTA+FFRCT pathway to be a more effective approach in guiding and informing treatment. FISH&CHIPS confirms and extends these results at a population level, delivering marked improvements in the hard clinical endpoints of all-cause and cardiovascular mortality, extending patients’ lives without adversely impacting other clinical events.

    ###

    About University Hospitals / Cleveland, Ohio Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 21 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, the Technion Israel Institute of Technology and National Taiwan University College of Medicine. The main campus also includes the UH Rainbow Babies & Children’s Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women’s Hospital, Ohio’s only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.

     

     

     

     

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  • I Had Quintuple Bypass Surgery. A Trait I Never Guessed Might Affect My Heart May Be To Blame.

    I Had Quintuple Bypass Surgery. A Trait I Never Guessed Might Affect My Heart May Be To Blame.

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    My ex-wife used to say my heart kept her awake at night. The pounding, she said, sent reverberations through the mattress. Like the partner who snores, I was unaware of this nocturnal Buddy Rich drum solo. Even if I did notice, and it shames me to say, even if I believed her, I wasn’t sure what I could have done to prevent it. My options seemed limited. Either it beat or it didn’t.

    A few months ago, that theory was tested. After reporting a pain in my neck to my physician, I walked into an outpatient diagnostic exam in Portland, Maine, expecting to be home for dinner. In the catheterization lab, I was awake, lying in a dark room and somewhat pleasantly buzzed from calming medication as a large humming angiographic X-ray machine orbited my body. The medical team was friendly and chatty, and as they played sophisticated music trendier than anything I might have suggested, we joked that the procedure seemed more like a spa treatment.

    I don’t remember if the chatter or music stopped first, like one of those comedies where the needle is snatched from the turntable as it scratches the record. They sat me up and pointed to a black and white grainy video of my beating heart, saying, “Watch.”

    A puff of what looked like smoke billowed. I learned the smoke was actually an injectable dye, which should have entered my heart instead of curling backward. A voice in the dark, suddenly laced with accusation, asked, “How long did you say you’ve been feeling discomfort?”

    As a closeted gay man who grew up in the southern United States, I have maintained hypervigilance toward potential threats my entire life. First, that someone would find out that I was gay, and after I came out at 43, that someone would wish to do me harm. This wasn’t the discomfort they were questioning, but as the cardiologist explained the procedure that would stop my heart (it was quite literally put on ice), I couldn’t help but wonder if they were somehow related.

    During my 10 days in the hospital, I shared a room with four different roommates. All of them, like me, older white men, but there was one thing we didn’t have in common: Unlike me, they were all heterosexual. Even in their ill health, perhaps because of it, three out of four made sexually harassing and often misogynistic comments toward the female nurses. This small sample mirrors my experience in the world — a large percentage of men displaying their toxic masculinity, prompting me to retreat deep into the closet. The difference here was that I could not escape.

    Even if I had wanted to remain private and denied the existence of who I love, which no one should ever have to do to maintain a sense of safety, it was impossible. With each shift change and on every round with multiple health care workers, one question always surfaced: Who do you have to care for you when you return home?

    The author in the hospital with his daughter, Marisa Dameron.

    Courtesy of William Dameron

    I came out multiple times a day in the hospital. Because I live in liberal New England, where diversity usually is celebrated, this was not a difficult task. However, more often than not, even after clearly articulating that Paul was my husband, he was referred to as my “partner.” What would my experience have been like if we were in Florida?

    In conservative regions of the country, where there is an insidious assault on the LGBTQ+ community — especially trans people — in a particularly focused and horrific manner, how would a scared young queer person navigate the double trauma of surgery and then bigotry?

    When I asked the cardiologist if I faced any specific risks with open-heart surgery, he replied that my most significant risk was my young age. Blushing, I laughed. He did not.

    “The amount of blockage for someone your age, 59, is extensive and something we typically see in someone much older and will likely reappear. We’re only treating the symptoms, not the underlying cause, and you may have to face this again at some point.”

    My husband, Paul, has never complained about my heart, but he snores. (Hello, karma). The maximum nudge count is three before I’ll get up and stumble through the dark into the spare bedroom. While staring at the ceiling — I used to be a side sleeper before the surgery — my mind goes back to those nights with my ex-wife and the beating drum. Was my heart issuing a warning?

    The American Heart Association reported that LGBTQ+ individuals were 36% less likely to have ideal cardiovascular health and found higher levels of heart disease among transgender individuals related to stigma and discrimination.

    The New York Times notes that LGBTQ adults “face unique stressors — stigma, discrimination, the fear of violence — which can both indirectly and directly lead to disease” by causing chronic inflammation and raising blood pressure and heart rate, among other effects.

    While I cannot make a direct correlation between my heart disease and this particular environmental stressor, consider my three straight siblings whose blood pressure is normal and cholesterol levels are ideal.

    My cohort and older LGBTQ+ individuals have survived legalized discrimination, attacks from performative Christianity, assaults from right-wing politicians, the HIV/AIDS epidemic, gay bashing and worse. What did not kill us then was only a matter of time.

    The author and Paul (left).
    The author and Paul (left).

    Courtesy of William Dameron

    For all the progress we have made, we are currently experiencing a devastating backlash. We, as a society, must come to understand that banning books with LGBTQ+ themes, legislating hatred in the form of “Don’t Say Gay” laws, halting gender-affirming care and enacting anti-trans laws, like those in Florida and other conservative states, are not protecting our children but instead are erasing them. Forcing our children into silence now is quite literally breaking their hearts. The Silence=Death project was born of the AIDS crisis but is still significantly resonant.

    The worst part of quintuple bypass surgery was not waking up with a tube down my throat, choosing between breathing or speaking, or looking at the reflection in the mirror of what looked like an autopsy cadaver riddled with scars and bruising. It was not the bizarre end-of-the-world nightmares, the uncontrollable sobbing or even learning to sleep on my back. It was the pained expression on my husband’s face when he realized death was no longer a theory but a fact. I will die. I will cease to exist, and someday, perhaps sooner than he previously thought, he will forever sleep alone.

    If there was a worst thing about open-heart surgery, it is logical that there would be a best or, perhaps, least worst thing. It forever altered my outlook on life, to cherish all I am so fortunate to possess and speak up when I am feeling pain instead of remaining silent. I want our children to know that living joyfully in an imperfect world is possible, to find great beauty, even in pain, and to love with abandon.

    Was my heart tapping out an SOS those many years ago? I will never know, but this I do: In the face of death — no, because I faced death — I never felt so grateful to be alive. My heart no longer pounds to break free.

    May our children be so fortunate.

    William Dameron is an award-winning blogger, memoirist, essayist and author of the novel “The Way Life Should Be” and his memoir, “The Lie,” a New York Times Editors’ Choice. His work has appeared in The New York Times, The Times (UK), The Telegraph, The Boston Globe, The Washington Post, Salon, Oprah Daily and in the book “Fashionably Late: Gay, Bi & Trans Men Who Came Out Later In Life.”

    Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and send us a pitch.

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  • Stress, insomnia linked to irregular heart rhythms after menopause

    Stress, insomnia linked to irregular heart rhythms after menopause

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    Research Highlights:

    • A study of more than 83,000 questionnaires by women ages 50-79, found more than 25% developed irregular heart rhythms, known as atrial fibrillation, which may increase their risk for stroke and heart failure.
    • Stressful life events and insomnia were strongly linked to the development of atrial fibrillation, highlighting the need for mental well-being evaluations to be included with physical health examinations.

     

    Newswise — DALLAS, Aug. 30, 2023 — After menopause an estimated 1 in 4 women may develop irregular heart rhythms — known as atrial fibrillation – in their lifetime, with stressful life events and insomnia being major contributing factors, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    Atrial fibrillation may lead to blood clots, stroke, heart failure or other cardiovascular complications. It primarily affects older adults, and more than 12 million people in the U.S. are expected to develop atrial fibrillation by 2030, according to the American Heart Association.

    “In my general cardiology practice, I see many postmenopausal women with picture perfect physical health who struggle with poor sleep and negative psychological emotional feelings or experience, which we now know may put them at risk for developing atrial fibrillation,” said lead study author Susan X. Zhao, M.D., a cardiologist at Santa Clara Valley Medical Center in San Jose, California. “I strongly believe that in addition to age, genetic and other heart-health related risk factors, psychosocial factors are the missing piece to the puzzle of the genesis of atrial fibrillation.“

    Researchers reviewed data from more than 83,000 questionnaires by women ages 50-79 from the Women’s Health Initiative, a major U.S. study. Participants were asked a series of questions in key categories: stressful life events, their sense of optimism, social support and insomnia. Questions about stressful life events addressed topics such as loss of a loved one; illness; divorce; financial pressure; and domestic, verbal, physical or sexual abuse. Questions about sleeping habits focused on if participants had trouble falling asleep, wake up several times during the night and  overall sleep quality, for example. Questions about participants’ outlook on life and social supports addressed having friends to talk with during and about difficult or stressful situations; a sense of optimism such as believing good things are on the horizon; and having help with daily chores.

    During approximately a decade of follow-up, the study found:

    • About 25% or 23,954 women developed atrial fibrillation.
    • A two-cluster system (the stress cluster and the strain cluster).
    • For each additional point on the insomnia scale, there is a 4% higher likelihood of developing atrial fibrillation. Similarly, for each additional point on the stressful life event scale, there is a 2% higher likelihood of having atrial fibrillation.

    “The heart and brain connection has been long established in many conditions,” Zhao said. “Atrial fibrillation is a disease of the electrical conduction system and is prone to hormonal changes stemming from stress and poor sleep. These common pathways likely underpin the association between stress and insomnia with atrial fibrillation.”

    Researchers noted that stressful life events, poor sleep and feelings, such as depression, anxiety or feeling overwhelmed by one’s circumstances, are often interrelated. It’s difficult to know whether these factors accumulate gradually over the years to increase the risk of atrial fibrillation as women age.

    Chronic stress has not been consistently associated with atrial fibrillation, and the researchers note that a limitation of their study is that it relied on patient questionnaires utilized at the start of the study. Stressful life events, however, though significant and traumatic, may not be long lasting, Zhao notes. Further research is needed to confirm these associations and evaluate whether customized stress-relieving interventions may modify atrial fibrillation risk.

    Study details and background:

    • Participants were recruited between 1994 and 1998.
    • The average age of the 83,736 women included in the study was about 64 years old. Approximately 88% of the group were women who self-identified as white; 7.2% identified as Black women; and 2.9% self-identified as Hispanic women.
    • As women live longer, they may face higher risk and poorer outcomes associated with atrial fibrillation. While high blood pressure, obesity, Type 2 diabetes and heart failure are recognized risk factors, more research is needed about how the exposure to psychosocial stress and overall emotional well-being over time may affect the potential development of atrial fibrillation.

    Co-authors, their disclosures and funding sources for the study are listed in the manuscript.

    Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. 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.

     

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  • Half as many AF patients dying of heart attacks and strokes in the UK

    Half as many AF patients dying of heart attacks and strokes in the UK

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    Newswise — Patients living with one of the UK’s most common heart rhythm conditions are 50% less likely to die from a heart attack or stroke than they were at the start of the millennium, new research has found. 

    Analysis of the health records of more than 70,000 patients newly diagnosed with atrial fibrillation (AF) showed that mortality from related cardiovascular and cerebrovascular diseases more than halved over the 16-year study period. 

    AF is associated with an increased risk of stroke. 

    The research showed that dementia now accounts for more deaths within one year of an AF diagnosis than acute stroke, heart attack and heart failure combined, demonstrating the need for more research into the link between dementia and AF. 

    The study team believe the lower mortality rate can be attributed to better detection and treatment for AF, which, according to the British Heart Foundation, affects more than 1.5 million people in the UK. 

    But the findings reveal significant health inequalities, showing that the most socioeconomically deprived patients were 22% more likely to die from AF-related conditions than people from the most affluent group. 

    Additionally, patients are now more likely to be diagnosed with coexisting health conditions such as diabetes, cancer and chronic kidney disease, which have greater health implications for them than AF. 

    Senior author Chris Gale, Professor of Cardiovascular Medicine, Honorary Consultant Cardiologist, and Co-Director of the Leeds Institute for Data Analytics at the University of Leeds said: “Atrial fibrillation is a common and often undetected heart rhythm disorder that increases the risk of stroke. Advances in health care have now reduced the chance of having a stroke related to AF, and from dying as result of it, if AF is detected and treated. 

    “However, our study also reveals important disparities in care associated with deprivation and the co-existence of other illnesses. Proactively diagnosing and treating AF in these groups will likely further reduce death and disability from cardiovascular disease. Equally, for many people, AF is a marker of co-existent disease – identifying and treating these additional disease states could further improve outcome for people with AF.” 

    The team is now calling for randomised clinical trials to determine whether the earlier identification and treatment of AF and associated co-morbidities could effectively improve cardiovascular health. 

    Data analysis 

    The research examined data from electronic health records of 72,412 patients from a representative sample of the UK population, who had been diagnosed with AF between 2001 and 2017. The team assessed the health outcomes in patients in the first year after their AF diagnosis, and analysed changes in cause-specific mortality and hospitalisation over time and by sex, age, socioeconomic status and diagnostic care setting. 

    The average patient was aged 75.6. Some 48.2% of patients were women, and 61.8% had three or more comorbidities. 

    Over the study period, coexisting health concerns became more common, with almost 70% of newly diagnosed AF patients also having at least three comorbidities. 

    Mortality rates at one year post diagnosis were investigated, as well as the number of hospital admissions with an overnight stay within 1 year of diagnosis. 

    Over the study period, 20% of patients died from any cause within a year of being diagnosed with AF – but this declined over time. 

    However the researchers found that deaths due to cardiovascular and cerebrovascular events (strokes) more than halved over the study period. Cardiovascular deaths declined from 7.3% in 2001/02 to 3% in 2016/2017, while cerebrovascular deaths declined from 2.6% to 1.1%. 

    The researchers say that the lower rates of cardiovascular deaths among AF patients in the study may be partly explained by improvements in strategies to prevent heart disease, and by changes in clinical practice that could lead to people being diagnosed earlier. 

    By contrast, there was an increase in mortality rates from mental and neurological disorders, from 2.5% in 2001/02 to 10.1% in 2016/17. Of these deaths, 87.2% were caused by dementia, Alzheimer’s disease and Parkinson’s disease. The research team say that while this could be partly due to greater awareness 

    of dementia, it also strengthens the evidence that the relationship between AF and dementia is a pressing research priority. 

    Other findings include: 

    • Hospitalisation is common within a year of AF diagnosis, with almost two further admissions experienced by patients 

    • Hospitalisation rates have increased by 17% due to increasing admissions from non-cardio/cerebrovascular causes, especially in older patients 

    • Hospitalisation for cardiovascular and cerebrovascular causes have decreased by 38% and 28%, respectively, but for non-cardio/cerebrovascular causes hospitalisation has increased by 42% 

    • Older people have experienced the greatest rise in hospitalisation, with those aged 80 years or more experiencing a 39% rise in hospitalisation within a year of AF diagnosis 

    Health inequalities 

    Professor Gale said: “Patients diagnosed in hospital or from the most deprived group had worse outcomes compared with those diagnosed in the community or from the most affluent group. 

    “Although increased burden of comorbidities might partly explain the increased frequency of death in these groups, the persisting difference after full adjustment for these factors suggests other social and health-care factors might also contribute. 

    “Our previous research showed that the most deprived individuals in the UK experience an AF diagnosis at a younger age than the most affluent individuals. This discrepancy in outcomes warrants targeted strategies and healthcare resource planning.” 

    Lead author Jianhua Wu, Professor of Biostatistics and Health Data Science in the Queen Mary University of London’s Wolfson Institute of Population Health said: “AF is one of the most prevalent heart conditions in the UK and as such it is crucial that we understand whether or not the current management of the condition is successful. Our findings provide vital evidence about the effectiveness of treatments for this condition, while also showing that other conditions are becoming more prevalent among AF patients – potentially providing avenues for exploration of more targeted treatments.” 

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  • Myocardial infarction, the number one cause of sudden death, may be treated by modulating the immune response

    Myocardial infarction, the number one cause of sudden death, may be treated by modulating the immune response

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    Newswise — Myocardial infarction, the number one cause of sudden death in adults and the number two cause of death in Korea, is a deadly disease with an initial mortality rate of 30%, and about 5-10% of patients die even if they are transported to a medical center for treatment. The number of myocardial infarction patients in Korea has been increasing steeply, from 99,647 in 2017 to 126,342 in 2021, an increase of 26.8% in five years. Until now, drug administration, percutaneous angioplasty, and arterial bypass surgery have been known as treatments, but they are difficult to apply to severe cases that do not respond to them.

    Dr. Yoon Ki Joung and Dr. Juro Lee of the Biomaterials Research Center at the Korea Institute of Science and Technology (KIST), together with Prof. Hun-Jun Park and Dr. Bong-Woo Park of the Catholic University of Korea College of Medicine, have developed a new treatment for myocardial infarction that uses nanovesicles derived from fibroblasts with induced apoptosis to modulate the immune response.

    Myocardial infarction is an ischemic heart disease in which the coronary arteries, the blood vessels that supply blood to the heart, become narrowed or blocked, resulting in insufficient blood supply to the heart muscle, which causes nutrient and oxygen deficiency in the myocardium, leading to poor heart function. According to market research firm Technavio, the global myocardial infarction therapeutics market is expected to reach $2.02 billion by 2026, at a CAGR of 4.7%. In recent years, stem cell-derived nanovesicles, such as exosomes, have been used to treat myocardial infarction by modulating the inflammatory response, but stem cells are difficult to produce in large quantities, limiting their economic viability.

    The research team identified the possibility of treating severe myocardial infarction by reducing the inflammatory response in the heart muscle through a nanomedicine based on apoptotic cells, which are cells that commit suicide due to biochemical changes in their cells. This response was achieved by attaching peptides specific to the site of ischemic myocardial infarction and substances specific to macrophage phagocytosis to the surface of fibroblasts. To this end, the team developed anti-inflammatory nanovesicles that can be delivered specifically to macrophages at the site of myocardial infarction.

    In animal studies, we found that intravenously injected nanovesicles were effectively delivered to the myocardial infarction site in rats and were specifically recruited to macrophages. As a result, the left ventricular ejection fraction, an indicator of the contractile force of the left ventricle, increased by more than 1.5 times compared to the control group for 4 weeks. In addition, the effects of reducing inflammation and fibrosis, and increasing blood vessels preservation rate enhanced cardiomyocytes survival, which resulted in cardiac function improvement.

    “This is the first study to use nanovesicles produced from apoptosis-induced cells to treat myocardial infarction, and it has the advantage of being able to mass-produce them because it uses other cells rather than stem cells,” said Dr. Yoon Ki Joung of KIST. “In the future, we plan to conduct a research to verify the effectiveness and safety of the treatment, including clinical trials, through a collaborative research with Catholic University of Korea Medical School and bio companies.”

     

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    KIST was established in 1966 as the first government-funded research institute in Korea. KIST now strives to solve national and social challenges and secure growth engines through leading and innovative research. For more information, please visit KIST’s website at https://eng.kist.re.kr/

    This research was supported by the Ministry of Science and ICT (Minister Lee Jong-ho) through the Korea Research Foundation Nano and Material Technology Development Project and the Sejong Science Fellowship Program, and the results were published in the June issue of Advanced Functional Materials (IF:19.0, JCR top 4.7%), an international journal in the field of materials.

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  • E. Dale Abel Receives Endocrine Society Lifetime Achievement Award

    E. Dale Abel Receives Endocrine Society Lifetime Achievement Award

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    Newswise — E. Dale Abel, MD, PhD, chair of the Department of Medicine at the David Geffen School of Medicine at UCLA and executive medical director of the UCLA Health Department of Medicine has received the Endocrine Society Fred Conrad Koch Lifetime Achievement Award. The award, the group’s highest honor, recognizes individuals who have made exceptional contributions to the field of endocrinology through their lifetime.

    Dr. Abel’s pioneering work on glucose transport and mitochondrial metabolism in the heart guided his research interest in molecular mechanisms responsible for cardiovascular complications of diabetes. His laboratory has provided important insights into the contribution of mitochondrial dysfunction and aberrant insulin signaling to heart failure risk in diabetes.

    Dr. Abel’s research on cardiovascular complications of obesity and insulin resistance has garnered recognition and continuous support from the National Institutes of Health (NIH) for over two decades. Among the honors he has received for scholarship, scientific and academic achievement, Dr. Abel is an elected member of the National Academy of Medicine, the National Academy of Sciences, the Association of American Physicians and the American Society for Clinical Investigation.

    In addition, Dr. Abel has been recognized for a longstanding commitment to mentoring the next generation of endocrine researchers and biomedical scientists. He has served as the program chair for the annual Network of Minority Investigators workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Disorders to increase the success of minority biomedical researchers.  Since 2012, he has been a principal investigator for the Endocrine Society’s FLARE program, which has successfully increased the pipeline of underrepresented groups into productive careers in endocrinology and diabetes research.

    “I am humbled to be the recipient of the highest award from the Endocrine Society, the world’s largest professional association of endocrinologists,” said Dr. Abel. “The Endocrine Society has been my professional home for nearly 30 years. During this time, I have benefitted immensely through the Society, from mentorship to numerous opportunities for professional development within the field. As such it has been easy to give back and provide mentorship to emerging leaders in the field. My accomplishments as an endocrine investigator reflects the efforts of many trainees with whom I have been privileged to work over the past three decades and generosity of mentors and collaborators. I hope that our work, will ultimately impact the lives of many patients with diabetes.”

    Abel has held several leadership positions at the Endocrine Society including Past President. He is currently a Deputy Editor for the peer-reviewed journal Endocrine Reviews. Before joining the David Geffen School of Medicine at UCLA, he served as the Chair and Executive Officer of the Department of Internal Medicine and Professor of Medicine, Biochemistry and Biomedical Engineering at the University of Iowa in Iowa City, Iowa. Since 2012, he has been a principal investigator for the Endocrine Society’s Future Leaders Advancing Research in Endocrinology (FLARE) program, which has helped individuals from underrepresented groups establish successful careers in endocrinology and diabetes research.

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    University of California, Los Angeles (UCLA), Health Sciences

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  • You’re Probably Drinking Enough Water

    You’re Probably Drinking Enough Water

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    As recently as the 1990s, Jodi Stookey, a nutrition consultant based in California, remembers hydration research being a very lonely field. The health chatter was all about fat and carbs; children routinely subsisted on a single pouch of Capri Sun a day. Even athletes were discouraged from sipping on fields and race tracks, lest the excess liquid slow them down. “I can’t tell you how many people told me I was stupid,” Stookey told me, for being one of water’s few advocates.

    But around the turn of the millennium, hydration became an American fixation. Celebrities touted water’s benefits in magazines; branded bottles overran supermarket shelves. Academic research on hydration underwent a mini-boom. After ages of being persistently parched, we were suddenly all drinking, drinking, drinking, because we felt like we should. It was an aquatic about-face—and it didn’t make total scientific sense.

    The importance of hydration, in the abstract, is indisputable. Water keeps our organs chugging and our muscles agile; it helps distribute nutrients through the body and maintains our inner thermostat. Take it away, and cells inevitably die. But the concrete specifics of adequate water intake are still, in large part, a mess. For hydration, “there are no clear numbers, or a threshold you have to maintain,” says Yasuki Sekiguchi, a sports-performance scientist at Texas Tech University. Experts don’t agree on how much water people need, or the best ways to tell when someone should drink; they differ on how to measure hydration, which beverages are adequately hydrating, and how much importance to attribute to thirst. They have yet to reach quorum on what hydration—a process that’s sustained life since its primordial inception—fundamentally is. The murkiness has left the field of hydration research, still relatively young and relatively small, rife with “vicious camps against each other,” says Tamara Hew-Butler, an exercise physiologist at Wayne State University.

    Read: Drink more water

    Forget, for instance, one of water’s most persistent myths: the oft-repeated advice to down eight 8-ounce glasses of water each day. No one can say for certain, but one theory is that the idea  sprouted from a misinterpretation of a nutrition document from the 1940s, which stated that 2.5 liters of water a day (that is, approximately 10 8-ounce glasses) was “a suitable allowance for adults” in “most instances.” The guidance also noted, in the very same paragraph, “Most of this quantity is contained in prepared foods.” But the bigger issue is this: Probably no single number for water intake will ever suffice—not for a population of people with varying weights, genetics, diets, and activity levels, living in varying climates. Even within an individual, what’s best will change through a lifetime. The answer to How much water should I be drinking? is invariably Uh, it really depends.

    Today’s hydration zeitgeist seems to hold that no amount of water is too much. The market teems with intake-tracking smartphone apps and time-stamped bottles that cheer drinkers toward hydration goals as high as a gallon a day—a quota astronomical enough to be stressful, even dangerous, should people flood their bodies all at once. But America’s hydration hype machine “has established a narrative that we are all walking around dehydrated, and need to drink more,” Hew-Butler told me. It’s no wonder that some people have reported legitimate anxiety over falling short on water intake.

    No single source sold America on water. But a 2021 episode of the podcast Decoder Ring points to Gatorade as one of the first companies to pitch dehydration as a health problem—while simultaneously offering a cure. The company’s sports drinks were originally billed as thirst-quenchers, designed to stave off performance dips. But by the 1980s, Decoder Ring reported, the Gatorade Sports Science Institute was churning out data that supported the benefits of drinking before the mouth got parched. A decade later, the American College of Sports Medicine was recommending that athletes consume “the maximal amount” of water they could stand to keep down.

    Read: The organic Gatorade illusion

    Around the same time, during the fitness craze of the ’70s and ’80s, water was acquiring another identity: the enlightened socialite’s clean drink of choice. When European companies such as Perrier and Evian brought their bottled water to North America, they found a market among those wanting a high-end, calorie- and sweetener-free alternative to sodas, alcohol, and juice. Water “had this healthy, good-for-you halo,” says Michael Bellas, the chair and CEO of the Beverage Marketing Corporation. “There were no negatives.” In 2016, water became the U.S.’s leading bottled beverage, a title it has maintained since.

    As water’s market share grew, so did its mythos. Companies hocked the illusion that their products could make people not just healthier but “sexier and more popular,” Peter Gleick, the author of The Three Ages of Water, told me. Hydration was so clearly vital to life that truth-adjacent ideas about its benefits, many of them pushed by prominent people, were easy to buy. Even concerns over single-use plastic bottles could not slow water’s roll: In response, the world cooked up eco-friendly Yetis, HydroFlasks, and Nalgenes, and made those trendy, too.

    The Three Ages Of Water – Prehistoric Past, Imperiled Present, And A Hope For The Future

    By Peter Gleick

    It’s not that water isn’t healthy. There’s just no evidence to show that guzzling tons of water can fix all our ailments. For people prone to kidney stones and UTIs, drinking more has been shown to cut down on risks; as a swap for sugary beverages, it can also help with weight loss. But for a variety of other issues—such as heart disease, metabolic issues, and cancer—the data is often “really mixed,” Hew-Butler told me. Although researchers have sometimes found evidence that dehydration may raise certain conditions’ risks, that doesn’t automatically imply the inverse—that extra water intake then lowers risk from a typical baseline. At very rare extremes, overdoing it on water can kill us, too.

    The connections between hydration and health are shaky enough that health authorities have been reluctant to push a strict recommended daily allowance, like the ones that exist for various vitamins. Instead, the National Academy of Medicine proposes a tentative “adequate intake”: 3.7 liters of total water intake for men, and 2.7 for women (both including hydration from food). Recently, Abigail Colburn, a physiology researcher at Yale, and her colleagues ran an analysis that concluded those figures were sound. Still, the numbers came from population surveys, published in the early aughts, of the amounts that Americans were already drinking—a reflection of how things were, but not necessarily how they should be. And they represent medians within a huge range. Over the years, multiple studies have documented people living, by all appearances healthfully, on daily water budgets that span less than a liter to four, five, or six—sometimes more.

    If researchers don’t agree on how much water is good, they also differ on how little water is bad: the point at which dehydration starts to become a problem—or how long people can linger at that threshold without raising long-term health risks.

    A bit of water loss should be completely fine. Fluid status is, by design, “a constantly changing state,” Colburn told me. When the body doesn’t take in enough water to recoup the liquid it’s lost—as it naturally does throughout the day, via sweat, urine, and breath—the brain releases a hormone called vasopressin that prompts the kidneys to hold onto fluid. The urine gets darker and less voluminous; eventually, blood-salt levels rise, and the mouth and throat ache with thirst. The goal is to get the body to excrete less water out and take more in so we don’t wring our vital tissues dry. Life forms have evolved to tread carefully down this cascade of steps, and the flexibility is built in—much like a rubber band that snaps back after being stretched and released.

    Read: Why ‘drink more water’?

    But some researchers have started to worry about repeatedly asking the body to compensate for less than optimal hydration—stretching the band over and over again. The issue isn’t chronic dehydration, Colburn told me, but a subtler precursor state called underhydration, which occurs after a lack of water intake has prompted the body to conserve but before the appearance of signals such as thirst. It’s not clear how worrying teetering on that precipice is. In the same way a rubber band is “designed to stretch,” our fluid balance is built to bounce back, says Evan Johnson, a hydration expert at the University of Wyoming. Over time, though, wear and tear could add up, and resilience could drop.

    Tracking those outcomes gets even more complicated when researchers try to quantify how dehydrated individual people are—another thing that experts can’t agree on. “We really don’t have a gold standard for measuring the all-encompassing term of hydration,” Johnson told me, especially one that’s both simple and cheap, and can account for body water’s constant flux. Which leaves scientists with imperfect proxies. Broadly speaking, there’s a urine camp and a blood camp, Stookey told me. Those in the pee camp tend to be hydration conservatives. A change in urine color or volume, they argue, is an early sign—well in advance of thirst—of impending dehydration. The blood-camp crew is more laissez-faire. Diet, medications, and supplements can all alter the shade of urine, making it a fickle clue; Hew-Butler for instance, defines true dehydration as what happens when the plasma’s gotten saltier than usual, to the point where cells have started to shrink—a sign that retaining water is no longer sufficient, and that the body needs to drink.

    Which camp researchers fall into influences how bad they think America’s hydration problem is. “When you draw blood, most people are within a normal range if they’re not thirsty,” Hew-Butler told me. But Stookey, who’s firmly in the pee camp, contends that a majority of Americans are “walking around dehydrated” and should be drinking far more. Colburn, too, would rather err on the side of heeding urine’s warning signs. By the time thirst kicks in, “you’re already in a dangerous zone,” she told me.

    There can be a middle ground. Sekiguchi, of Texas Tech, told me that for most young, healthy people who are spending plenty of time in the air-conditioned indoors—as so many Americans do—it’s probably fine to just drink when thirsty. (That advice works less well for older people, because the sensation of thirst tends to dull with age.) When specific circumstances shift—a stint of heavy exercise, a week of toasty days—people can take notice, and adjust accordingly.

    But guidelines for typical water intake, under typical conditions, are quickly going out the window as heat waves get more frequent and intense. When temperatures skyrocket and humidity makes otherwise-cooling sweat stick stubbornly on skin, our bodies need more water to keep cool and functional, beyond what thirst alone might dictate. Part of the problem is that thirst vanishes more quickly than the body rehydrates, Sekiguchi told me, which means that people who drink until they think they’re sated tend to replace only a fraction of the fluids that they’ve lost.

    “We’re never going to be able to tell people an exact number,” Colburn told me, for how much to drink. But in reality, many of the healthy people most worried about fine-tuning their hydration to a perfect level are probably among those that least need to fret. The dangers of water tend to happen not in those middle grounds, but at its extremes—especially when failing infrastructure hampers access to water, or contamination makes it undrinkable. Many of the populations that are most vulnerable to dehydration’s effects also happen to be the same groups that probably aren’t getting enough to drink, Johnson told me. While bottled-water markets boom, plenty of pockets of the U.S. still lack consistent access to safe, reliable water from the tap. And the situation is even worse in many places abroad. Perhaps nothing reminds us of water’s power like dramatic deficit: Water, simply, is what keeps us alive.

    ​When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

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    Katherine J. Wu

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  • Damar Hamlin puts aside fear and practices in pads for the first time since cardiac arrest

    Damar Hamlin puts aside fear and practices in pads for the first time since cardiac arrest

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    PITTSFORD, N.Y. — Of the thousands of emotions — trepidation among them — running through Damar Hamlin’s head Monday while he pulled on his pads for practice for the first time at training camp, the one that ultimately won out was joy.

    For everything the Buffalo Bills safety has overcome in seven months since going into cardiac arrest during a game and needing to be resuscitated on the field, Hamlin leaned on his faith in God and himself, along with the support from his family and teammates, to take another step toward resume his playing career.

    “A super big hurdle as you can imagine. Like, I pretty much lost my life playing this sport,” Hamlin said at a news conference after practice.

    “I made the choice to play. But I’m processing a thousand emotions. I’m not afraid to say that it crosses my mind of being a little scared here and there,” he added. “My faith is stronger than any fear. That’s what I want to preach up here. And that’s the message I want to spread on to the world that as long as your faith is stronger than your fear, you can get through anything.”

    Though Hamlin was cleared to resume practicing in mid-April, he did so wearing a helmet and shorts with the rest of his teammates through their spring sessions and first four days of training camp, as mandated by NFL rules. The magnitude of the Bills’ first day in pads wasn’t lost on Hamlin, given it marked the first time he was in full uniform since collapsing on the field in Cincinnati on Jan. 2 after making what appeared to be a routine tackle of Bengals receiver Tee Higgins.

    “Ah man, it feels amazing. It’s a roller coaster of emotions. I was kind of all over the place just being back for the first time,” Hamlin said. “Just trying to keep everything as normal as possible.”

    The normality of struck him about an hour into practice when Hamlin took the field for the first time during a team red-zone running drill in which tackling was still not allowed.

    On his second play, Hamlin showed no hesitation when bursting toward Damien Harris and wrapping him up with both arms. A play later, running back James Cook broke a tackle before Hamlin joined a teammate in wrapping him up just before the goal line.

    Hamlin’s biggest contact came on the final play of practice, when he avoided a block to work his way into the backfield and help a teammate stop tight end Quintin Morris for what would have been a loss.

    “That first little moment of contact, that was just letting me know. I felt alive, man. I felt like I’m here,” Hamlin said with a wide grin. “So it felt good. It was just that moment of: ‘All right, let’s settle in and let’s just take one play at a time. Let’s just keep going.’”

    Hamlin’s only lament was not having any balls thrown in his direction during team drills, though he laughed when saying that might not be a bad thing.

    “When the ball’s not coming my way, that makes you think you’re doing your job right,” Hamlin said. “But, you know, I would love some more opportunities to make a big play and turn practice up a bit.”

    The 25-year-old from the Pittsburgh area is entering his third NFL season. Selected by Buffalo in the sixth round of the 2021 draft out of Pitt, he opened last season as a backup before starting 13 games after Micah Hyde sustained a season-ending neck injury.

    This year, Hamlin is competing with offseason free agent addition Taylor Rapp for a backup role behind Hyde and Jordan Poyer. As for Hamlin’s next hurdle, it’ll come Aug. 12, when the Bills open their preseason schedule at home against Indianapolis.

    Rapp, who spent his first four NFL seasons with the Los Angeles Rams, might be new to Buffalo but is impressed with how Hamlin has handled himself.

    “How far he’s come and what he’s able to come back from late last season and just seeing how he goes about himself and attacks the rehab at the facility is nothing short of inspiring,” Rapp said.

    A day earlier, coach Sean McDermott said he was walking a fine line in treating Hamlin much like any other player, while keeping in mind what he’s gone through.

    “I think awareness is important, right? You’ve got X amount of guys out here and then you have Damar in there as well and trying to make it as a normal as possible,” McDermott said. “We’re going to support him through this, and to this point he’s done a phenomenal job.”

    ___

    AP NFL: https://apnews.com/hub/nfl and https://twitter.com/AP_NFL

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  • Bronny James plays piano, dines out in video, photos emerging days after he suffers cardiac arrest

    Bronny James plays piano, dines out in video, photos emerging days after he suffers cardiac arrest

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    Bronny James is playing piano and dining out with his family in video and photos posted days after he suffered cardiac arrest

    FILE – LeBron James, left, poses with his son Bronny after Sierra Canyon beat Akron St. Vincent – St. Mary in a high school basketball game, Saturday, Dec. 14, 2019, in Columbus, Ohio. Bronny James, son of NBA superstar LeBron James, was hospitalized after going into cardiac arrest while participating in a practice at Southern California on Monday, July 24, 2023. (AP Photo/Jay LaPrete, File)

    The Associated Press

    LOS ANGELES — Bronny James plays piano in a video posted by his father, LeBron James, on Saturday, four days after the teenager went into cardiac arrest during a basketball workout at the University of Southern California.

    The 18-year-old plays a brief melody in front of his family, smiles and gets up without speaking in the video posted on his father’s Instagram account. The video doesn’t indicate where or when it was shot.

    “A man of many talents,” the Los Angeles Lakers superstar can be heard saying in the background as Bronny finishes playing with his two younger siblings looking on.

    TMZ posted photos of Bronny out to dinner with his family, which it says were taken Friday night. They show the teenager with his father outside celebrity hot spot Giorgio Baldi in Santa Monica.

    Wearing black pants and a zip-up hoodie, Bronny carried his phone while standing outside the Italian restaurant.

    Bronny was released from the hospital on Thursday. He will continue to undergo tests to determine the cause of his cardiac arrest, which occurred Monday morning during a workout at USC’s Galen Center.

    Bronny, whose full name is LeBron James Jr., committed to USC in May after the 6-foot-3 guard became one of the nation’s top prospects out of Sierra Canyon School in nearby Chatsworth.

    ___

    AP college basketball: https://apnews.com/hub/college-basketball and https://apnews.com/hub/ap-top-25-college-basketball-poll and https://apnews.com/hub/lebron-james

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  • Women less likely to be routed to comprehensive stroke centers for large vessel acute ischemic stroke, according to UTHealth Houston research

    Women less likely to be routed to comprehensive stroke centers for large vessel acute ischemic stroke, according to UTHealth Houston research

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    Newswise — Despite having worse stroke symptoms and living within comparable distances to comprehensive stroke centers, women with large vessel occlusion acute ischemic stroke are less likely to be routed to the centers compared to men, according to a new study from UTHealth Houston.

    Led by corresponding author Sunil Sheth, MD, associate professor of neurology and director of the vascular neurology program with McGovern Medical School at UTHealth Houston, and senior author Youngran Kim, PhD, assistant professor of management, policy, and community health with UTHealth Houston School of Public Health, the study was published today in the Journal of the American Heart Association.

    Large vessel occlusion stroke occurs when a major artery in the brain is blocked. They are considered one of the more severe kinds of strokes, accounting for an estimated 24% to 46% of acute ischemic strokes.

    “Timely treatment of stroke is incredibly important; the faster a doctor is able to get the vessel open, the better the patient’s chance of having a good outcome. These routing systems in hospitals are designed to get patients to the best care as quickly as possible,” Sheth said. “We don’t know exactly why women were less likely than men to be routed to comprehensive stroke centers, but we do know that gender is an implicit bias. Getting to the granular level of what went into a hospital’s routing decision will be very important for future studies.”

    Researchers identified consecutive patients with large vessel occlusion acute ischemic stroke from a prospectively collected multi-hospital registry for the Greater Houston area from January 2019 to June 2020. They compared prehospital routing of men and women to centers capable of performing endovascular therapy to remove the clot blocking the artery. Among 503 patients, 82% were routed to comprehensive stroke centers. Women made up 46% of the study participants.

    Compared with men, women with large vessel occlusion acute ischemic stroke were older (73 versus 65) and presented with a greater National Institutes of Health Stroke Scale (NIHSS) Score (14 versus 12), meaning their symptoms were worse. After adjusting for differences in stroke type, age, travel distance, and other relevant factors, women with large vessel occlusion acute ischemic stroke were approximately 9% less likely than men to be routed to comprehensive stroke centers.

    “The greater NIHSS score in women may be partially attributed to their older age, as age itself is a known contributing factor to sex differences in stroke severity,” Kim said. “Moreover, elderly women are more likely to live alone and experience social isolation, which can result in delayed recognition of stroke symptoms and subsequent delays in seeking medical attention.”

    Additionally, patients living within a 10-mile distance to the nearest comprehensive stroke center were 38% more likely to be routed to one.

    Stroke is the fifth-leading cause of death for women, according to the Centers for Disease Control and Prevention, and because women generally live longer than men, more women have strokes over their lifetimes.

    Previous studies have shown that women with acute ischemic stroke were less likely than men to receive the clot-busting intravenous tissue-plasminogen activator (tPA) treatment, and that women with stroke are 33% more likely to be misdiagnosed with non-stroke related issues, such as headache or dizziness.

    “Older age at onset and severe stroke in women, compounded by a higher likelihood of age-related risk factors, can contribute to the higher rate of death from stroke and higher risk for disability after stroke in women,” Kim said. “Therefore, appropriate triage and prehospital routing can be even more critical for women. Whether large vessel occlusions in women are less likely to be identified using current screening tools due to older age, premorbidity, or nontraditional symptoms needs to be investigated.”

    Muhammad Tariq, MD, chief resident in the Department of Neurology at McGovern Medical School, was first author on the study. Other co-authors with McGovern Medical School’s neurology department included student Iman Ali, BS; resident Sergio Salazar-Marioni, MD; research coordinator Ananya Iyyangar, BSA; research coordinator Hussain Azeem, BS; resident Swapnil Khose, MD; research assistant Rania Abdelkhaleq, MPH; and Louise McCullough, MD, PhD, professor and chair of the department and the Roy M. and Phyllis Gough Huffington Distinguished Chair at McGovern Medical School. Abdelkhaleq is also a student at UTHealth Houston School of Public Health. McCullough is a member of The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences.

    Also co-authoring the study was Victor Lopez, MD, a resident at Emory School of Medicine.

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    University of Texas Health Science Center at Houston

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  • Dialysis exercise improves health, study says

    Dialysis exercise improves health, study says

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    Newswise — Patients who engage in light exercise while undergoing dialysis are physically fitter and are admitted to hospital less frequently than those who do not. These are the findings of a large-scale study conducted by a consortium led by the Technical University of Munich (TUM). The researchers believe that exercise programs should be offered to dialysis patients as standard.

    Around 558,000 people in the United States have such severely impaired kidney function that they require dialysis several times per week. In Germany, about 80,000 people regularly undergo dialysis. Many also suffer from additional health issues such as diabetes and heart disease. “The limitations imposed by these diseases, and the time required for dialysis, often mean that those affected engage in little physical exercise. We wanted to change that,” says Martin Halle, Professor of Preventive and Rehabilitative Sports Medicine at TUM, who headed up the study.

    Personalized exercise plans

    Approximately 1,000 patients at 21 dialysis centers in Germany took part in the study, which has been published in the New England Journal of Medicine – Evidence. “We mounted one of the world’s largest studies on physical activity in the context of specific diseases,” says Martin Halle. Data from health insurance providers was consulted to ensure that the participant pool was representative of dialysis patients in Germany in terms of aspects such as age, gender and overall health.

    Over a twelve-month period, half of the study participants completed accompanied exercise sessions at least once and ideally three times per week alongside their dialysis, while others were subject only to medical monitoring. These sessions included 30 minutes of endurance training with a bed-cycle ergometer and a further 30 minutes of exercises with weights, resistance bands and balls. The exercises were tailored to each patient’s ability.

    Improvements in standardized testing

    After a year, the health of the study’s active participants had improved significantly. This included completing more repetitions in a one-minute sit-to-stand test and walking further in six minutes than at the start of the study. In the control group, these values were even lower at the end of the study period than at the outset.

    “This type of standardized testing may admittedly not appear to be particularly reflective of everyday life,” says Martin Halle. “However, the results demonstrate tangible improvements in quality of life and autonomy. For example, the participants were able to stand up from a chair at home without assistance, which was not always the case beforehand.” There are other signs of the training program’s positive effects: participants who completed regular training sessions spent an average of two days in hospital during the study, compared to an average of five days for the control group.

    Low costs per training unit

    “To my mind, the results speak for themselves,” says Martin Halle. “We were able to improve the participants’ health and also reduce the costs to the healthcare system with relatively little outlay.” The researchers’ figures suggest that the costs for personalized training would be around €25 per session per person.

    The DiaTT (Dialysis Training Therapy) consortium submitted the final report to the Federal Joint Committee (Gemeinsamer Bundesausschuss – G-BA), which had financed the study through its Innovation Fund (Innovationsfonds). This committee will ultimately determine whether this training is offered to all dialysis patients with statutory health insurance. “I hope our exercise program will become standard in statutory health insurance in Germany,” says Martin Halle. “The benefits will likely also apply to patients in other countries. However, the best approach for a broad implementation has to be found for each society.”

    The study participants will continue to be monitored in future to help researchers learn more about the effects of exercise over the long term. “Our study shows how important it is to adopt a holistic view of health, especially when it comes to elderly and infirm patients”, says Martin Halle. “While high-tech medicine is important, it can only achieve its full potential in combination with other fields, such as preventive medicine.”

    Publication:

    K. Anding-Rost, G. von Gersdorff, P. von Korn, G. Ihorst, A. Josef, M. Kaufmann, M. Huber, T. Bär, S. Zeißler, S. Höfling, C. Breuer, N. Gärtner, M.J. Haykowsky, S. Degenhardt, C. Wanner and M. Halle, for the DiaTT Study Group. “Exercise during Hemodialysis in Patients with Chronic Kidney Failure.” NEJM Evidence (2023). DOI: 10.1056/EVIDoa230005

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    Technical University of Munich

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  • Lisa Marie Presley died of complications from prior weight-loss surgery, autopsy report shows | CNN

    Lisa Marie Presley died of complications from prior weight-loss surgery, autopsy report shows | CNN

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    CNN
     — 

    A report by the Los Angeles County Medical Examiner states Lisa Marie Presley’s death in January was caused by a “sequelae of a small bowel obstruction.”

    A small bowel obstruction is a blockage in the small intestine, often because of things like scar tissue, a hernia or cancer. Without surgery, it can cause bowel tissue to die or perforate, leading to death.

    Presley’s autopsy report, obtained by CNN on Thursday, included the official opinion of deputy medical examiner Dr. Juan M. Carrillo, who attributed her small bowel obstruction to “adhesions (or, scar tissue) that developed after bariatric surgery years ago. This is a known long term complication of this type of surgery.”

    Carrillo also stated that he reviewed the autopsy toxicology results, which showed “therapeutic” levels of oxycodone in Presley’s blood – i.e., levels that are in the range of medically helpful, and not dangerous. He added that quetapine metabolite (used to treat depression, schizophrenia or manic episodes) and buprenorphine (a painkiller that can also be used to treat opioid addiction) were present but “not contributory to death.”

    “There is no evidence of injury or foul play. The manner of death is deemed natural,” Carrillo concluded.

    Dr. Michael Camilleri, a consultant and professor in the Division of Gastroenterology and Hepatology at the Mayo Clinic, told CNN on Thursday that the medications found in Presley’s may “have slowed down the motility of the intestine and would have made it perhaps more likely” for it to get “obstructed by the adhesions.”

    “Unfortunately, adhesions can happen to anybody,” he added. “And just because there were these other medications on board doesn’t necessarily mean that the person was more prone to develop the complications.”

    Lisa Marie Presley, the only daughter of the late Elvis Presley and Priscilla Presley, died hours after being hospitalized following an apparent cardiac arrest on January 12. The medical examiner’s report also detailed that she was complaining of abdominal pain on the morning of her death.

    Dr. Folasade P. May, associate professor of medicine at the David Geffen School of Medicine at UCLA and director of the Melvin and Bren Simon Gastroenterology Quality Improvement Program, told CNN Thursday that she suspects Presley “developed a cardiac arrest because she had a severe complication from the small bowel obstruction.” Neither doctor interviewed by CNN for this report was directly involved in Presley’s case.

    She was 54.

    Video shows Lisa Marie Presley on the Golden Globes red carpet

    “Priscilla Presley and the Presley family are shocked and devastated by the tragic death of their beloved Lisa Marie,” the family said in a statement at the time. “They are profoundly grateful for the support, love and prayers of everyone, and ask for privacy during this very difficult time.”

    Lisa Marie Presley’s last public appearance just days before her death was at the Golden Globe Awards, which she attended with her mother to support the Baz Luhrmann film “Elvis,” about her late father.

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  • Gut bacteria linked to heart artery plaque

    Gut bacteria linked to heart artery plaque

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    Newswise — In a major Swedish study, researchers have discovered a link between the levels of certain bacteria living in the gut and coronary atherosclerotic plaques. Such atherosclerotic plaques, which are formed by the build-up of fatty and cholesterol deposits, constitute a major cause of heart attacks. The study was led by researchers at Uppsala and Lund University and the findings have now been published in the scientific journal Circulation.

    The new study was based on analyses of gut bacteria and cardiac imaging among 8,973 participants aged 50 to 65 from Uppsala and Malmö without previously known heart disease. They were all participants in the Swedish CArdioPulmonary bioImage Study (SCAPIS).

    “We found that oral bacteria, especially species from the Streptococcus genus, are associated with increased occurrence of atherosclerotic plaques in the small arteries of the heart when present in the gut flora. Species from the Streptococcus genus are common causes of pneumonia and infections of the throat, skin and heart valves. We now need to understand whether these bacteria are contributing to atherosclerosis development,” says Tove Fall, Professor in Molecular Epidemiology at the Department of Medical Sciences and the SciLifeLab, Uppsala University, who coordinated the study together with researchers from Lund University.

    Advancements in technology have enabled large-scale deep characterisation of bacterial communities in biological samples by sequencing the DNA content and comparing it to known bacteria sequences. Additionally, improvements in imaging techniques have enabled the detection and measurement of early changes in the small vessels of the heart. The SCAPIS study represents one of the largest collections in the world of both these kinds of data. In this study, scientists investigated the links between the gut microbiota and the build-up of fatty deposits in the arteries of the heart.

    “The large number of samples with high-quality data from cardiac imaging and gut flora allowed us to identify novel associations. Among our most significant findings, Streptococcus anginosus and S. oralis subsp. oralis were the two strongest ones,” says Sergi Sayols-Baixeras, lead author from Uppsala University.

    The research team also found that some of the species linked to the build-up of fatty deposits in heart arteries were linked to the levels of the same species in the mouth. This was measured using faecal and saliva samples collected from the Malmö Offspring Study and Malmö Offspring Dental Study. Furthermore, these bacteria were associated with inflammation markers in the blood, even after accounting for differences in diet and medication between the participants who carried the bacteria and those who did not.

    “We have just started to understand how the human host and the bacterial community in the different compartments of the body affect each other. Our study shows worse cardiovascular health in carriers of streptococci in their gut. We now need to investigate if these bacteria are important players in atherosclerosis development,” notes Marju Orho-Melander, Professor in Genetic Epidemiology at Lund University and one of the senior authors of the study.

    Publication: Sergi Sayols-Baixeras et al.; Streptococcus species abundance in the gut is linked to subclinical coronary atherosclerosis in 8973 participants from the SCAPIS cohort. Circulation. 2023. DOI: 10.1161/CIRCULATIONAHA.123.063914 [Online ahead-of-print], the link will be: https://doi.org/10.1161/CIRCULATIONAHA.123.063914

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    Uppsala University

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  • Study challenges advice to limit high-fat dairy in global diet

    Study challenges advice to limit high-fat dairy in global diet

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    Newswise — Sophia Antipolis, 7 July 2023:  Unprocessed red meat and whole grains can be included or left out of a healthy diet, according to a study conducted in 80 countries across all inhabited continents and published today in European Heart Journal, a journal of the European Society of Cardiology (ESC).1 Diets emphasising fruit, vegetables, dairy (mainly whole-fat), nuts, legumes and fish were linked with a lower risk of cardiovascular disease (CVD) and premature death in all world regions. The addition of unprocessed red meat or whole grains had little impact on outcomes.

    “Low-fat foods have taken centre stage with the public, food industry and policymakers, with nutrition labels focused on reducing fat and saturated fat,” said study author Dr. Andrew Mente of the Population Health Research Institute, McMaster University, Hamilton, Canada. “Our findings suggest that the priority should be increasing protective foods such as nuts (often avoided as too energy dense), fish and dairy, rather than restricting dairy (especially whole-fat) to very low amounts. Our results show that up to two servings a day of dairy, mainly whole-fat, can be included in a healthy diet. This is in keeping with modern nutrition science showing that dairy, particularly whole-fat, may protect against high blood pressure and metabolic syndrome.”

    The study examined the relationships between a new diet score and health outcomes in a global population. A healthy diet score was created based on six foods that have each been linked with longevity. The PURE diet included 2-3 servings of fruit per day, 2-3 servings of vegetables per day, 3-4 servings of legumes per week, 7 servings of nuts per week, 2-3 servings of fish per week, and 14 servings of dairy products (mainly whole fat but not including butter or whipped cream) per week. A score of 1 (healthy) was assigned for intake above the median in the group and a score of 0 (unhealthy) for intake at or below the median, for a total of 0 to 6. Dr. Mente explained: “Participants in the top 50% of the population – an achievable level – on each of the six food components attained the maximum diet score of six.”

    Associations of the score with mortality, myocardial infarction, stroke and total CVD (including fatal CVD and non-fatal myocardial infarction, stroke and heart failure) were tested in the PURE study which included 147,642 people from the general population in 21 countries. The analyses were adjusted for factors that could influence the relationships such as age, sex, waist-to-hip ratio, education level, income, urban or rural location, physical activity, smoking status, diabetes, use of statins or high blood pressure medications, and total energy intake.

    The average diet score was 2.95. During a median follow-up of 9.3 years, there were 15,707 deaths and 40,764 cardiovascular events. Compared with the least healthy diet (score of 1 or less), the healthiest diet (score of 5 or more) was linked with a 30% lower risk of death, 18% lower likelihood of CVD, 14% lower risk of myocardial infarction and 19% lower risk of stroke. Associations between the healthy diet score and outcomes were confirmed in five independent studies including a total of 96,955 patients with CVD in 70 countries.

    Dr. Mente said: “This was by far the most diverse study of nutrition and health outcomes in the world and the only one with sufficient representation from high-, middle- and low-income countries. The connection between the PURE diet and health outcomes was found in generally healthy people, patients with CVD, patients with diabetes, and across economies.”

    “The associations were strongest in areas with the poorest quality diet, including South Asia, China and Africa, where calorie intake was low and dominated by refined carbohydrates. This suggests that a large proportion of deaths and CVD in adults around the world may be due to undernutrition, that is, low intakes of energy and protective foods, rather than overnutrition. This challenges current beliefs,” said Professor Salim Yusuf, senior author and principal investigator of PURE.

    In an accompanying editorial, Dr. Dariush Mozaffarian of the Friedman School of Nutrition Science and Policy, Tufts University, Boston, US stated: “The new results in PURE, in combination with prior reports, call for a re-evaluation of unrelenting guidelines to avoid whole-fat dairy products. Investigations such as the one by Mente and colleagues remind us of the continuing and devastating rise in diet-related chronic diseases globally, and of the power of protective foods to help address these burdens. It is time for national nutrition guidelines, private sector innovations, government tax policy and agricultural incentives, food procurement policies, labelling and other regulatory priorities, and food-based healthcare interventions to catch up to the science. Millions of lives depend on it.”

     

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    European Society of Cardiology

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