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A Roadmap for Understanding COVID Vaccines

Yes, we are still in the middle of the COVID pandemic. With the help of more people getting vaccinated and mask mandates in effect, a post-pandemic world is no longer a mere imagination. While waiting for the pandemic to be over, there are some doubts about whether the COVID vaccines should be cleared to facilitate a faster transition back to normal life.

  1.  What are the leading COVID vaccines?

    Figure: Overview of the diverse types of vaccines, and their potential advantages and disadvantages (Dong et al. 2020).

Currently, two COVID-19 vaccines are authorized and then recommended for use in the United States–the Pfizer-BioNTech COVID-19 vaccine(Polack et al. 2020) and the Moderna’s COVID-19 vaccine(Baden et al. 2020). Both of the vaccines used a cutting-edge technology, the messenger RNA (mRNA) vaccine which has been developed in the 1990s.

As of December 28th, 2020, three other COVID-19 vaccines are undergoing large-scale (Phase 3) clinical trials in the United States: AstraZeneca’s COVID-19 vaccine(Knoll and Wonodi 2021), Janssen’s COVID-19 vaccine and Novavax’s COVID-19 vaccine(Sadoff et al. 2021). Both the AstraZeneca COVID-19 vaccine and Janssen’s COVID-19 vaccines (Johnson& Johnson) used a weakened adenovirus vector strategy to tackle the spike protein on the SARS-CoV-2 virus. The weakened virus vector serves as a “Trojan horse” to deliver “information” to the cells in order to stimulate the memory of immune defense against SARS-CoV-2 virus. The adenovirus-based vaccines are relatively less foreign to the public, currently they are used against a wide variety of pathogens such as Mycobacterium tuberculosis, human immunodeficiency virus (HIV), and Plasmodium falciparum. The AstraZeneca COVID-19 vaccine has already authorized to use in Europe on January 12th, 2021 and possibly obtains approval in the United States early 2021. On January 29th, Johnson& Johnson announced its interim clinical Phase 3 trial results and a single-shot Janssen COVID-19 vaccine is on the way for FDA approval.

Novavax COVID-19 vaccine, a protein subunit-based vaccine, just announced its interim UK Phase 3 clinical trial results on January 28th, 2021. It shows promising protection to the SARS-CoV-2 virus, as well as the UK and South Africa variants. The company has already signed purchase agreements with many governments including Australia and Canada.

Two other vaccines– Russia’s sputnik V vaccine and China’s COVID-19 vaccine developed by Sinovac Biotech are also the lead runners in the vaccine race. The sputnik V vaccine which has obtained authorization to use in Russia back in November 2020, just published its Phase 3 data on February 2nd(Logunov et al. 2021). It’s an adenovirus-based vaccine, similar as the AstraZeneca COVID-19 vaccine and Janssen’s COVID-19 vaccine.

China’s COVID vaccine used a relatively well-understood technology: an inactivated SARS-CoV-2 virus. The inactivated virus vaccine approach has been implemented for a wide range of vaccines such as polio vaccine, hepatitis A vaccine, rabies vaccine and most flu vaccines. So far it received some inconsistent results from Brazil, Indonesia and Turkey and it’s not applicable in the United States. Overall, the efficacy is encouraging (50.38% to 91.25%) and requires more data to reach a more consistent result.

  1. How to understand the efficacy?

It’s a numbers game or is it? The high efficacy (95%) data released from Pfizer and Moderna at the end of last year received with great applause. The 70% protection starting after a first dose from AstraZeneca seems less impressive. The AstraZeneca COVID-19 vaccine confirms 100% protection against severe disease, hospitalization and death in the primary analysis of Phase 3 trial suggesting a total success. The recent Phase 3 trial results from Johnson& Johnson’s single-shot vaccine shows 72% effective in the United States and 66% effective overall at preventing moderate to severe COVID-19, 28 days after vaccination. The efficacy number simply cannot be interpreted as the higher the better. Like all of the clinical trials, compounding factors need to take into consideration. Their vaccine impact may depend on sex, age, genetics, geography, the timing of assessment of the end-point, the percentage of population affected by new variant compared to the original variant.

The thing matters the most is to reduce hospitalization and death. So far most of the leading vaccines have showed great promise. At the current stage, whatever vaccine is available to you could protect you from getting serious disease and prevent the virus spread to your loved ones one way or another. Herd immunity could finally be reached if enough people are getting vaccinated in the near future.

  1. mRNA technology: what is it? And is it safe?

Considering mRNA vaccine is the new kid on the block, it’s understandable that certain hesitancy and reluctance towards getting vaccinated. mRNA therapy has been developed and used to target certain types of cancer for more than twenty years. It has recently been used to target SARS-CoV-2 virus. The nucleic acid fragment of SARS-CoV-2 virus spike protein is packaged in a lipid nanoparticle. Like how most vaccine works, it tricks your body to formulate a defense memory using a small piece of information from the virus. When the actual attacks occurred, you are protected with a pre-programmed defense mechanism already. It does not change your DNA. It just helps your body to remember what it feels like to successfully combat the virus. Some of the side effects from clinical trials could be another reason to cause hesitancy. Don’t blame the messenger. The individual response elicited by the vaccines is just a small fraction of what you might experience when the real attack occurs. Some extreme allergic responses, a few reported in a million cases are rare. The chance is as similar as winning a Powerball or Mega Millions lottery. At the end of the day, the benefits still outweigh the risks.

  1. Early progress and new variants

Israel’s vaccination program shows encouraging outcome, results from a recently published preprint(Chodick et al. 2021). It’s in agreement with the Phase 3 clinical trial results from Pfizer. Data collected by Israel’s Ministry of Health shows a 41% reduction in confirmed COVID-19 infections in people aged 60 and order. Close to 90% of that age group has been administered with the first dose of Pfizer’s 2-dose vaccine. For people aged 59 and younger, the infected cases and hospitalization are also dropped.

Viruses like SARS-CoV-2 mutate all the time. There are 3 concerned variants: the UK variant (B.1.1.7), Brazil (P.1) and South Africa (B.1.351) have already been found in the United States. With the surge of new variants of SARS-CoV-2, the effectiveness of the COVID-19 vaccine also dropped. Some new data from Johnson& Johnson and Novavax suggest that the COVID-19 vaccines can prevent a lot of mild and moderate cases, and are still very effective against preventing hospitalization and deaths. Other company such as Moderna, has already developed booster shots to combat new variants. If most of the population got vaccinated, it will stop the virus’s replication and ultimately stop mutation completely. The recommended measure is to vaccine as many people as possible at current stage.

In conclusion, no matter which vaccine you got or are going to get, as long as it’s approved and authorized by the FDA, the chance of having effective protection is still very good. At the end of the day, the benefits outweigh the risks.

Reference

Baden, Lindsey R., Hana M. El Sahly, Brandon Essink, Karen Kotloff, Sharon Frey, Rick Novak, David Diemert, et al. 2020. “Efficacy and Safety of the MRNA-1273 SARS-CoV-2 Vaccine.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa2035389.

Chodick, Gabriel, Lilac Tene, Tal Patalon, Sivan Gazit, Amir Ben Tov, Dani Cohen, and Khitam Muhsen. 2021. “The Effectiveness of the First Dose of BNT162b2 Vaccine in Reducing SARS-CoV-2 Infection 13-24 Days after Immunization: Real-World Evidence.” MedRxiv, January, 2021.01.27.21250612. https://doi.org/10.1101/2021.01.27.21250612.

Dong, Yetian, Tong Dai, Yujun Wei, Long Zhang, Min Zheng, and Fangfang Zhou. 2020. “A Systematic Review of SARS-CoV-2 Vaccine Candidates.” Signal Transduction and Targeted Therapy. https://doi.org/10.1038/s41392-020-00352-y.

Knoll, Maria Deloria, and Chizoba Wonodi. 2021. “Oxford–AstraZeneca COVID-19 Vaccine Efficacy.” The Lancet. https://doi.org/10.1016/S0140-6736(20)32623-4.

Logunov, Denis Y, Inna V Dolzhikova, Dmitry V Shcheblyakov, Amir I Tukhvatulin, Olga V Zubkova, Alina S Dzharullaeva, Anna V Kovyrshina, et al. 2021. “Safety and Efficacy of an RAd26 and RAd5 Vector-Based Heterologous Prime-Boost COVID-19 Vaccine: An Interim Analysis of a Randomised Controlled Phase 3 Trial in Russia.” The Lancet, February. https://doi.org/10.1016/S0140-6736(21)00234-8.

Polack, Fernando P., Stephen J. Thomas, Nicholas Kitchin, Judith Absalon, Alejandra Gurtman, Stephen Lockhart, John L. Perez, et al. 2020. “Safety and Efficacy of the BNT162b2 MRNA Covid-19 Vaccine.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa2034577.

Sadoff, Jerald, Mathieu Le Gars, Georgi Shukarev, Dirk Heerwegh, Carla Truyers, Anne M. de Groot, Jeroen Stoop, et al. 2021. “Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa2034201.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Start 2021 in a Good Night Sleep

Picture source: (Kuehn 2019)

Should you make new year’s resolutions? Many may think the new year’s resolutions are meaningless. Especially after a year of frustration and uncertainty, New year’s resolutions seem less encouraging. A few small and attainable goals could help to provide a sense of purpose and improve our well-being. The most popular goals for new year’s resolutions include exercise more, eat healthier, and get rid of bad habits.

[1]Sleep deprivation is one of the common bad habits in modern society. According to a study in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Report, 1 in 3 Americans don’t get enough sleep on a regular basis. To promote optimal health and well-being, the American Academy of Sleep Medicine and the Sleep Research Society recommend at least 7 hours of sleep each night for adults aged 18-60 years old. The adverse effects of sleep deprivation (less than seven hours per day) include obesity(Beccuti and Pannain 2011), diabetes(Shan et al. 2015), high blood pressure(Gangwisch et al. 2006), cardiovascular disease(Nagai, Hoshide, and Kario 2010; Kuehn 2019), stroke, and mental distress(Baglioni et al. 2016). It’s undeniable that having sufficient sleep is essential to our optimal health and well-being. Here are some helpful tips to start your 2021 with a good night’s sleep.

Bedroom: light, noise, and temperature

Research shows artificial light at night can disrupt circadian rhythms and cause adverse effects on sleep(Aulsebrook et al. 2018). A dim bedroom environment can help the body to recognize the time to rest. Electronic devices emit blue lights, many studies show that blocking blue light is beneficial for patients to suffer from insomnia(Janků et al. 2020). Restricting electronic devices before sleep or using blue-light blocking approaches are helpful to maintain a good quality sleep.

Noise can also affect sleep(Basner and McGuire 2018). Try to reduce noise in the bedroom environment could fall asleep faster and minimize disruption during sleep. Both environmental and body temperature impact sleep duration and sleep quality(Troynikov, Watson, and Nawaz 2018). Increased bedroom and body temperature decrease sleep quality. Finding a comfortable temperature for yourself will improve sleep quality. For most people, the desirable bedroom temperature is around 70 ˚F (20 ˚C). Taking a good bath or shower before bed will prepare the body to adjust to a favorable temperature for sleep.

De-stress: mentally and physically

Most of us have experienced some form of insomnia when we have something in our minds. Integrative approaches to insomnia such as mind-body therapies (mindfulness mediation, yoga, tai chi) have been shown beneficial to de-stress the body as well the mind(Zhou, Gardiner, and Bertisch 2017). Exercise is beneficial for the overall well-being, can improve the quality of sleep(Kelley and Kelley 2017). Various approaches can help relax the body and mind, finding your favorite ones requires a little bit of exploration.

Routine: timing and time

We are creatures of habits. Especially when it comes to sleep. Disruption of the circadian clock adversely affects sleep, which causes cardiovascular diseases(Chellappa et al. 2019). Cultivating a wake-up and night-time routine will have profound impacts on the overall performance. When to go to bed is different for everyone. Anecdotally, it’s best to go to bed earlier and wake up early each day. This may not work for everyone’s schedule. Keeping the recommended amount of sleep is more important than strictly enforcing yourself against your circadian clock.

Food and drink

Investigation of the impact of food choice and consumption on sleep is an emerging field. Early clinical studies investigated the effects of certain macronutrients such as carbohydrate, protein or fat on daytime alertness and nighttime sleep. Some popular sleep–promoting foods, such as milk, fatty fish, cherries, and kiwifruit have been reported(St-Onge, Mikic, and Pietrolungo 2016). Avoid late caffeine consumption(Clark and Landolt 2017) and alcohol(Thakkar, Sharma, and Sahota 2015) are common practices to improve sleep quality.

All of the above are potential strategies for sleep improvement. Making small adjustments in your sleep hygiene routine could have a promising outcome. The key is to start small and stick to it until it incorporates into your day-to-day life.

Reference:

Aulsebrook, Anne E., Therésa M. Jones, Raoul A. Mulder, and John A. Lesku. 2018. “Impacts of Artificial Light at Night on Sleep: A Review and Prospectus.” Journal of Experimental Zoology Part A: Ecological and Integrative Physiology. https://doi.org/10.1002/jez.2189.

Baglioni, Chiara, Svetoslava Nanovska, Wolfram Regen, Kai Spiegelhalder, Bernd Feige, Christoph Nissen, Charles F. Reynolds, and Dieter Riemann. 2016. “Sleep and Mental Disorders: A Meta-Analysis of Polysomnographic Research.” Psychological Bulletin. https://doi.org/10.1037/bul0000053.

Basner, Mathias, and Sarah McGuire. 2018. “WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep.” International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph15030519.

Beccuti, Guglielmo, and Silvana Pannain. 2011. “Sleep and Obesity.” Current Opinion in Clinical Nutrition and Metabolic Care. https://doi.org/10.1097/MCO.0b013e3283479109.

Chellappa, Sarah L., Nina Vujovic, Jonathan S. Williams, and Frank A.J.L. Scheer. 2019. “Impact of Circadian Disruption on Cardiovascular Function and Disease.” Trends in Endocrinology and Metabolism. https://doi.org/10.1016/j.tem.2019.07.008.

Clark, Ian, and Hans Peter Landolt. 2017. “Coffee, Caffeine, and Sleep: A Systematic Review of Epidemiological Studies and Randomized Controlled Trials.” Sleep Medicine Reviews. https://doi.org/10.1016/j.smrv.2016.01.006.

Gangwisch, James E., Steven B. Heymsfield, Bernadette Boden-Albala, Ruud M. Buijs, Felix Kreier, Thomas G. Pickering, Andrew G. Rundle, Gary K. Zammit, and Dolores Malaspina. 2006. “Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey.” Hypertension. https://doi.org/10.1161/01.HYP.0000217362.34748.e0.

Janků, Karolina, Michal Šmotek, Eva Fárková, and Jana Kopřivová. 2020. “Block the Light and Sleep Well: Evening Blue Light Filtration as a Part of Cognitive Behavioral Therapy for Insomnia.” Chronobiology International. https://doi.org/10.1080/07420528.2019.1692859.

Kelley, George A., and Kristi Sharpe Kelley. 2017. “Exercise and Sleep: A Systematic Review of Previous Meta-Analyses.” Journal of Evidence-Based Medicine. https://doi.org/10.1111/jebm.12236.

Kuehn, Bridget M. 2019. “Sleep Duration Linked to Cardiovascular Disease.” Circulation 139 (21): 2483–84. https://doi.org/10.1161/CIRCULATIONAHA.119.041278.

Nagai, Michiaki, Satoshi Hoshide, and Kazuomi Kario. 2010. “Sleep Duration as a Risk Factor for Cardiovascular Disease- a Review of the Recent Literature.” Current Cardiology Reviews. https://doi.org/10.2174/157340310790231635.

Shan, Zhilei, Hongfei Ma, Manling Xie, Peipei Yan, Yanjun Guo, Wei Bao, Ying Rong, Chandra L. Jackson, Frank B. Hu, and Liegang Liu. 2015. “Sleep Duration and Risk of Type 2 Diabetes: A Meta-Analysis of Prospective Studies.” Diabetes Care. https://doi.org/10.2337/dc14-2073.

St-Onge, Marie Pierre, Anja Mikic, and Cara E. Pietrolungo. 2016. “Effects of Diet on Sleep Quality.” Advances in Nutrition. https://doi.org/10.3945/an.116.012336.

Thakkar, Mahesh M., Rishi Sharma, and Pradeep Sahota. 2015. “Alcohol Disrupts Sleep Homeostasis.” Alcohol. https://doi.org/10.1016/j.alcohol.2014.07.019.

Troynikov, Olga, Christopher G. Watson, and Nazia Nawaz. 2018. “Sleep Environments and Sleep Physiology: A Review.” Journal of Thermal Biology. https://doi.org/10.1016/j.jtherbio.2018.09.012.

Zhou, Eric S., Paula Gardiner, and Suzanne M. Bertisch. 2017. “Integrative Medicine for Insomnia.” Medical Clinics of North America. https://doi.org/10.1016/j.mcna.2017.04.005.

[1] Picture source: (Kuehn 2019)

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Be In the Room Where It Happens

“It was the best of times, it was the worst of times” ––Charles Dickens

COVID pandemics has changed courses in many people’s lives, as well as approaches in professional development. Amidst many obstacles and disadvantages in 2020, the American Heart Association (AHA) made a remarkable attempt to host a successful virtual scientific conference and brought the scientific community even closer. It exemplifies the AHA mission perfectly: “To be a relentless force for a world of longer, healthier lives”.

Can you image a scientific conference started out with a dance tutorial at the beginning of the day? Can you image a virtual matchmaker helping you arrange a meeting schedule based on your own interest? Can you image getting fresh insights on how to cook and eat healthy food in a scientific conference which traditionally centered mostly on basic and clinical sciences? None of these are classic meeting experiences. The technological development and the focus on mental health as well as physical health in the past few decades made these experiences possible. AHA implemented a well-thought-out plan to capitalize technology and carry out its goal elegantly. The “previews” and “daily recap” videos in the Scientific Session 2020 are both entertaining and informative. Each day, a few short videos encompassed the highlights and the anticipations of the next day featuring four prominent scientists including Drs. Donald Lloyd-Jones and Manesh Patel (Fig. 1). This sophisticated approach helped attendees navigate the meeting effortlessly.

Fig 1: Screen shot of the daily recap from AHA website. (http://sessions.hub.heart.org)

Just like the president of AHA, Mitchell S.V. Elkind, MD, MS, FAHA, FAAN, mentioned at his Conner lecture in Scientific Session 2020, there are many problems we are facing right now such as COVID pandemics, economic depression, structural racism and climate change. These seemingly distinct crisis underlies the fundamental threat to humanity and public health disparities. He sees the “bridges” connecting these issues and which will shed light to “the brighter and more hopeful future beyond”.

The AHA new 2024 impact goal announced by AHA CEO Nancy Brown provides a clear vision of the AHA future endeavor:

“Every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the AHA will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.”

Brown emphasized the everlasting long-term commitment of AHA to the well-being of all people everywhere. She listed many significant contributions AHA made in 2020 to address these issues. These efforts span a wide range of addressing issues including supporting social entrepreneurs working in under-resourced communities, supporting Voices for Healthy Kids project, Lifeline projects in many regions, COVID related supports, research and technology-focused projects to help heart and brain research, women’s health, establishing a center of hemorrhagic stroke research and training opportunities, investing research on e-cigarettes and nicotine consumptions among youth, etc. These extraordinary efforts AHA made in the year of COVID pandemic bring us hope that humanity can still thrive even in the events of great disadvantages.

The “OnDemand” function is the crown jewel of virtual experience in Scientific Session 2020. A well-organized scientific conference usually is very compact. Running around and trying to navigate in a big convention center is not a fun memory, especially if the meeting schedule was back-to-back. Another frustration involves in having to choose between two concurrent sessions and inevitably missed the other. The “OnDemand” function makes the old problems obsolete. To maximize the meeting experience, it provides freedom to visit the session when and where it’s convenient to you and rewind as you please. It ultimately puts you “in the room where it happens”. Thanks to this “intimate” approach, the meeting experience is even more welcoming in Scientific Session 2020. It’s undeniable that face-to-face conversations cannot be completely replaced by virtual experience, this year’s unique opportunity provides a strong potential for a “hybrid” meeting format, which could maximize future experiences in scientific learning and interactions profoundly.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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What Do We Know About the Future? The Digital Health Era

What do we know about the future? Although millions of possibilities come into mind, one thing is certain. One way or another, our lives are more and more dependent on computers and social media networks. How many of you check on your smartwatch or social media feeds more than once a day? I, for instance, am occasionally obsessed with my heart rate measurements and sleep patterns and constantly try to get a better understanding on how to optimize my own health. It’s very easy to get lost in trying to find the right kind of research from scientific journals. Most of the time people turn to social media to get ideas to make a healthcare decision. Study shows that 80% of internet users are looking specifically for health information1.

In today’s American Heart Association Scientific Sessions, a group of pioneers shares their insights in novel technologies for arrhythmia detection2 using big data to manage patient care systems. Dr. Leslie Saxon, of the University of Southern California Center for Body Computing, discussed the advancements of digital health, such as increased diversity of computer monitoring devices, increased data accessibility via the cloud, and novel digital biomarker identification. Particularly, using remote device follow-up improved 30-40% survival rate of patients after cardiac defibrillator implantation, according to a published clinical study (the ALTITUTE survival study)3. Another highlight from Dr. Leslie’s research, CORA, is a patient-facing, manufacturer-agnostic mobile application. CORA can help improve communications between patients and caregivers, visualize complex data in a simple way, and educate patients and caregivers about their health conditions.

Other advances in finding software solutions driven by big data collection are also critical in this digital era. An ongoing clinical study to determine if the Apple Watch and a heart health program can improve heart health outcomes, HEARTLINE, are recently launched in Feb 2020 with a collaboration between Johnson& Johnson and Apple (Clinical Trial NCT04276441).

Dr. Marco V. Perez from Stanford University talked out the recent developments of patient-acquired wearable technology, such as devices to monitor blood oxygen levels, glucose levels, and sleep rhythm. One of the challenges is potential data overload. Dr. Perez’s team implemented a machine learning algorism using a convolutional neural network to investigate 1.5 million ECG graphs from 500,000 patients collected from wearable devices. This artificial intelligence approach opens a new window with many possibilities in the health care systems and address novel research problems. Dr. Khaldoun G. Tarakji from Cleveland Clinic discussed how to use wearable devices to detect atrial fibrillation from a clinical practice perspective. He presented several case studies on using Apple watch to help diagnose and manage atrial fibrillation. In the field of telemedicine, Dr. Tarakji mentioned the advantages of using wearable devices to conduct virtual visits to improve patient care outcomes.

Figure 1: New technologies for the detection of atrial fibrillation 2

Despite apparent advantages of the application of wearable devices in the health care system, Dr. Paul D. Varosy from the University of Colorado discussed the challenges of using wearable devices regarding clinical, legal, cybersecurity, and ethical implications. The main questions are: How to fit data management into busy clinical practice? How to maintain financial sustainability? How to improve cybersecurity vulnerability? How to handle potential oversight? And who owns the data? These questions require continuing efforts from policy workers, researchers, doctors, and patients to work together to find solutions.

The new kid on the block: social media in the health care system. Dr. Janet K. Han from UCLA talked about the possibility of using social media to transform arrhythmia health care. Social media can make health information more accessible, engage patients better, provide valuable social and emotional supports4. Combining social media with big data with artificial intelligence and machine learning provides faster diagnosis and management5.

Wearable devices in combination with big data analyses in healthcare practices have a promising future. They are more accessible, engaging, and high payoff. Despite potential challenges, the era of digital health presents many possibilities and advantages in patients’ healthcare outcomes.

Reference

  1. Fox S. Profiles of Health Information Seekers. Pew Internet & American Life Project. 2011.
  2. Zungsontiporn N, Link MS. Newer technologies for detection of atrial fibrillation. BMJ (Online). 2018.
  3. Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, Meyer TE, Jones PW, Boehmer JP. Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: The ALTITUDE survival study. Circulation. 2010.
  4. Hawkins CM, DeLaO AJ, Hung C. Social Media and the Patient Experience. Journal of the American College of Radiology. 2016.
  5. Simonsen L, Gog JR, Olson D, Viboud C. Infectious disease surveillance in the big data era: Towards faster and locally relevant systems. Journal of Infectious Diseases. 2016.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Can Fish Oil Supplements Help Your Heart? Consumer Discretion is Advised

The health benefits of fish oil, particularly omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) have been studied for decades. The key discoveries regarding the beneficial effects of n-3 LC-PUFAs include anti-inflammation, lowering blood lipid levels, anti-thrombotic effects, and possibly anti-arrhythmia (Mason, Libby, and Bhatt 2020). The market size of fish oil supplements expands rapidly in recent years and is estimated to reach USD 4.5 billion by 2027 (REPORTS AND DATA 2020). In many European nations, omega-3-acid ethyl esters have been prescribed to patients to reduce blood lipid levels for at least a decade and they also obtained US FDA approval in 2004 (Bays et al. 2008). However, not all news is encouraging. The findings of anti-arrhythmia effects of fish oil are mixed, with some trials demonstrating beneficial outcomes (Fig 1) and others finding no significant effects (Mozaffarian and Wu 2011; Reiffel and McDonald 2006).

Fig1. Physiological effects of n-3 PUFA that might influence cardiovascular risk.

The results of REDUCE-IT clinical trial published in 2019 promised a bright future for cardiovascular risk reduction using omega-3 fatty acids (Bhatt et al. 2019). In AHA 2020 late-breaking science session: “Fish Oil, Fancy Drugs, and Frustrations in Lipid Management”, Drs. A Michael Lincoff, Are Annesoenn Kalstad and Alberico Catapano presented compelling evidence on surprising neutral effects with omega-3 carboxylic acids supplement in two clinical trials. These controversial results provide an interesting argument on whether or not to take fish oil supplements for cardiovascular health protection.

Dr. Lincoff presented recent results about the effects of high-dose omega-3 fatty acids from the STRENGTH clinical trial (Nicholls et al. 2020). Despite moderate improvements in the blood lipid levels, patients with omega-3 supplementation have significantly increased risks of atrial fibrillation. The net outcome of omega-3 fatty acid supplementation is not beneficial. One of the possible explanations for this controversial result is using corn oil as a control condition instead of mineral oil–the control treatment in REDUCE-IT trial. Mineral oil treatment caused adverse effects, and corn oil had neutral effects on patients. Dr. Kalstad shared results from another clinical trial which showed similar findings (the OMEMI clinical trial) (Kalstad et al., n.d.). The overall effects of omega-3 fatty acids were neutral with an increased risk of atrial fibrillation. To bring together what we have learned, a summary was presented by Dr. Catapano to further evaluated the STRENGTH and OMEMI clinical trials. He thoughtfully discussed the discrepancies in REDUCE-IT, STRENGTH, and OMEMI trials, and provided several explanations such as the biochemical nature of DHA and EPA, different control conditions, and treatment dosage discrepancies.

Regardless of the discrepancies between STRENGTH and OMEMI trials, one thing is common, the increased risk of atrial fibrillation. So, if you are elderly with high cardiovascular risk, please think twice and monitor your response closely when taking fish oil as a dietary supplement. The frustrating results from STRENGTH and OMEMI trials don’t necessarily negate the beneficial effects in other aspects of the physiological benefits of fish oil (Fig 1) (Mozaffarian and Wu 2011). More research studies are needed in the future to better understand the effects and mechanisms of fish oil supplementation.

Reference

REPORTS AND DATA. 2020. Omega-3 Market To Reach USD 4.50 Billion By 2027 | CAGR: 7.2% | Reports And Data. Aug 10. https://www.prnewswire.com/news-releases/omega-3-market-to-reach-usd-4-50-billion-by-2027–cagr-7-2–reports-and-data-301109147.html.

Bays, Harold E., Ann P. Tighe, Richard Sadovsky, and Michael H. Davidson. 2008. “Prescription Omega-3 Fatty Acids and Their Lipid Effects: Physiologic Mechanisms of Action and Clinical Implications.” Expert Review of Cardiovascular Therapy. https://doi.org/10.1586/14779072.6.3.391.

Bhatt, Deepak L., P. Gabriel Steg, Michael Miller, Eliot A. Brinton, Terry A. Jacobson, Steven B. Ketchum, Ralph T. Doyle, et al. 2019. “Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa1812792.

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