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Diet, Fat, and Healthy Heart

What type of milk do you prefer? Most people will give you their answers quickly without much hesitation. Besides taste and flavor, whether to choose whole milk (~3.5% fat), reduced-fat milk (2% fat) or skim milk (0% fat) depends mostly on how much fat do you prefer in your diet. Reduced fat milk and skim milk have become the poster children for heart beneficial diets in the past decades. The long-held belief that fat is bad for your heart originates from a famous epidemiology study conducted by Ancel Keys and colleagues1.

Ancel Keys’ Seven Countries Studies influenced dietary recommendation on fat for decades. Keys believed that fatty foods such as dairy products and red meat are the culprit for coronary heart disease. He studied diet, lifestyle, and incidence of coronary heart diseases in about 13,000 adult men in Finland, Greece, Italy, Japan, the Netherlands, the United States, and Yugoslavia1, and found that countries with diets high in saturated fat including the United States have the highest blood cholesterol levels and heart-attack death rates. Based on Keys’ studies and other similar findings, the United States and the United Kingdom introduced dietary guidelines which recommend reducing consumption of saturated fat to about 10% of total energy intake, to lower cholesterol in the blood and therefore decrease the risks of a heart attack. A low-fat diet has been associated with good health practices ever since. Here is a twist to this story, Keys didn’t include France, where the nation’s high-fat diet doesn’t correlate with the occurrence of heart diseases. It turns out to be the opposite.

Not all fat is created equal. Let’s take milk fat for example. Milk fat contains a variety of fats such as saturated fat, unsaturated fat, and trans-fat. Generally, trans-fat is considered as “bad” fat in processed foods and fried foods, however, naturally found trans-fat in milk is beneficial. Another example is cholesterol. It’s taken for granted to associate dysregulated blood cholesterol levels with dietary cholesterol intake. In fact, it’s not cholesterol itself that causes high blood cholesterol levels, but rather the lipoproteins that move cholesterol in and out of cells. Broadly, there are the “good” cholesterol– high-density lipoprotein (HDL) and the “bad” cholesterol­­­– low-density and very-low-density lipoproteins (LDL and VLDL). Seventy percent of milk fat is saturated fat, and saturated fats in milk raise both HDL (good) and LDL (bad) cholesterol. The net effect of milk fat might be neutral. Processed foods, fried foods and stick margarine have lots of trans-fats from production and are known for raising LDL cholesterol and lowering HDL cholesterol.

The “good” and “bad” cholesterol levels are considered as the golden standard for cardiovascular risk prediction. However, recent research shows that high HDL levels in some cases associated with higher risks in heart disease2. The plot is thickened. It turns out that some people with a genetic mutation in HDL receptor gene fail to transport cholesterol outside of blood, therefore results in higher level of fats in the body despite having high levels of HDL cholesterols in the circulation. In conclusion, blindly relying on fat content in the Nutrition label is simply not enough.

Now, let’s go back to the milk choice question one more time. Not only we need to consider what type of fat in cow milk, but we also need to look at other factors too. Sugar is often ignored when it comes to buying milk. Reduced fat and skim milk contain slightly more carbohydrates than whole fat milk does. If your goal is to lose weight by reducing fat content in your milk, you might get disappointed. The relationship between milk fat and weight management is still not clear. An epidemiology study shows that women who consumed more than 1 serving of whole fat milk per day were 15% less likely to gain weight compared to those who drink low fat milk3. Also recent research show that consuming saturated fat does not directly cause heart disease4. Therefore, how much you eat doesn’t necessarily translate to how much will end up in your body. It depends on how you body metabolizes it, what’s your genetic makeup and what else in your diet potentially positively or negatively contribute to the net outcomes. Last not the least, even not all fat creates equal, trans-fat from fried foods and processed foods are still universally considered bad for your health. Try to avoid those if it’s possible.

 

REFERENCE

  1. Keys A. Seven Countries. Harvard University Press; 2013.
  2. Zanoni P, Khetarpal SA, Larach DB, Hancock-Cerutti WF, Millar JS, Cuchel M, DerOhannessian S, Kontush A, Surendran P, Saleheen D, Trompet S, Jukema JW, De Craen A, Deloukas P, Sattar N, et al. Rare variant in scavenger receptor BI raises HDL cholesterol and increases risk of coronary heart disease. Science. 2016;351(6278):1166 LP – 1171.
  3. Rosell M, Håkansson NN, Wolk A. Association between dairy food consumption and weight change over 9 y in 19 352 perimenopausal women. The American Journal of Clinical Nutrition. 2006;84(6):1481–1488.
  4. Weinberg SL. The diet–heart hypothesis: a critique. Journal of the American College of Cardiology. 2004;43(5):731–733.
  5. “The facts on fats infographic” [Image] (2017). American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/the-facts-on-fats

“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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Speak to Me: effective scientific communication

What is science communication? What are the differences between a research seminar and a TED-style talk? I recently had a chance to present my research discoveries in a very short (3min) format to fellow colleagues. It didn’t go as well as I planned. I noticed the varieties of styles and topics, so I decided to look into effective ways for science communication. “Science communication is defined as the use of appropriate skills, media, activities, and dialogue to produce one or more of the following personal responses to science: Awareness, Enjoyment, Interest, Opinion-forming, and Understanding”, a contemporary definition of science communication1. Scientists are more aware of the importance of scientific communication in recent decades. The reasons for science communications range from grant requirements, public engagement, to feelings of moral obligation2. Audiences are also very diverse such as interested/non-interested laypeople, engaged stakeholders and policymakers, and scientific colleagues from other disciplines.

Many articles discussed the techniques for effective science communication. They are very accessible through websites. An article published by Steven J. Cooke and colleagues shared a nice collection of useful websites in a table format with emphasis on key resources on science communication for scientists3. With a great wealth of information online, I’m going to share some major points regarding effective science communication.

Know your audiences

For any kind of effective science communication, the first step is to set objectives. Why are you interested in sharing what you know? What do you want your audiences to take home? Then the next question naturally will be who are your audiences? The knowledge depth of your audience decides how you want to present your story. Imagine a nuclear scientist tries to tell a government official that what is radioactive. Think critically about what aspect of your science will reach the target audience. It’s paramount that the information you share is of appropriate complexity. For example, you would describe your research differently to a group of colleagues than to high school students– and even specialized audiences like colleagues are not homogeneous. Some may specialize in a different field.

Avoid acronyms and jargons

One of the biggest obstacles to effective communication is acronyms and jargon. Imagine if you hear a spy uses morse code to communicate. It’s basically the same when a scientist uses his/her “comfortable languages” to talk to “insiders”. Sometimes it forms a special bond and feels very exclusive. Most of the time it saves lots of time and energy to repeat some concepts over and over. Scientific concepts sometimes could be less institutional. Avoid acronyms that could reach a broader audience. Regardless of what forms of communication, acronyms should be critically scrutinized based on necessity and commonality. Multidisciplinary studies embrace effective communication among scientists and acronyms are not going to make it easier. Jargon is a similar but different issue. If you look at the word panel in Fig14. You might find some commonly used words by in the jargon category. When you bury yourself in your specialized field long enough, you might find it harder to distinguish what is jargon and what is not. A group scientists developed a program to help scientists identify jargons4 and there might be other resources online to achieve a similar goal.

Fig1: Screen shot showing words after de-jargoning4.

Focus on the science

It’s not a big surprise for scientists to think and talk about science all the time. Avoiding granular details is one of the top lessons I learned as a graduate student. If you practice this fashion in an extreme way, if could be counterproductive. Good science is the foundation of quality science communication. Don’t lose sight that people are interested in your talk/post because you have a unique science-based perspective. “Avoid patronizing an audience by oversimplifying or glossing over important scientific details, as interested people want to hear about the scientific process and see the data themselves.”3. An effective science communication should include appropriate details which covers significance, background, challenges, as well as results. Be creative, be relatable and be interesting. Most importantly, be true to the data and don’t oversell or overstate the results. Share with the audiences your enthusiasm based on the science, don’t sensationalize and overpromise research outcomes.

Most scientists don’t have formal training in science communication. Universities and government agencies are starting to realize the importance and are working on to incorporating proper training for the next generation scientists. Some universities opened graduate program in science communication major. It’s a fast-growing field that we should all consider improving our science communication skill in the future.

 

References

  1. Burns TW, O’Connor DJ, Stocklmayer SM. Science Communication: A Contemporary Definition. Public Understanding of Science. 2003;12(2):183–202.
  2. Poliakoff E, Webb TL. What Factors Predict Scientists’ Intentions to Participate in Public Engagement of Science Activities? Science Communication. 2007;29(2):242–263.
  3. Cooke S, Gallagher AJ, Sopinka N, Nguyen VM, Skubel R, Hammerschlag N, Boon S, Young N, Danylchuk A. Considerations for effective science communication. In: ; 2017.
  4. Rakedzon T, Segev E, Chapnik N, Yosef R, Baram-Tsabari A. Automatic jargon identifier for scientists engaging with the public and science communication educators. PLOS ONE. 2017;12(8):e0181742.

“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 your leg and arm tell a failing heart?

For the heart’s health condition, everything is interconnected. Other parts of the body might be reflective or instigators of a failing heart. Among all of the important issues related to cardiovascular disease, skeletal muscle is on top of that list. Conventionally, the main function of skeletal muscle is tightly related to physical capabilities. It’s only the partial facts. Skeletal muscle plays a pivotal role in supporting our physical well-being in many ways that are more than organizational. The relationship between skeletal muscle mass and cardiometabolic health starts to attract the researcher’s attention.

As we know, skeletal muscle mass decreases during the aging process, while cardiometabolic health often declines. A recently published epidemiology study investigated the relationship between skeletal muscle mass and cardiovascular disease in a group of adults (3042 people) without pre-existing cardiovascular risk in a 10-year follow-up study, ATTICA1. After adjusting for various confounders, this study showed a significant inverse association between skeletal muscle mass and cardiovascular incidence (HR 0.06, 95% CI 0.005 to 0.78). Moreover, it showed that people in the highest skeletal muscle mass group had 81% lower risk for a cardiovascular event. The results are quite intriguing. Does decreased skeletal muscle mass contribute to poor heart health or does a failing heart cause muscle mass decrease? It’s hard to figure out the cause and effect without understanding the relationship between skeletal muscle and the heart.

Chronic heart diseases and heart failure impair muscle function2. In particular, many heart diseases affect exercise performance. For certain cardiac conditions such as atherosclerotic heart disease, exercise stress test is widely used to measure heart functional capacity, and also used as a diagnostic tool to evaluate the efficacy of treatment and predict prognosis. Cardiac function affects exercise performance in many ways and reduced cardiac output response to exercise leading to skeletal muscle hypoperfusion and lactic acidosis3. The pathophysiological mechanisms impairing skeletal muscle function in heart failure are discussed in a review, shown in Fig12. In heart failure, many stimuli contribute to skeletal muscle contractility apparatus dysfunction such as systemic inflammation, TGF family members, adrenergic signaling, decreased anabolic stimuli and increased calcium shuttling/overload (Fig. 1). Skeletal muscle atrophy can be caused by biological processes such as protein degradation, impaired growth factor signaling and skeletal muscle inflammation.

Heart failure with increased systemic inflammation can trigger skeletal muscle inflammation. it’s also true the other way around: skeletal muscle injury can cause local activation of innate immune system4. Danger-associated molecular patterns (DAMPs) can be released from dying myocytes. DAMPs encompass diverse mediators including alarmins (HMGB1, S100A8/9/12, S100B, IL1a, HSPs), bioactive lipids, extracellular matrix fragments and nucleotides (ATP, CpG, dsRNA)5. The impact of local skeletal muscle immune responses has been proved both harmful and beneficial. Traditionally, a stimulated immune response (M1-like macrophages) is a sign of disease. However, distinct macrophage subsets (M2-like macrophages) help tissue regeneration in chronic skeletal muscle pathologies6. The relationship between skeletal muscle damage and inflammation is complicated. And how they play a role in heart diseases require more research in the future.

To go back to the original question in this blog, the answer is a yes. Yes, skeletal muscle (leg and arm muscle) can tell the basic condition of the heart. And is it good for your heart if there is more muscle mass? Maybe. The absolute muscle mass does not tell us the function of the muscle, other aspects of muscle, for example, different types of fiber may hold the key.

References

  1. Tyrovolas S, Panagiotakos D, Georgousopoulou E, Chrysohoou C, Tousoulis D, Haro JM, Pitsavos C. Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study. Journal of Epidemiology and Community Health. 2020;74(1):26 LP – 31.
  2. Kennel PJ, Mancini DM, Schulze PC. Skeletal Muscle Changes in Chronic Cardiac Disease and Failure. Comprehensive Physiology. 2015;5(4):1947–1969.
  3. Lunde PK, Sjaastad I, Schiøtz Thorud H-M, Sejersted OM. Skeletal muscle disorders in heart failure. Acta Physiologica Scandinavica. 2001;171(3):277–294.
  4. Lavine KJ, Sierra OL. Skeletal muscle inflammation and atrophy in heart failure. Heart failure reviews. 2017;22(2):179–189.
  5. Chan JK, Roth J, Oppenheim JJ, Tracey KJ, Vogl T, Feldmann M, Horwood N, Nanchahal J. Alarmins: awaiting a clinical response. The Journal of Clinical Investigation. 2012;122(8):2711–2719.
  6. Villalta SA, Deng B, Rinaldi C, Wehling-Henricks M, Tidball JG. IFN-γ Promotes Muscle Damage in the <em>mdx</em> Mouse Model of Duchenne Muscular Dystrophy by Suppressing M2 Macrophage Activation and Inhibiting Muscle Cell Proliferation. The Journal of Immunology. 2011;187(10):5419 LP – 5428.

“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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On the Basis of Sex: Are males more vulnerable in severity and mortality from COVID-19?

Fig1: Data source: The sex, Gender and Covid-19 Project. (https://globalhealth5050.org/the-sex-gender-and-covid-19-project/about-us/)

As we just passed our first anniversary of fighting COVID-19, we are in a better position than we used to be a year ago. Nationwide vaccine efforts encourage us to see the light at the end of the tunnel. However, the virus is still lurking around and always finds its way back in many unpredictable forms as it evolves rapidly. We need to stay vigilant and use what we learned from the previous years’ knowledge to guide us defend any future attacks. One pertinent piece of information we discovered is that COVID-19 attacks us unequally. People are over 65 years old and people with any underlying complications are more at risk. Another important discovery is that there is a sex difference in infection, severity, and death among women and men.

In most countries, the incidence of infection (percent of cases) is similar in both sexes. However, men consistently develop more serious symptoms and have more mortalities across age groups on a global level (Fig1). More specifically, men account for about 59% to 75% of total mortality1. It’s indisputable that sex is an important factor when it comes to understand and combat COVID-19. Here are a couple of candidate mechanisms potentially contributing to sex-biased COVID-19 mortality.

Hormones

Many sex differences in the manifestation of disease development have long been attributed to sex hormones, particularly in the realm of immune responses. Both innate and adaptive immune responses are affected by sex-dependent factors2. Males are more susceptible to infections caused by parasites, fungi, bacteria, and viruses, one of the possible determining factors is sex hormone3. More specifically, the immune-suppressive androgens reside in males and immune protective estrogens reside in females. Females might produce more antibodies and launch a stronger immune defense to infection because of estrogens, while males lack the advantage to react the same way. Female hormones, estrogens, can ameliorate the severity of influenza infections by suppressing pro-inflammatory responses in mice4. The anti-inflammatory activity of estrogen is potentially through the regulation of the SOCS3 and STAT3 signaling pathways, specifically to promote the progression of the anti-inflammatory process towards the IL-10-dependent pathway in macrophages5. Sex hormones can regulate the immune response via regulating circadian rhythm, microbial composition, and transcriptional regulation such as estrogen receptors (ERs) and peroxisome proliferator-activated receptors (PPARs)6.

Fig2: Potential mechanisms of male bias of COVID-19 mortality7.

Sex chromosomes

One of the fundamental differences between men and women is the X and Y sex chromosomes. Females have two X chromosomes with a functional one and an inactive one to maintain the balance of chromosomal X gene dosage, while males only have one functional X chromosome and one Y chromosome to maintain the identity of sex-specific effects and testis development. This evolutional advantage in females provides a “back-up” plan in case of a “disease gene” on X chromosome inherited from either the maternal or paternal side. Some genes can escape from X chromosomal inactivation and consequently express higher levels. The gene encoding a receptor that is responsible for SAS-CoV-2 virus cellular entry is called ACE2. ACE2 locates at X chromosome and is potentially a target for ineffective chromosome inactivation, and which could cause a female-biased increased level of ACE2 expression7. A higher level of ACE2 in females promotes viral clearance. On the contrary, a lower level of ACE2 causes dysregulated inflammation, increased cardiovascular comorbidities, increased risk of respiratory failure in males7 (Fig2). Other inflammatory response-related genes on the X chromosome include pattern recognition receptors such as toll-like receptor 7 (TLR7), TLR8, interleukin-1 receptor-associated genes, and NFKB essential modulator genes8. Additionally, it has been shown that TLR3, TLR7, and TLR9 are female-biased while TLR2 and TLR4 are male-biased. These differences potentially reveal why males and females respond to infection differently7,8. The research on understanding sex dimorphisms in immunity is critical to help us fight COVID-19 more effectively.

In conclusion, strong evidence shows that COVID-19 affects men and women unequally. Aside from socio-economic, lifestyle and environmental differences, biology plays an important role in male-biased COVID-19 severity and mortality. To understand and combat infection more precisely, we need to consider sex as a biological variable and develop therapeutic strategies for men and women respectively.

References

  1. Griffith DM, Sharma G, Holliday CS, Enyia OK, Valliere M, Semlow AR, Stewart EC, Blumenthal RS. Men and COVID-19: A Biopsychosocial Approach to Understanding Sex Differences in Mortality and Recommendations for Practice and Policy Interventions. Preventing chronic disease. 2020;17:E63.
  2. Markle JG, Fish EN. SeXX matters in immunity. Trends in Immunology. 2014;35(3):97–104.
  3. Klein SL. The effects of hormones on sex differences in infection: from genes to behavior. Neuroscience & Biobehavioral Reviews. 2000;24(6):627–638.
  4. Robinson DP, Lorenzo ME, Jian W, Klein SL. Elevated 17β-Estradiol Protects Females from Influenza A Virus Pathogenesis by Suppressing Inflammatory Responses. PLOS Pathogens. 2011;7(7):e1002149.
  5. Villa A, Rizzi N, Vegeto E, Ciana P, Maggi A. Estrogen accelerates the resolution of inflammation in macrophagic cells. Scientific Reports. 2015;5(1):15224.
  6. Taneja V. Sex Hormones Determine Immune Response. Frontiers in immunology. 2018;9:1931.
  7. Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovascular Research. 2020;116(14):2197–2206.
  8. Pradhan A, Olsson P-E. Sex differences in severity and mortality from COVID-19: are males more vulnerable? Biology of Sex Differences. 2020;11(1):53.

“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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Heart-Healthy Diet for Women

March is both Women’s History month and National Nutrition month. It’s a good time of the year to pay attention to women’s health in a more constructive way. Heart disease is the #1 cause of death in women, according to a 2017 CDC report1. One in 4 women in the United States dies of heart disease, while only 1 in 30 dies of breast cancer. Within 6 years of having a heart attack, about 46 percent of women become disabled with heart failure. Astonishingly, two-thirds of women failed to make a full recovery after a heart attack2. The risks of heart disease and heart attack increase dramatically after a woman reaches menopause. One in 8 women between 45-64 years old suffers some form of heart disease and the number jumps to one in 4 for women are over 65 years old. Therefore, it’s pertinent to tackle this long-ignored problem, especially for women.

Good progress has been made and continued to be making. The American Heart Association (AHA) launched a movement in 2004, Go Red for Women®, which has reached great success in increasing awareness for heart health in women. Through their relentless efforts in education, innovation, health equity, research development, women are more engaged in preventing and fighting heart disease in the recent decades. Clinical research on cardiovascular disease starts to identify sex difference effects on drug response to help physicians develop a more targeted treatment for women3,4.

To have a healthy heart, besides avoiding some known risk factors such as smoking, drinking and obesity, dietary intervention is one of the most attenable, yet effective ways to live a healthy life. AHA made several educational infographics to promote healthy eating habits. For instance, the figure on the right gives simple suggestions on how to increase diversity of your food choice. It emphasizes the importance of fruits and vegetable consumptions. There are more infographics in the AHA website, if you are interested in learning more, please check it out. Many healthy eating suggestions are developed to combat cardiometabolic diseases. In general, fruits, vegetables, whole grain products, fish, poultry, beans, seeds, and nuts are good for your health, while too many calories, processed food, too much salt/sodium, added sugar, trans-fat and saturated fat are bad for you.

Research shows that Mediterranean diet can reduce risks of cardiovascular diseases5. Table 1 on the right represents a breakdown of Mediterranean diet5. Most of recommended foods are considered general healthy foods. Another study suggests that Mediterranean diet decreases incidences and mortality from coronary heart diseases and stroke in women6.

How to decide which healthy dietary pattern you want follow? Eating index was developed to help evaluate healthy eating habits. Four major indexes including Healthy Eating Index-2015, Alternate Mediterranean Diet Score (AMED), Healthful Plant-Based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI) all show reduced incidences of cardiovascular disease with healthy eating patterns7. If you have trouble deciding which eating habit you want to develop, just follow the general recommendation first. After all, a little bit of deviation won’t change the overall benefits. The key is to stick to it and keep consistent.

 

References

  1. Heron M. Deaths: Leading Causes for 2017. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2019.
  2. Sandmaier Marian A4  – National Heart, Lung, and Blood Institute MA-S. The healthy heart handbook for women. 2005:1 online resource (106 pages) : illustrations (some color)-Other US.
  3. Jin X, Chandramouli C, Allocco B, Gong E, Lam CSP, Yan LL. Women’s participation in cardiovascular clinical trials from 2010 to 2017. Circulation. 2020.
  4. Scott PE, Unger EF, Jenkins MR, Southworth MR, McDowell TY, Geller RJ, Elahi M, Temple RJ, Woodcock J. Participation of Women in Clinical Trials Supporting FDA Approval of Cardiovascular Drugs. Journal of the American College of Cardiology. 2018.
  5. Anon. Primary prevention of cardiovascular disease with a mediterranean diet. Zeitschrift fur Gefassmedizin. 2013.
  6. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009.
  7. Shan Z, Li Y, Baden MY, Bhupathiraju SN, Wang DD, Sun Q, Rexrode KM, Rimm EB, Qi L, Willett WC, Manson JAE, Qi Q, Hu FB. Association between healthy eating patterns and risk of cardiovascular disease. JAMA Internal Medicine. 2020.

 

“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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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.

Kalstad, Are Annesønn, Peder Langeland Myhre, Kristian Laake, Sjur Hansen Tveit, Erik Berg Schmidt, Pal Smith, Dennis Winston Trygve Nilsen, et al. n.d. “Effects of N-3 Fatty Acid Supplements in Elderly Patients after Myocardial Infarction: A Randomized Controlled Trial.” Circulation 0 (0). https://doi.org/10.1161/CIRCULATIONAHA.120.052209.

Mason, R. Preston, Peter Libby, and Deepak L. Bhatt. 2020. “Emerging Mechanisms of Cardiovascular Protection for the Omega-3 Fatty Acid Eicosapentaenoic Acid.” Arteriosclerosis, Thrombosis, and Vascular Biology. https://doi.org/10.1161/ATVBAHA.119.313286.

Mozaffarian, Dariush, and Jason H.Y. Wu. 2011. “Omega-3 Fatty Acids and Cardiovascular Disease: Effects on Risk Factors, Molecular Pathways, and Clinical Events.” Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2011.06.063.

Nicholls, Stephen J, A Michael Lincoff, Michelle Garcia, Dianna Bash, Christie M Ballantyne, Philip J Barter, Michael H Davidson, et al. 2020. “Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial.” JAMA, November. https://doi.org/10.1001/jama.2020.22258.

Reiffel, James A., and Arline McDonald. 2006. “Antiarrhythmic Effects of Omega-3 Fatty Acids.” American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2005.12.027.

 

“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.”