Anberitha Matthews, PhD – Page 2 – The Early Career Voice

Role of Curcumin on Inflammation

January 10, 2019March 28, 2019 Anberitha Matthews, PhD

There has recently been a craze about using turmeric for a number of health-related issues. Are these claims valid? What is turmeric anyway? I mean, where did it come from and what is the mechanism of action if this root does indeed work for improving health? I intend to reveal here whether jumping on yellow wagon is worth the hype.

Being a rhizomatous, herbaceous perennial from the ginger family, this plant is native to the Indian subcontinent and Southeast Asia. To preserve these roots after harvest, the rhizomes are boiled, dried and ground into powder that can be used for cooking, coloring, and flavoring in many dishes such as curries. It is often used in Ayurvedic medicine because of the curcumin constituents that are thought to be therapeutic. However, curcumin makes up approximately 3% (with an average of 1.5%) of turmeric powder commercially sold including curcumin, demethoxycurcumin, and bisdemethoxycurcumin. Interesting!!! What about the essential oils, you may ask? There are about 34 oils, including tumerone, germacrone (antiviral isolate), atlantone, and zingiberene (the monocyclic sesquiterpene component of ginger comprising ~30% of the essential oils).

Traditionally, turmeric was used in traditional Siddha or Ayurveda medicine, generally place on the skin or adorned the body. For example, during the Haldi ceremony, Gaye holud (yellow on the body), turmeric is used in weddings. In Tamil Nadu and Andhra Pradesh, it is strung into a necklace, or in Marathi the tubers are tied by the couples to their wrists. However, because it is sold by weight, it is commonly adulterated by the addition of toxic powders such as lead oxide, changing the color from its native golden yellow to an orange-red color. Additionally, a compound known as acid yellow 36 is added for use in food products but is deemed illegal in some countries. Does this now make you want to read the label of the turmeric in your spice cabinet? However, in traditional medicine, curcumin has been used to alleviate respiratory conditions, anorexia, coryza, cough, and hepatic diseases.

Research is now supporting the medicinal uses for turmeric’s active ingredient, curcumin, because it has been demonstrated to reduce pro-inflammatory-induced chronic illnesses including cardiovascular, metabolic, pulmonary, auto immune and malignant diseases (Prasad et al). This group went on to suggest that inhibition of transcription factors nuclear factor-kappaB (NF-κB), Wnt/beta-catenin, and activates peroxisome proliferator-activated receptor-gamma and Nrf2 cell signaling pathways. Modulating these activities can potentially lead to downregulation of adipokines and upregulation of adiponectin and other gene products. Curcumin has also been shown to modulate not only cell survival proteins and inflammatory components on a biological level, but it has also been linked to histone acetylase, deacetylase, protein kinases and reductases, and glyoxalase I, as well as DNA, RNA, and metal ions. Needless to say, these are a vast number of pathways being acted upon by this compound.

A recent article by Dai et al suggest curcumin plays a role in alleviating collagen-induced inflammation by targeting the mTOR pathway. Although this study is focused on rheumatoid arthritis, the inflammatory markers that were explored play a vital role in vascular inflammation such as chemokines, cathepsin, matrix matalloproteinases, TNF-α, and IL-1 to breakdown the extracellular matrix and ultimately lead to vascular remodeling. Curcumin is considerably cheap and easily available, making it attractive to use in inflammation studies. Rapamycin (mTOR) role in cellular proliferation, differentiation, and apoptosis makes it an important player in cellular regulation. Using Wistar rats as their model, Dai et al suggest curcumin can potentially inhibit the mTOR pathway under collagen-induced inflammatory conditions when compared to the control group. Additionally, this group demonstrated a reduction in inflammatory cell infiltration in the treatment group alleviating the hyperplasia with curcumin therapy.

Promising results were demonstrated by Xiao et al with hemeoxygenase-1 (HO-1) with cytoprotective effects under some pathological conditions. This group used New Zealand white rabbits that were fed curcumin for four weeks. Once the acute vascular inflammation was induced, there was an increase in serum bilirubin and vascular, liver, and spleen HO-1 mRNA levels with curcumin treatment compared to control, as well as a decrease in vascular inflammation. Furthermore, with HO inhibition or HO-1 siRNA knock down, there was an amelioration of carotid artery HO-1, impeding vascular inflammation. Xiao et al went on to report treatment of human artery endothelial cells with curcumin lead to the activation of the Nrf2 and p38 MAPK signaling pathways.

Ultimately, the active compound in turmeric, curcumin, has been shown to contribute to the reduction of vascular inflammation in addition to rheumatoid arthritis-induced inflammation by decreasing the proinflammatory cytokines and chemokines. Additionally, antioxidant response elements are responsive in the presence of curcumin. The thing to remember here is, with all the positive results, curcumin is not readily bioavailable. To get a therapeutic amount, it should be formulated with delivery compounds such as capsaicin or hyaluronic acid (see image). Furthermore, the dose that is necessary to have an effect may be higher than the amount delivered if it is not correctly monitored. For example, it takes up to 90 mg orally to attenuate oxidative stress following a downhill run according to Kawanishi et al. This reduction was observed due to the increase in the blood’s antioxidant capabilities that utilize the TNF, cyclooxygenase-2, and iNOS to initiate anti-inflammatory mechanisms.

So the question, is it a good idea to jump on the yellow band wagon? Yes. However, some things to keep in mind is to read the labels to be sure the turmeric is pure or try to purchase the root in its native form and dry it to the powder at home. Do your research to make sure you are consuming enough to get the benefits from the product. Make sure you are mixing it with the right compounds. I have been utilizing turmeric for years before this band wagon came along, and I will continue to purchase turmeric roots from the farmer’s market and make powder by drying it out in a low temperature oven overnight (get to the powder by blending in the Ninja Blender). I do not think I will use the diatomaceous earth (silica) that was suggested in one of the recipes I saw online.

If you are interested in recipes using turmeric, there are a lot on @dashdiet1 www.AHA.org. I also post on my twitter.

Remember to follow me on Twitter @AnberithaT where I will keep you posted on #AHAMeetingsReports @AHA_Meetings and #VascularScience. See you in Hawaii for #ISC2019!

Interview with Roxanne at AHA18

November 21, 2018March 28, 2019 Anberitha Matthews, PhD

Imagine having an annoying pain that you thought was just a pulled muscle. No, I am not referencing that episode of The Resident, a medical drama prime time series aired by Fox, where a young immigrant was having pains in her side and it ended up being a rare cancer. However, I am referring to a real-life hero story about Roxanne (an organ recipient) and Michael (an organ donor). Roxanne had complaints of side pain for about a week, but she continued to work because she thought it was a pulled muscle. She tolerated the pain for about six weeks before she arrived at the emergency room (ER) where she was diagnosed with cardiovascular disease (CVD). She was immediately taken into cardiac care, underwent extensive diagnostic test, and her medical team concluded they could not give her the required treatment locally. Roxanne was transferred to the Cardiac Care unit in Bronx, New York where she was admitted to the hospital for nine days of extensive medical consultations. Upon receiving the diagnostic results, her primary physician approached her with both good news and bad. The bad news was that her heart had started to fail; the good news was she was in a state of stable instability. Roxanne was placed on list to receive a heart transplant as Stat 2.

By Christmas 2009 Roxanne’s health started to rapidly fail. She was losing weight at a rate of five pounds per day going from an average weigh of about 140 lbs to less than 90 lbs. By the spring she was upgraded on the transplant list from a Stat 2 to a Stat 1; that was when she was offered her first heart. She accepted, but she was second priority of the patients admitted to receive the heart. Thus, the wait continued. The second viable heart offer came, but the heart itself was damaged. Roxanne never gave up hope. Although her health was rapidly declining, and her family was feeling the stress of potentially losing her, she held on to her faith that her healing would come. The next heart offer was made but the donor was HIV positive. At that time AIDS was considered a deadly disease, so she rejected the heart. At this point she had been in the hospital for 100 days; her prognosis was becoming grim. Seventy-eight days later an unfortunate accident caused her to get an offer.

Meanwhile, Michael, an E3 Fireman with the Coast Guard, was brought into the Bronx hospital after a motor vehicle accident. July 2010, his dream to become an Aviation Maintenance Technician and a Flight Mechanic was brought to an end. Upon being guided by his family he registered to become an organ donor. Michael was a generous person with a spirit that prompted him to help others even postmortem. However, to his parent’s dismay they lost their son that night and was faced with the decision to donate his organs. In their grief, it took them a few days to reconcile whether to offer his body up for organ donation. From Sunday to Wednesday for his family wrestled with making the decision. Michael was their only male offspring! How would a father, a mother loses an only son and have his organs scattered from hither to thither? To strangers nonetheless? Ultimately, the family decided to allow the medical team to make their son a lifesaver for people they may never know. Michael has saved people from different cultural backgrounds. Scott, a Caucasian male received a double lung transplant allowing him to become a father. Elijah, an African American male, the kidney recipient, was afforded the opportunity to complete high school. Zhou, an Asian was able to return to work with his liver transplant. Finally, Michael’s heart, the most important organ of the body, went to Roxanne. Michael and his family gave freely; without cultural limitations, transcending socioeconomic barriers, and without regret. This heroic story of a man that was guided by his family to be an organ donor and unbeknownst to them lost their oldest only son, I could imagine was the hardest decision they could have made, but a necessary one.

Michael through his tragic accident saved the lives of four people changing them forever. Roxanne, determined to make the most out of this opportunity to live another day, became an advocate for organ donations; possibly signing up a record number of donors with over 11,000 people committed to organ donation. Michael had given her another chance at life; one she would not take for granted. Upon asking if anything in her life had changed, she indicated she developed a love for power tools. She had never had an interest in them before, but now she made daily trips to Home Depot just to look at the tools and dream of projects that she could take on. Along her life’s journey she expressed her interest in meeting the donor’s family. She dreamed about how she would respond to meeting the mother of the person that saved her life. Serendipitously, she was in Home Depot during her regular wish trips and was approached by the staff from The Oprah Winfrey Show. She was invited to go on the show to tell her story and encourage people to become organ donors as well as increasing minority organ donation, but during the airing, she met the donor family. Oprah introduced her to Michael with a photo, and subsequently his parents came out. Roxanne could not look upon Michael’s father without emotion. She thought she would have that feeling about his mother, but she found there was a close father-son bond between the two. It was then she found that Michael had a passion for mechanics and working with his hands. He and his father worked together on projects and build a bond that can only be between a father and his son. Roxanne feels receiving the organ increased her desire for crafts. She has taken on some projects since but intends to continue with small do it yourself changes around her home. Roxanne remains in touch with the family and does various outreach and social projects together.

Roxanne has changed her activity of daily living to accommodate the dietary habits suggested by her nutritionist in addition to referencing a book she received outlining the things that she could and could not continue to remain healthy. She was adamant about following the instructions that were given because she did not want to risk damaging her new heart. She is now a self-proclaimed foodie although she had no interest in food or cooking to the extent she has developed. She has taken cooking classes and learned more details about mixing spices. Roxanne regularly attends conferences and deliver seminars to assist in her goal of encouraging people become organ donors. Roxanne has become an advocate for people that cannot advocate for themselves. This is an example that all can admire. Michael, real-life superhero, lives on though Roxanne as she goes on a mission to change people’s outlook on organ donations.

Scientific Sessions 2018 – You Should Be Here!

November 11, 2018March 28, 2019 Anberitha Matthews, PhD

This year I decided to attend American Heart Association Sessions in Chicago rather than online as I did last year. This meeting was not for the faint at heart. There were sessions for everyone. So much so that people were packed in meeting halls with overflow standing around hoping to get a glimpse of the happenings from the doorway. I, on the other hand, went to #AHA18 armed with a schedule and the determination to follow it strictly. My day started with media meetings to hear about any breaking news and novel findings. After, there were meetings all day covering hypertension, mental disorders, diabetes, and more. The vast amount of science being presented necessitated variety of disorders covered in each session with only an underlying commonality. Even as I went on the floor to experience the trade show, not only were there vendors chatting to the attendees about the products represented by each company, but also sessions ranging from clinical trials to device utilization in patient care.

Being that all the official AHA Early Career Bloggers are members of different AHA Councils, we do not always get the opportunity to meet. This was the first opportunity I have had to meet a large number of my blogging colleagues as well as AHA staff that I correspond via email. Initially walking through the McCormick Center looking for meeting halls, I was overwhelmed. To be able to network with such an impressive crowd sparked apprehensions. Then I remembered I was armed with my schedule and would to follow it without deviation; from meeting key opinion leaders to reconnecting with my network and potentially making more connection. Learning how to navigate though a conference as massive as this through going to Experimental Biology. All those previous sessions allowed me to navigate #AHA18 successfully. I look forward to another productive day of learning and networking here in Chicago.

You should be here!

Joint Hypertension 2018 Scientific Sessions – You Should Have Been There

September 21, 2018March 28, 2019 Anberitha Matthews, PhD

hypertension 2018

Just as promised, the Joint Hypertension 2018 Scientific Sessions (Hypertension18) was indeed among the most impactful meetings one could have attended. Council on Hypertension Scientific Sessions Planning Committee Vice Chair Dr. Karen Griffin, FAHA was accurate in her statement that it would be “the premier scientific meeting.” There were experts from all parts of the world covering more cardiovascular topics that I think my fingers could not keep up with in note taking, and each session was more informative than the next with up-to-date information on hypertension.

During the President’s Welcome Address, Dr. Ivor Benjamin, FAHA foreshadowed what was to be expected during the meeting. He gave general overviews of the hypertension guidelines, what the changes mean to clinicians and researchers, as well as the role AHA will play in helping drive those changes forward. His welcome was a great introduction to the ‘Recent Advances in Hypertension’ Session chaired by Drs. Joey Granger from the University of Mississippi Medical Center and John Bisognano from University of Rochester Medical Center. This session covered the new guidelines, implementation, and basic research advances of clinical hypertension moving forward by Drs Basile, Egan, Oparil, and Ellison. The whirlwind of information was just the icebreaker! During the refreshment break and exhibits, I met a number of “Rockstars” including clinicians and researchers from University of Alabama Birmingham, Drs. David and Jennifer Pollock and AHA Early Career blogger Tanja Dudenbostel. Additionally, this was the only time I spent visiting with vendors. Among them, Hulu explained the importance of calibrating automatic blood pressure machines. Historically blood pressure was taken with a manual sphygmomanometer and a technician listening for ausculatory sounds via a stethoscope, but now it is all automated. Generally one machine is used for all patients. This technology forces us to question the accuracy of the readings of the machines. Are they calibrated? Should the BP be taken radially or at the wrist? Should the machine be changed throughout the day? There was Aegis representatives sharing information about products to assist medical professionals determine patient compliance to therapy and toxicology testing equipment. During these conversations, it was surprising to discover some of the rationales behind why people would opt to not take medicine as prescribed.

With my research being focused on oxidative stress-induced vascular injury and since I have become increasingly more interested in health and wellness, I took particular interest in the session focused on “Lifestyle Modifications and Impact on BP” chaired by the Associate Editor of Hypertension, David Harrison, MD, FACC, FAHA, “Recent Advances Obesity and Cardiovascular Disease” chaired by the consulting Editor of Hypertension Suzann Oparil, MD, FAHA, and “Obesity, Diabetes, and Metabolic Syndrome” chaired by Drs. Kamal Rahmouni and Carmen De Miguel. During these sessions, it was not surprising that regular exercise reduced vascular stiffness, but what was noteworthy was that weight training contributes to atherosclerosis. Additionally, the sympathetic nervous system seems to be important in glomerular filtration. Dr. Elizabeth Lambert delivered an intriguing talk about how diet and exercise can significantly decrease metabolic syndrome in middle aged obese individuals, which is consistent with a recent study (Hypertension18 Meeting Report P388) that suggests lifestyle changes can reduce hypertension in both men and women. Further, the study suggests that following the DASH diet, exercising, and weight management over a course of 16 weeks were contributing factors in reducing BP in test subjects. We all know anti-hypertensives work in reducing BP. Lifestyle changes should be the first line of defense in evading hypertension and getting it under control at the onset, according to the American Heart Association/American College of Cardiology Hypertension Guidelines. We have all heard that we have to get out there and get moving. Choosing the right exercise is just as important as exercising, according to Dr. Tanaka.

I recently wrote a blog discussing metabolic syndrome and therein indicated there is not a direct correlation between obesity and diet. During this conference, Dr. John Hall lectured on the recent advances in CVD and obesity. He suggested that epigenetic transmission of obesity in humans (and others) is associated with increased adiposity and insulin resistance, depletion of nuclear protein, influence chromatin conformation, and altered germ cell methylation and gamete micro RNA.

The new concurrent session Clinical Practice Clinical Science and Primary Care tracks did not go unnoticed. Although I did not get to attend many of these sessions, I did pass them to see that they were well attended. I did attend some of the lunch meetings and they were very insightful. Please refer to my Twitter to see my detailed notes. As mentioned in my pre-conference blog, with all the sessions that were available one should not have had an issue meeting the goals outlined in the program by coordinators (infra vide). Several sessions that met the interest of all researchers/clinicians, early career, and everyone in between. Not a person that attended Hypertension18 could say they could not find a learning opportunity at the Joint Hypertension 2018 Scientific Sessions! Even if one was merely a passerby, there was a session relevant to them. For example, I was on my way to get coffee when I encountered Drs. Yagna Jarajapu from North Dakota State University and Daniel Batlle from University of Chicago discussing research concerning STZ diabetic Foxn1 mice that were ischemic for several days. Subsequently, Eric Metterhausen shared his mission of services (MOS, for you military people) with me as we conversed about field medicine with the United States Public Health Services (USPHS). I did know our US Armed Forces had research officers and divisions of research, but the amount of detail that Major Metterhausen described was a beast that I had not known. Conversations such as these lead to increased mentoring relationship, as well as potential collaborations in research and grant proposals. We all go to conferences to learn, to purchase new research equipment, and to present our data, but we also should not forget to network and build relationships.

Conference Learning Objectives:

Discuss changes to the AHA/ACC guidelines for the management of hypertension and their clinical implications.

Describe opportunities to improve blood pressure measurement in the clinical setting to provide more accurate results.

Identify immune and inflammatory mechanisms that contribute to the development of hypertension and hypertension-related end-organ damage and discuss the research and clinical implications.

Educate participants about medical approaches for the management of comorbid obesity in patients with hypertension.

Describe new and emerging strategies for treating resistant hypertension.

Describe participants on the impact of value-based reimbursement on hypertension management and identify opportunities to improve its management.

See you all in Chicago at Scientific Sessions 2018!!!

Leave a comment and follow me on Twitter @AnberithaT and @AHAMeetings if you have questions or are interested in something else specifically.

Anberitha Matthews, PhD is a Postdoctoral Fellow at the University of Tennessee Health Science Center in Memphis TN. She is living a dream by researching vascular injury as it pertains to oxidative stress, volunteers with the Mississippi State University Alumni Association, serves as Chapter President and does consulting work with regard to scientific editing.

What to expect at Joint Hypertension 2018 Scientific Sessions – Treating Hypertension in 2018

September 4, 2018March 28, 2019 Anberitha Matthews, PhD

Two AHA Councils, the Council on Hypertension and the Council on Kidney in Cardiovascular Disease, have joined forces with the American Society of Hypertension to make Joint Hyptertension 2018 Scientific Sessions (#Hypertension18) among the most impactful. Dr. Karen Griffin, FAHA Vice Chair for the Council on Hypertension Scientific Sessions Planning Committee calls it the “premier scientific meeting on hypertension in the world”. Understandably so; it boast experts from areas of cardiorenal disease, cardiovascular disease, stroke, and genetics to make for a vast cross-disciplianry session with the up-to-date information on hypertension. This year’s meeting received 439 abstracts in 37 categories, over 125 expert peer reviewers, and more than 20 countries represented.

There will be several interactive sessions that will target the established researcher/clinician, early career, and everything in between. With the addition of the new concurrent session D-Track, Clinical Practice Clinical Science and Primary Care tracks, a dimension will be added for elucidate the research science/clinical practice as it relates to patient care. In light of all the sessions that are available one should not have a problem reaching the milestones set by the program coordinators (infra vide).

To point out a few conference highlights, there will be 24 oral sessions, 3 poster sessions, and travel award talks:

The Excellence Award for Hypertension Research (Saturday, September 8, 2018)

R. Clinton Webb, PhD, FAHA presents “A Study of the Innate Immune Response in Hypertension”
Paul K. Whelton, MB, MD, MSc, FAHA presents “Clinical Trials and Practice Guidelines: Evidence-Based Progress in Lowering Blood Pressure”

Conference Awards

10 Council on Hypertension New Investigator Travel Awards
10 Council on Kidney in Cardiovascular Disease New Investigator Awards
4 New Investigator Travel Awards
6 Hypertension Early Career Oral Award Finalists
12 AFHRE Travel Award for Patient-Oriented or Clinical Research in Hypertension
1 Clinical Science Investigator Award for Excellence in Translational or Clinical Hypertension Research
3 New Investigator Awards for Japanese Fellows

25 Poster Presenters can potentially win the competition this year! Which has gone up significantly from the previous years.

I am excited to go to Chicago for #Hypertension18 this year. If there is anything you need to enhance your experience during your time at the conference contact the program officials (directions in the program book).

I look forward to meeting you all! If you see me around tweeting, introduce yourself. I love meeting new people and learning new things. After all, that is why we are all going, right? 🙂

#Hypertension18 Conference Learning Objectives:

Discuss changes to the AHA/ACC guidelines for the management of hypertension and their clinical implications.
Describe opportunities to improve blood pressure measurement in the clinical setting to provide more accurate results.
Identify immune and inflammatory mechanisms that contribute to the development of hypertension and hypertension-related end-organ damage and discuss the research and clinical implications.
Educate participants about medical approaches for the management of co-morbid obesity in patients with hypertension.
Describe new and emerging strategies for treating resistant hypertension.
Describe participants on the impact of value-based reimbursement on hypertension management and identify opportunities to improve its management.

Leave a comment or tweet @AnberithaT and @AHAMeetings if you have questions or are interested in something else specifically.

Follow me and @American_Heart @AHA_Research @AHAScience and @HyperAHA on twitter for more #HeartSmart information.

For meeting Tweets follow @AHAMeetings @HyperAHA @AHAScience #JAHAMeetingReports @JAHA_AHA for the latest on#Hypertension18!

Growing My Network at BCVS18

August 28, 2018March 28, 2019 Anberitha Matthews, PhD

Basic Cardiovascular Science 2018 (BCVS18) Scientific Sessions was held in San Antonio this year. I had no initial intention on attending BCVS18, but there was an email notification urging members to participate in a tweeting competition. A Researcher from University of Tennessee Health Science Center challenged me to participate in the competition to try to win one of the two prizes, which ultimately led to my attending the session to assist with social media coverage of the programs. Although I took part in the tweet storm, I was not in the running for the prize. We thought it best to leave those for another researcher.

As with most meetings, this gave me the opportunity to reconnect with people that I had previously met as well as receive career guidance. This meeting was different for me in the respect that, in addition to diving into the science aspect, I actively sought out vendors from organizations of interest to me as a means of gaining insight into transitioning from academic research to industry. This is often an underexplored opportunity at meetings. As a scientist, I spend most of my time going to scientific sessions and poster sessions, and only visit the vendors that I need to meet with to purchase equipment/products or get information about equipment/products that are currently in use in the lab. BCVS is a smaller meeting with fewer vendors allowing more opportunity to go to sessions, as well as spend time gathering career information. I met with people from three noteworthy organizations.

Kara Keehan, Executive Editor for AJP-Heart and Circulatory Physiology took several moments to share with me ways to interact more openly as an introvert. Often times introverted people are perceived as being standoffish or anti-social, but in reality, may just be uncomfortable in social or unfamiliar settings. Kara shared with me some strategies to mingle in social and professional settings to increase my ability to network. For example, walk up to someone and start talking about the last session or Twitter. Additionally, she gave me some insight into the role of an editor and the requirements.
I have become increasingly more interesting in Medical Science Liaison (MSL) positions. Having the ability to be connected to the science and share the information in a way that will help people life a healthier life has resonated with me on many levels. However, understanding how to translate an academic research background into one that will be appealing to recruiters in the industry has proven to be difficult. George Ruth III, Sale Consultant at Pfizer, gave me ample amount of guidance on creating a resume that will catch the eye of the human resource personnel that will be looking to fill those positions. Searching the career website is not always as clear as one would hope, thus George also gave advice on how to identify positions of an MSL with a pharmaceutical company.
Chandler Dental Center came to BCVS to share information about “Oral Systemic Health Services” for patients struggling with inflammatory diseases such as cardiovascular disease. His booth had information about The Heart Gene and articles to support studies that suggest a link between dental health and vascular health. In our one-on-one dialog, he suggested that 78% of people suffering from myocardial infarctions had bacteria in their thrombus that were specific to the mouth. As a dentist, he can take saliva samples and test for the bacterial strain for early detection and treatment, leading to subsequent offset of CVD symptoms. This conversation reiterated the point that physicians rely on scientist to assist in conducting studies that are otherwise not feasible. Thus, Bryce (dentist) works in concert with Bradley Bale (clinical assistant professor) School of Medicine, Texas Tech Health Sciences Center to conduct the cardio-dental research.

When going to a conference, one should take advantage of the total experience. Do not get caught up in only one portion of the meeting. Yes, the science is important, but networking and looking out for the next career step is equally as important. Was it Darwin that said, “Chance favors a prepared mind?”

Leave a comment or tweet @AnberithaT and @AHAMeetings if you have questions or are interested in a specific topic. Also, follow me and @American_Heart for more #HeartSmart information.

Improving Vascular Health: Nutritional Coaching

August 20, 2018March 28, 2019 Anberitha Matthews, PhD

There has been an ongoing misconception of weight being a consequence of over-nutrition. The relationship between calorie intake versus calories spent continues to overshadow the biological forces that resist the maintenance of weight. Although scientists started to recognize obesity as a chronic disease in 1985, it was about 28 years later before the American Medical Association made the acknowledgement. The recognition of obesity being classified in the cluster of metabolic syndrome (MS) was a significant milestone in weight loss and primary health care.

Metabolic syndrome (MS) is defined as a homeostatic disturbance in the metabolic system characterized by visceral obesity, atherogenic dyslipidemia, hypertension, insulin resistance, and more recently, adipose tissue dysfunction. Increasing studies are exploring adipose tissue (AT) as an endocrine organ system encompassing physiological functions that assist in the regulation of weight, insulin sensitivity, inflammation, and vascular function. Matthews et al (opens in a new window) described the role of macrophages in the inflammatory response. Additionally, Dias et al (opens in a new window) expounded on the various inflammatory cytokines in AT that can potentially be modulated suggesting an anti-inflammatory role for statins. These reports have demonstrated a reduction in stress-induced inflammatory cytokines such as IL-6 and C-reactive protein as well as the upregulation of PPARγ, inhibition in ER stress, PA1 promoter activity through MAPKKK1 and to a lesser extent NFκB with the therapeutic use of statin drugs. There are conflicting data on the utilization of statins; however, their potential to induce the expression of PPAR and SRB1 in adipocytes can directly and inadvertently lower cholesterol and SRB1 stimulation. Generally, obesity has been controlled using pharmaceutical supplements; some examples include: Topiramate, Diethylpropion, Phentermine, and Lorcaserin. Among the medicinal weight therapies, Orlistat plays a direct role in digestion by inhibiting the absorption of dietary fat and subsequently body weight reduction. Orlistat inhibits diacylglycerol lipase (DAGL), the enzyme that catalyzes the hydrolysis of diacylglycerol leading to the liberation of free fatty acids and monoacylglycerol. This information is noteworthy due to the mechanistic pathways delineated in an article by Matthews and Lee (opens in a new window) (Figure) suggesting an important connection between the endocannabinoid ligand 2-arachidonylglycerol (2-AG) and oxidized low density lipoproteins (oxLDLs). This group and others have demonstrated DAGL and PLC-β are Ca2+ dependent enzymes that are important in the biosynthesis of 2-AG. However, during my time in Dr. Matthew Ross’s lab we found oxyradical fluxes and 2-AG generation had a positive correlation that lead to an antioxidant and anti-inflammatory effect associated with the 2-AG ligand. Thus, Orlistat combined with a low-calorie diet can have a synergetic effect of inhibiting fat absorption, reducing leptin concentration in plasma, CRP, IL-6 TNFα and inducing vascular protection.

In relation to food and nutrition, there are several articles that are related to the mechanistic action of the gut in relation to blood pressure including the role of gut microflora, oxidative stress, and lipid pathways that lead to metabolic changes. Being that my knowledge of nutrition is limited. I interviewed Tina Brown, FNP (opens in a new window) from Elite Health for expert advice.

Improving Vascular Health: Nutritional Coaching

I met Tina one morning on my way to campus. As I started my long walk down the sidewalk, I saw a sign across from a restaurant saying, “Weight Loss”. I thought to myself, “There is always a weight program somewhere. I’m in Memphis after all.” Memphis is known for their food, such as the Green Beetle that became popular back in 1939, the flavorful Curry-N-Jerk Caribbean cuisine, BB King BBQ Joint, the Redbird Field food court, and anything down Beale Street. Memphians are foodies and have the whole month of May dedicated to Blues and Barbeque! So, it comes as no surprise to see a “Weight Loss” facility in Memphis. Shelley White-Means, PhD (opens in a new window), University of Tennessee Health Science Center presented on, “Disparities in Breast Cancer Mortality: A Perfect Storm in Memphis.” I would like to modify that to say, “Disparities in CVD mortality: A Perfect Storm in Memphis” due to the culture and prevalence of food, as well as the activities surrounded by an abundance of great barbeque.

I spoke with Tina via phone in addition to a face-to-face interview. To give some background as to why nutrition is an important second step in one’s health journey, it is important to understand that one in three Americans are diagnosed with a metabolic dysfunction consistent with cardiovascular disease, such as hypertension, diabetes, renal dysfunction, or obesity.

The interview went as follows:

Q1. What are your qualifications?

A. I attended Nursing school at University of Memphis (@UofM) as an adult learner receiving a Bachelor of Science in Nursing. After working for several years as a nurse, first doing rotations and finally settling in the medical surgical unit I returned to UofM to specialize.

Q2. Are you aware of any nutritional requirements for a patient that has cardiovascular disease namely, hypertension?

A. I was watching an infomercial about L-Arginine and how it helps with cleaning the vascular system and vasodilation. After watching for several minutes, I realized it was an infomercial, but it was good information and research. I don’t recall the author.

Note: Upon looking for the information, I was not able to find the exact infomercial that Tina was referring; however, I did find information on L-arginine’s effect on the vascular system. Arginine is the precursor for nitric oxide (NO) in endothelial nitric oxide (eNOS), since eNOS is necessary for gas exchange and the regulation of various biological functions it is reasonable that L-arginine can play a role in maintaining vascular homeostasis. Allerton et al (opens in a new window) (Figure) compared in a review the use of L-arginine with citrulline supplementation to determine whether there were any significant changes in cardiometabolic health. Patients with elevated blood pressure has been reported to display labs with reduced NO bioavailability and subsequent vasoconstriction. Incorporating L-arginine (and l-citrulline) into the diet can potentially indirectly or directly increase vasodilation by increasing eNOS expression and NO production thereby its bioavailability leading to reduced blood pressure.

Q3. What advice will you give a patient regarding these diagnoses?

A. Eating a low carbohydrate diet. Choosing the good carbs such as eliminating white bread and sugars.

Note: In a randomized clinical trial, Dr. Christopher Gardner et al (opens in a new window). evaluated the effects of low-fat (HLF) versus low-carbohydrate (HLC) healthy diets to determine whether there were any genotypic alterations in regard to weight loss that were effected by either of the dietary patterns. The HLF or HLC diets had no statistical significant in weight loss by genotype, insulin interactions. These data and others suggest that eating a low carb diet can be beneficial in weight loss, but in addition to other healthy lifestyle changes. Especially in light of statin therapy assist in reduction in fat absorption.

B. Combining the ketogenic diet (high protein, high fat) and paleo (organic) diets together can work as a sustainable diet that will allow one to get all the nutrients the body need to work properly. The keto diet done alone is not as healthy:

Ketogenic diet is a plan that consist of minimizing carbohydrate intake while maximizing fats to force the body to use fat as its form of energy for expenditure. Generally, this mechanism translates to calories being consumed from 60-75% fat, 15-30% protein, and 5-10% carbohydrates. On average it takes about 2-7 days for the body to go into ketosis on this meal plan.
Paleolithic times was a period when certain food stuffers were not available, thus the paleo diet is a nutritional approach that is focused on eating unprocessed foods based on those guidelines. The primary backbone of it is to only consume food that would have been available before the industrial agriculture, domestication of animals, and modern food processing.

Note: There is a vast amount of research indicating that branched chain amino acids (BCAA) are linked to diabetes, and this is showing an increasing trend over the past decade. In an Editorial in the Journal of Diabetes (opens in a new window), Bloomgarden described a Young Finn’s Study suggesting phenylalanine and tyrosine, aromatic amino acids are linked to insulin resistance in men and obesity my track more strongly in the presence of BCAA. In addition to BCAA leading to increased risk of MS: obesity CVD, dyslipidemia, and hypertension; medium-and long-chain acylcarnitine’s, the metabolic byproducts of mitochondrial catabolism of BCAA, plays a role in insulin resistance.

C. Know that vitamins are being taken and do not just listen to what you are hearing. If you are healthy, you will lose weight as a side effect if weight loss is necessary. Making lifestyle changes that will result in small gains will generate the momentum needed to be successful in moving forward in sustaining the lifestyle. Once a person sees results, compliance becomes easy.

Note: Dalia Gaddis, PhD and Wei Ling Lau, MD also gave some insightful information in their blogs on these topics such as: “Weight Loss and Exercise: A Remedy For A Better Functioning HDL”, “Can Increasing HDL Reduce Heart Disease? An Issue of Constant Debate!”, “Natural Supplements Can Be A Pain in The Kidneys” and “If you give a patient calcium…” respectively.

D. Increasing physical activity is important. One must get the heart rate up and maintain the increased heart rate for short intervals (Note: it is recommended to get heart rate up for ~30 minutes 3 days per week). Doing simple things make a big difference such as standing up and moving around. Incorporate things that will make the muscles work rather than just sitting or standing stationary. For example, there are now the balance boards to stand on at the standing desk, or a body ball to sit on at a sitting desk.

Note: “Therapeutic elevation of HDL-Cholesterol to prevent atherosclerosis and coronary heart disease” Pharmacology and Therapeutics 2006 (opens in a new window); 111(3):893-908. The study delineated that HDLs play a role in cholesterol transport. However, Ross et al (opens in a new window) suggested only free cholesterol is effluxed from macrophages via ABCA1 transporters. It has also been reported that macrophage cholesterol exchange can be modulated by toxins in the body by down regulation of CD36 and SR-A protein expression.

Q4. How will you advise a patient suffering with CVD symptoms on improving their vascular health from a nutrition standpoint?

A. Get weight under control. Determine the underlying reason/condition behind the weight gain/vascular injury. Determine whether there is a metabolic disorder, rule out any hormonal deficiencies such as thyroid or testosterone, vitamin levels

B. Reduce any inflammation if necessary by potentially using a low dose pharmaceutical regimen until the patient lose weight or get hypertension under control. Especially if it is acute rather than chronic.

Q5. Any overall/general nutritional guidelines you would suggest for a patient with hypertension to consider modifying?

A. Meal preparation is the best option. By planning meals, one can look ahead at the menu and make good choices about what is being prepared. Even going to the grocery store, shopping the perimeter will generally give the healthier options.

B. Avoid eating out. When meals are prepared at home everything that goes in the meal can be a healthy option without any cheats. When eating out, one never knows whether there are cheats such as saturated fats or salts

C. Limit sodium intake

D. Have healthy snacks readily available. This will help cut cravings and avoid picking up unhealthy sugary snacks due to the feeling of needing to eat quickly. If a person has the personality that they must eat all the time, it will be hard if not impossible to change, having healthy snacks on hand such as fermented snacks (pickles or sauerkraut) or dehydrated fruit and veggies is better than forcing them to change and these snacks assist in weight loss.

Q6. How important is reporting back to the physician/counselor?

A. Very important, accountability helps with compliance. It is also a trust issue; the medical professional wants them to want to come back. The patient needs to be able to ask questions and discuss any changes in treatment. If a patient starts to lose or gain weight their medicine may need to change thus making it necessary to visit the physician/counselor regularly. It is also a good idea to have a fitness buddy to hold each other accountable.

It is important to not only visit the doctor but also to ask questions about your health. Take the challenge to be the best you that you can be.

Upcoming posts:
• Fitness coaching
• Mental coaching

Leave a comment or tweet @AnberithaT and @AHAMeetings if you have questions or are interested in something else specifically.

Follow me and @American_Heart for more #HeartSmart information.

Improving Vascular Health: Health Coaching with Motivational Interviewing

July 18, 2018March 28, 2019 Anberitha Matthews, PhD

Summer months are always the hardest for lupus patients. For me, suffering from a severe flare up after returning from conference November 2017; I started a journey of getting into optimal health. I did an extensive literature search and the information was so limited that I was more confused than liberated. To take power over my health and not let my body defeat me, I started making vast changes. There was several studies that suggested loading up on proper nutrients prior to a flare up to strengthen the immune system prior to a stressful event. Other studies focused on staying active and incorporating exercise such as yoga and tai chi for muscle strength and flexibility. What does this have to do with CVD? I am glad you asked. Lupus is a chronic inflammatory disease, as is CVD. There are various forms such as lupus nephritis, systemic lupus erythematosus, mesenteric vasculitis, and others. These forms of lupus affect the vascular system in a similar manner as CVD and generally people with these diagnosis have hypertension. For me, I have started a journey that started from learning from other early career bloggers in addition to my own research, but for the general population health coaching may be a viable option.

Note: This post will be a part of a series of health coaching (1 of 4).

Dr. James Bailey Headshot As serendipity will have it, I met a summer student while I was having lunch in the common break room (which I never do because who has time for lunch?). This student was studying Motivational Interviews (MI) under the direction of James Bailey, MD, MPH from the University of Tennessee Health Science Center (UTHSC). I had often run into Dr. Bailey and had insightful conversations about health, insurance and UTHSC life in general. Speaking with this student piqued my curiosity about how health coaching can help patients improve vascular health. Thus, I scheduled a formal meeting with Dr. Bailey to discuss in more detail the role MI plays in reducing cardiovascular symptoms such as hypertension and subsequently boosting the immune response. The interview went as follows:

Q1. Why health coaching? Is it feasible, sustainable, and who will pay for the service?

A. Motivational interviews are patient centered communications that is used to encourage change and adherence to medical therapy.

B. We (physicians) are looking for the lowest cost evidence-based approaches that will help personnel and it was found that health coaches were most cost efficient. In this model lower level medical staff can do it with fidelity and be trained to conduct the interviews.

Note: There was a 2017 study in which a cohort of doctors used “Task-shifting” strategies as a means of improving patient compliance to medical treatment. In this model, there was a rational movement of primary care duties passed from physician to ‘lower medical staff’ or non-physician health care workers such as nurses or pharmacy residents to determine optimal management of disease. This study demonstrated two noteworthy findings: (1) there were disconnects in perspectives of disease states. The physician believes hypertension is a biomedical model which should be seen as a chronic life-long illness; whereas the patient sees it as a disease of nervousness in which the blood pressure can be reduced with reduced stress. (2) The way in which the intervention is perceived and the relationship with the provider impacted the degree of compliance to intervention.

Training for MI can be conducted over a 3-day period: 2 days training include lecture, discussion, demonstration, videos, and observed role playing of MI skills. Day 3 consist of simulated trainings with patients. Trainers are evaluated using the 7-point Likert-type scale for MI skills and spirit (expressing empathy, using reflective listening, and language to promote behavioral change).

C. MI is based on identifying and helping patients set their own goals. It is more effective than diabetes, hypertension, (and lupus) training. The interviewing help identify barriers/promoters in the patient’s life that can assist in improving adherence. Promoters such as: one patient said, “the nurse was convincing and her personal relationship drove me to attend’ or ‘the nurse gave me details and explanations from other patients in the program’. Barriers can include: ‘money for buying healthy food is difficult although some can be naturally grown, most have to be purchased’; ‘not all healthy food is available in my immediate surroundings so it is necessary to travel a few miles to buy them and I haven’t a car or money for a bus’; and ‘I always feel a bit tired after work and my family has been troublesome.’

Thinking of MI as a gym coach, there is a relationship of accountability that generates trust. This model only works if there is a level of communication and responsiveness because the patient is taking the lead in improving their life. The coach is there for support.

D. This model works better being a part of primary care rather than a part of insurance. High value care, care at low cost gives great care. A single ER visit can be $2,000 to $4,000, so to avoid at least one hospital visit with MI can reduce cost. Health care strengthen lifestyle changes and coaches are high value options.

Note: Previous use of this model demonstrated significant savings. In the 2011 study analyzing cost avoidance using clinical interventions there was an estimated $23,000 savings with the use of MI.

Q2. Where do we go from here to improve our health care?

A. As medical professionals are becoming more in tuned to high quality primary care they become more investing in health care to strengthen the primary care team. There is a model of value-based payment (VBP) vs pay per service (PPS). Many routine services are getting no benefit with and no return. VBP suggest we should pay a global payment to keep us well. This gives a huge incentive to keep people out of hospitals and keep them healthy. Changing the way you pay will keep people out of the hospital and keep them well. In this model it is the revisiting of the health maintenance model. This model could work through both the private and public health sectors to save on cost and improve overall patient health.

B. Health coaching can be the best tool for keeping people healthy and it cost less. We should have teams to make individual patients health better. For a health coach to work one-on-one with a patient via MI compliance will improve and physicians can see better outcomes with chronic illnesses.

Dr. Bailey is currently working on a study under the PCORI Model (Management of diabetes in everyday life) effectiveness trial of health coaching, motivational text studies, and health care. The pilot data thus far is promising suggesting a reduction in diabetes employing MI strategies.

Upcoming post:

Nutritional coaching
Fitness coaching
Mental coaching
Leave a comment or tweet @AnberithaT and @AHAMeetings if you have questions or are interested in something else specifically.

Follow Dr. Bailey on Twitter for more on motivational interviewing @thehealthycity

A Marathon of Conferences

June 14, 2018March 28, 2019 Anberitha Matthews, PhD

collage of images from conference The months of March and April were filled with a whirlwind of conferences. I had the pleasure of traveling to several meetings across the U.S. including the Wonder Women Confidence Conference (WWCC) in Stone Mountain, GA on April 18th, NIDDK NMRI workshop in Bethesda, MD on April 11-13th, Experimental Biology (EB) in San Diego, CA on April 20-26th, and Society for Cardiovascular Angiography and Interventions (SCAI) San Diego, CA on April 25-28. All these meetings had commonalities that included networking, publishing, funding, and of course, science.

My favorite part of attending scientific meetings is the science. I sit in on various talks that are related to things of interest to me, even if they are outside my area of research. Being an introvert, I find comfort in focusing on sessions that surround science and ways to gain the funding to move my research forward. My weakness is networking. I find it difficult to reach out to others and sustain a relationship of collaboration, mentoring, and professional socialization. This year at WWCC and NMRI, I had conversations with women who shared their thoughts on building a solid network. For example, networking is multifaceted that include mentoring, encouraging, challenging, counseling, advising, sponsoring, and affirmations; thus finding a supportive, like-minded network of individuals in the hypercompetitive world is vital. Although people are encouraged to build a network based on hierarchical relationships, it is now being emphasized to form relationships that can be sustained over an entire career. For example, Dr. Martin Frank has been a member of the American Physiological Society for over 20 years. During EB, there were people, including myself, that reflected on the benefit of him being a part of their network over the course of their entire career. Some networking opportunities can be found at National Research Mentoring Network (NRMN) and strategies on how to build a network in the 2016 article by McBride et al.

Some common aphorisms in science are “Publish or Perish” and “Fund or Fail”. EB lets you join conversations on the expectations of publishing. There were sessions that fully covered publishing ethics by American Journal of Physiology (AJP) that are similar for most journals including the Journal of the American Heart Association (JAHA). According to a talk given pertaining to funding by a representative from NIGMS, publication history is imperative in an application for funding. Publications give reviewers a snapshot into an investigator’s productivity and how they use their grant funds. Additionally, seminars explaining how to choose where to publish including section seminars from various vendors including: AHA as well as the American Kidney, Physiology, Nephrology, and Genomics Societies. The most noteworthy session for me was about blogging as a top way to communicate science to a large audience. Increasing people are using social media, such as Twitter, Facebook, Instagram, and SnapChat to share scientific information quickly in 150 characters or less. However, a Nature article suggests, although blogging is not for everyone, it is still a viable way to promote collaborations and share crucial information to the scientific community succinctly. Dissemination of research is a good way to advance the writer’s career, which is contrary to the thought that social media is phasing out blogging. Additionally, publishers shared ethics information, such as authorship, author responsibility, communicating with journals, rigor and reproducibility, transparency and data sharing. All now benchmarks of what reviewers are looking for in a publication. Since the NIH is looking for these things in grant applications, I would recommend looking for a workshop that covers these topics in detail either online or face-to-face.

As a researcher, it was also important for me to present my research at conference. My poster presentation at EB focused on NADPH oxidase-dependent ROS in renal cells. My research interest is elucidating the relationship CVD has on renal dysfunction in the presence of endogenous oxidative stress. During the poster session, I spent time speaking with researchers ranging from high school and undergraduate students spanning to late career investigators sharing information pertaining to the impact increased oxyradical stress have on the mechanistic pathways that lead to cardiorenal disease (CRD). During our dialog, I met with people that I had known previously, such as Dr. Robert Mallet from UNTHSC, my mentor from the STAR Fellowship program (pictured); Drs. Manuel Navedo from UC Davis, Layla Al-Nakkash from Midwestern University, and Adebowale Adebiyi from UTHSC (postdoc mentor), my mentor from previous EB years (pictured). During sessions and after hour socials, connected with Marsha Matyas and Dr. Marty Frank from APS, publishing mentors (pictured) and the amazing group at the Porter Physiology Development & Minority Travel Award committee as well as new investigators to potentially form collaborations. The people in my network may not speak with me daily or even monthly, but they are my support when I am working through the processes of designing research experiments, data analysis, identifying funding sources, writing grant applications, and writing for publication. While in San Diego, I took a detour to the Manchester Grand Hyatt Hotel where the SCAI Sessions were held to speak with clinicians working with cardiac devices. Being that I am interested in securing a career in industry, SCAI provided the opportunity to network with general cardiologist, pediatric cardiologist, cardiovascular surgeons and biomedical companies that produce the devices used in cardiac repair.

Not any of us builds a career alone. It takes knowing the area of study, networking with people that has solidified a career in that area, finding a mentor that will sponsor you in advancing your career, as well and publishing the data that was generated with the funding that supported the research. In an arena of diverse scientist and clinicians, all studying various CVDs, it is important to find the thing that drives your passion and people to help support that passion. Working together, we can fight the hard fight of cardiovascular disease. Keep reading updates of heart health guidelines on AHA New.

Science of Strokes

June 8, 2018March 28, 2019 Anberitha Matthews, PhD

types of strokes It has been well accepted that atherosclerosis is the result of chronic inflammation. I have spent several years exploring the role endocannabinoids, lipid-based neurotransmitters that bind to receptors that are expressed throughout the peripheral and central nervous system, play in decreasing oxyradical derived inflammation. Under normal conditions, lipids are metabolized and excreted from the body. It is my belief we have an endogenous mechanism that maintains balance within the vascular system that protects our arteries from becoming damaged; however, in the event of an injury the immune system is activated leading to cardiovascular dysfunction.

Flow resistance, sheer stress, ischemic reperfusion, and oxidized low-density lipoproteins (oxLDL) can contribute to microvascular dysfunction particularly at non-linear area of a vessel. The pathology of atherosclerosis/stroke starts with the monocytes being recruited to an injured site causing the production of NADPH oxidase-derived reactive oxygen species (ROS). The monocytes undergo a phenotypic change into macrophages and uncontrollably engulf the oxLDL and subsequently lead to the development of lipid laden foam cells. Apoptosis of the foam cells occurs due to their inability to metabolize the modified reactive lipid peroxidation products. The extracellular matrix becomes remodeled resulting in the formation of a fibrous cap. It is this cap that causes the occlusion of a vessel causing a heart attack or stroke.

circulating moncyte, macrophage and foam cell All strokes are not alike, they include ischemic, hemorrhagic, and transient ischemic attacks (TIA). Although older persons are thought to be the primary risk group for strokes, children and fetus can potentially be included in the risk population. The most common type is ischemic stroke caused by clots occluding the blood flow to the brain. The clots can be from congenital heart defects, sickle cell disease, and trauma that injures a large artery; however, they can also be a consequence of high cholesterol, oxLDL, and blood clots as well as exogenous and endogenous toxins. The foam cells in the artery can be either a stable plaque (solid fibrous extracellular tissue with small amounts of lipid) or vulnerable plaque (consist of macrophages and lipids in the artery wall that erosion prone). These “culprit” plaques are the cause of disruption in blood flow that leads to vascular events such as heart attacks and strokes. Hemorrhagic strokes are due to a rupture in the blood vessel that bleeds to the deep tissue of the brain; often caused by hypertension, but also aging vessels, arteriovenous malformations (cluster of deformed blood vessels), and aneurysms (a balloon of blood in the artery). Intracerebral hemorrhages are the most common type due to the prevalence of high blood pressure but can also be caused by exogenous toxins such as smoking, oral contraceptives with high estrogen, alcohol, and illegal drugs. TIAs often called mini-strokes, produce symptoms similar to those of stroke but without the lasting effects. They are thought to be warning signs to an ischemic stroke; the clots that cause them may be resolved without treatment, but without treatment they can lead to further strokes or death.

A recent report by Wang and colleagues demonstrated a linear correlation between oxLDL and the National Institutes of Health Stroke Scale (NIHSS). The results of their study indicated after adjusting for age, gender, ethnicity, and marriage, NIHSS score increased 1 μg/dL of oxLDL. Preparedness is the best defense to preventing a stroke. The Hip-Hop Stroke randomized trial suggest that preparedness can potentially delay a major thrombolysis event. Visits to a medical professional to recognize the symptoms will play a major role in prevention. Since atherosclerosis and stroke are complex process that involve oxyradical stress, immune dysfunction, and vulnerable vessels and the NIHSS score is widely used in the clinical setting to evaluate LDLs in plasma, one can only delineate that being prepared by getting tested is the best way to validly and reliably be prepared to combat a stroke. If you find someone displaying stroke symptoms act FAST to give the best prognosis. Share with me your experience or experiences you have heard of to combat the detrimental effects of stroke.