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Polycystic Ovary Syndrome was found to be associated with increased cardiovascular complications at the time of delivery

A new study published in the Journal of the American Heart Association shows that women of reproductive age with Polycystic Ovary Syndrome (PCOS) are at increased risk of cardiovascular events (peripartum cardiomyopathy, heart failure, cardiac arrhythmias, venous thromboembolism, and acute kidney injury) at the time of delivery admissions.1 PCOS is a common endocrine disorder affecting 5-13% of women in the United States. Previously PCOS was known to be associated with long-term cardiovascular complications. However, the current study has shown that women with PCOS can even develop acute CV complications during labor and delivery admissions.

The current study analyzes a national inpatient sample evaluating the data spanning 17 years from 2002 to 2019 and shows an exponential increase in cardiometabolic risk factors such as PCOS and obesity among reproductive age group women in the U.S. The results were notable for women with PCOS to be comparatively older, with higher comorbidities such as diabetes, obesity, and hyperlipidemia. For instance, PCOS prevalence increased from 569 to 15,348 per 100,000 deliveries. Similarly, obesity showed an exponential increase from 5.7% to 28.2%. This suggests poor cardiometabolic health among pregnant women in the U.S has significant public health implications. It is also noteworthy that patients with PCOS were found to have higher rates of pre-eclampsia, peripartum cardiomyopathy, and heart failure. The authors also reported the PCOS group to have longer hospital length of stay and higher cost of hospitalization.

The researchers also examined socioeconomic disparities and found that minority ethnic groups such as African American women and lower-income class groups are at the highest risk of developing cardiac complications. Hence an intervention aimed at this vulnerable population group may be most helpful in preventing future complications. “We want to stress the importance of optimizing the cardiovascular health of women with PCOS with prevention efforts, especially Black women and lower socioeconomic groups because we believe that those are the most vulnerable populations and will benefit most from intervention,” says Salman Zahid, M.D., a resident physician in the Rochester General Hospital Internal Medicine Residency program in Rochester, New York, and lead author of the study.

The author’s work in this area is commendable as the results of this study help in identifying necessary complications of PCOS and also shine a light on socioeconomic disparities. The results of this study can help in making important policy changes and also provide the framework to be more vigilant of the potential complications in PCOS patients.

In summary, the current work uncovers a worsening cardiometabolic health profile of reproductive age women in the U.S. Urgent public health interventions are needed to better screen and prevent cardiac disease with particular attention to at-risk groups. This work has tremendous implications for reducing the rising maternal mortality rate in the U.S.

Prominent researcher, cardiologist, and mentor of this important study, Dr. Michos comments “Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality of women of reproductive age.  PCOS is associated with a number of cardiometabolic abnormalities such as hyperandrogenism, insulin resistance, dyslipidemia, elevated blood pressure, and elevated body mass index.  Recent studies have shown that PCOS is associated with future risk of cardiovascular (CV) disease, although whether this is directly causal or mediated through those underlying cardiometabolic and endocrine abnormalities has been debated. Either way, it is important for women with PCOS to be screened for CVD risk factors, treated if risk factors are present, and implement healthy lifestyle changes.  Although prior work has focused on longer-term CV complications from PCOS, our current analysis examined acute peripartum CV complications at the time of pregnancy delivery. PCOS is associated with infertility, but our analysis using a large nationally representative U.S. sample showed even after these women become pregnant, they are still at heightened risk of adverse CV complications, including peripartum cardiomyopathy, acute heart failure, and venous thromboembolism. This association of PCOS with these acute cardiovascular complications was independent of preeclampsia/eclampsia risk.  Our study stresses on the importance of optimizing the cardiovascular health of women with PCOS before, during, and after pregnancy to prevent adverse cardiovascular complications.  We also showed that both PCOS and obesity prevalence was rising over this 17-year period (2002-2019), reflecting other national trends of the declining cardiovascular health of young adults, including reproductive age women.  So much work needs to be done to revamp prevention efforts in the U.S. including at the individual, healthcare, societal, and policy levels to reverse these very worrisome trends.”

References:

  1. Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002–2019) Salman Zahid MD , Muhammad Zia Khan MD, MS , Smitha Gowda MD , Nadeen N. Faza MD , Michael C. Honigberg MD, MPP , Arthur (Jason) Vaught MD , Carolyn Guan BA , Anum S. Minhas MD, MHS , and Erin D. Michos MD, MHS edonnell@jhmi.edu

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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Who Am I? Ruminations of a Cardiology Fellow

I walked out of the hospital after my last inpatient shift of my first year of Cardiology fellowship and let out a sigh. It felt like I was releasing a breath I’d been holding in for years. Four years ago, as I started intern year, I told myself that I would dedicate the first years of my career to becoming first the best internist, and then the best cardiologist that I could be. This decision was borne out of a desire to fully invest in my training, but also to some extent out of imposter syndrome. I worried (as many new interns do) about not being smart enough or good enough, so my natural reaction was to work hard to become a better physician.

The ensuing four years, during which I immersed myself in clinical medicine, have been transformative. My experiences as a budding internist and cardiologist reaffirmed time and time again that I chose the right path for me. Though I cannot say that my initial insecurities totally went away, somewhere along the way, I learned to accept and set aside feelings of inadequacy so that I could do my job and take care of my patients. My patients have been my guiding light and have taught me everything I know. Moreover, as a first year Cardiology fellow, I spent countless hours learning the amazing intricacies of cardiovascular pathophysiology. While I have much left to learn in the remainder of my fellowship, I feel much more adept at managing typical cardiovascular problems.

However, these incredible experiences have also come at a personal cost. I have missed weddings, birthdays, funerals of loved ones. I have relinquished hobbies that I used to cherish so that I could prioritize self care, sleep or precious moments with friends and family. Some days I can’t help but wonder if I lost a little bit of myself in devoting myself so wholly in caring for others. Have I sanded away the aspects of my personality that made me unique in service of my training? Who am I, beyond my job as a physician?

Now, don’t get me wrong – I love my job. There’s nothing I’d rather be than a cardiologist. I love being in the echo lab or the cath lab. The cardiac intensive care unit is my happy place. Being in the hospital feels like being at home. But my job also can’t be all that I am.

In my favorite AHA Early Career Voice blog post, Dr. Nasrien Ibrahim wrote about how important it is to “bring your whole self to work.” I loved the piece so much that it inspired me to apply to be a blogger for the AHA Early Career Blogger program myself. I loved the concept that we should bring all parts of ourselves with us in our daily life. “The authentic you,” as Dr. Ibrahim called it. Now, reading that piece back two years later, I ask myself – what parts of myself do I bring with me? What parts have I left behind? What other parts of myself do I need to cultivate and nurture again?

When I move on to my second year of Cardiology fellowship, I hope to have more time to answer these questions and rediscover who I am outside of my day job. It is a given that I will continue to improve my skills as a cardiologist. But I also hope to continue current hobbies, reignite old passions, and maybe even discover some new ones. I hope to write more. I hope to travel more. I hope to spend more time with my loved ones. Only then can I bring “my whole self” with me every day.

To every rising Cardiology fellow reading this, I say: The ride will be wild, but enjoy it as much as you can. Never forget why you decided to become a cardiologist in the first place, especially when you feel overwhelmed by all the demands being placed on your time or the seemingly endless consults you are seeing. Give yourself a chance to do the things that make you happy when you are not at work, but also give yourself some grace and recognize that it can also be ok to do nothing if that is what you need to recharge your battery. When in doubt, look to your patient and ask yourself what you would want from your cardiologist if you were in their shoes. And when you have the time, space and mental bandwidth, ask yourself: who am I and how do I ensure that I preserve myself in this journey?

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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Primordial Prevention of Cardiovascular Disease through Heart-Healthy Diet

The prevalence of cardiovascular disease has been rising in the past decades. Advances in cardiovascular therapies have significantly improved cardiovascular disease survival, which can augment the increasing trends of cardiovascular disease. Thus, the question is raised of how we can prevent this ongoing public health issue. Multiple strategies have been developed to prevent cardiovascular disease, including primordial, primary, secondary, and tertiary prevention. Primordial and primary preventions are established to reduce the prevalence of cardiovascular disease, secondary and tertiary preventions are intended to improve survival and quality of life of patients with cardiovascular disease. Primordial prevention refers to avoiding the development of cardiovascular risk factors― hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, physical inactivity, and poor diet quality― in the first place, while primary prevention is about treating risk factors to prevent cardiovascular disease. Studies have shown that atherosclerosis begins to develop in adolescents. Thus, we must implement prevention strategies early in life. American Heart Association (AHA) introduced the concept of ideal cardiovascular health in 2010 to slow down the rising trends in cardiovascular disease. Ideal cardiovascular health comprises seven components: three factors (total cholesterol, blood pressure, and glucose) and four behaviors (smoking, body mass index, physical activity, and diet). Population-based studies have shown that a meager percentage of the population fulfills all seven components of ideal cardiovascular health. Hence, primordial prevention in early life for the next generation is critical. The brain undergoes maximal developmental plasticity in the first 1,000 days of life. Primordial prevention during this period may place individuals on the healthiest trajectory of lifelong cardiovascular health.

Diet is one of the modifiable components of ideal cardiovascular health. Poor diet quality is strongly associated with elevated risk of cardiovascular disease, and adherence to a healthy diet is crucial in primordial prevention. Last year, the 2021 American Heart Association dietary guideline to improve cardiovascular health was released. The statement highlights the importance of adopting heart-healthy diet habits early in life. Based on the American Heart Association recommendations, a heart-healthy diet contains healthy sources of proteins, mostly plants (legumes and nuts), fish and seafood, low-fat/fat-free dairy, and IF meat or poultry is desired, lean cuts and unprocessed forms were recommended. Moreover, a heart-healthy diet comprises foods made with whole grains rather than refined grains and includes plenty of fruits and vegetables. The statement recommends consuming liquid plant oils such as canola or soybean oil.

Besides selecting healthy food, individuals need to adjust their energy intake to maintain healthy body weight. Body mass index (BMI) is an indicator of general boy fatness. BMI is calculated as body weight (kilogram) divided by height2 (meters). Individuals with BMI ≥ 30 kg/m2 are considered obese, and those with a BMI of 25-30 are overweight. BMI is not a perfect indicator of obesity as it fails to capture fully cardiometabolic risk and is an insufficient marker of abdominal obesity. Other indicators of obesity such as waist circumference or waist to hip ratio may identify patients with abdominal obesity more accurately. Individuals with waist circumference less than 40 inches in men or less than 35 inches in women, and waist to hip ratio less than 0.90 in men and 0.80 in women are considered healthy. Everyone should check their weight routinely and make themselves aware of these numbers to maintain their body weight within these ranges.

The 2021 dietary guideline specifies certain foods we need to minimize consumption. Ultra-processed food is the first one. Ultra-processed is any processed food that, beyond the addition of salt, sweeteners, or fat, includes artificial flavor and preservatives that are added to extend expiration date. Unfortunately, the production and consumption of ultra-processed food are expected to rise through 2024, and society needs to be aware of the adverse risks ―including obesity, diabetes, cardiovascular disease, and all-cause mortality―associated with consuming ultra-processed food. The statement also recommends against food high in salt, tropical oils, and processed meat. Lastly, if someone does not drink alcoholic beverages, it is NOT recommended to start drinking, and those who drink should restrict their alcohol intake to 1 drink per day for women and two drinks per day for men.

 

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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E-cigarette use is a health concern, but long-term consequences remain unknown

Recently, I happened to take a route home that led me through my local high school as the students were dismissed for the day. There was some traffic because of dismissal as students traveled home in their vehicles or were picked up by parents/guardians. As I inched along the path to the main road, the car ahead of me was being driven by a student, and I noticed he was vaping. With two small kids, I don’t get the privilege of observing teenagers too often, so it made me pause a bit to witness this. When I think back to my high school days, cigarette smoking was one of the salient issues with youth and substance use, and there were huge campaigns to limit tobacco use among adolescents. I was all too familiar with the D.A.R.E (drug abuse resistance education) program at every step of my education as an adolescent! But today, cigarette smoking is less common among adolescents than nearly 20 years ago.

As a cardiovascular epidemiologist, I’m aware of the available evidence and conflicting messages we receive about the costs and benefits of e-cigarette use among adults. But what is the message for youth? Is vaping as addictive as cigarettes, and does it offer similar health threats? And if so, are there programs in place to limit vaping? One thing is for sure, compared with our knowledge and evidence on decades of cigarette smoking, e-cigarette use and vaping research are still in their infancy, but a more explicit message is making its way through all the vapors.

The increasing use of electronic cigarettes (e-cigarettes or electronic nicotine delivery systems (ENDS)) and vaping products among youth continues to be recognized as a significant public health challenge. Severe cardiopulmonary disease and related deaths have been associated with the use of electronic cigarettes. To emphasize the importance of stronger public health policies and guide therapeutic strategies on the short- and long-term risks of vaping, the recent AHA scientific statement provides background on the cardiopulmonary consequences of e-cigarette use (vaping) in adolescents. Vaping may pose longer-term health threats like nicotine addiction and cardiopulmonary damage.

 

Figure 1. What is in E-cigarette Aerosol? CDC: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

Vaping involves heating a liquid — typically containing nicotine or cannabis, flavorings, and other substances and additives — to produce an aerosol inhaled through a battery-powered device. E-cigarettes have grown into a multi-billion-dollar industry since entering the U.S. market in 2007 as a potential smoking cessation tool. Still, they also appealed to youth – with fruity flavor additives and nicotine salts, making it less harsh on the throat and easier to use by adolescents. Over the years, e-cigarette use among US teenagers showed a 19% increase between 2011 and 2018. Vaping is still prevalent among adolescents, but we have seen a decline in 2019, some of which may be due to reduced access or disease-related concerns during the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) reports that in 2020, at least 3.6 million US youth, including about 1 in 5 high school students and about 1 in 20 middle school students, used e-cigarettes in the past 30 days. Notably, public health has made significant strides over the past decade in lowering the prevalence of cigarette smoking among adolescents to its lowest rates in history – fewer than 6% of high school students have smoked a cigarette in the past 30 days, and fewer than 3% report being daily users. Although the benefits won’t be realized for about 30 years, this accomplishment is enormous and portends reductions in smoking-related disabilities and death for generations to come.

On the other hand, the big question is whether e-cigarettes and vaping will have a deleterious effect on youth. In November 2019, we saw the impact of acute vaping-associated lung injuries and confirmed vaping-related deaths linked to vitamin E acetate – a chemical additive in the production of e-cigarette products. These events warned that additives could be involved in adverse health effects of vaping. Besides nicotine, vaping liquids contain vegetable glycerin and propylene glycol, which are on the FDA’s generally recognized as safe (GRAS) list. However, these components were not evaluated for inhalation toxicology. Like vitamin E acetate, these GRAS components may be associated with adverse health outcomes once inhaled. Thus, the long-term effects of vaping on the lungs in youth and young adults are worrisome and need to be better understood.

Studies have found higher rates of wheezing, greater prevalence of asthma, and increased incidence of respiratory disease in youth who were e-cigarette users. Among young adults, e-cigarette use is associated with higher arterial stiffness, impaired endothelial function, increased blood pressure, heart rate, and sympathetic tone, increased levels of oxidative stress biomarkers, and pro-inflammatory white blood cells that increase the risk of cardiovascular disease. Subclinical cardiopulmonary disease can likely start early in adolescence among youth who vape. Overall, lung development continues into the early 20s. Therefore, adolescents who vape are potentially stunting or altering their lung development, limiting their full lung function potential, and increasing their risk of pulmonary disorders.

Statistically, the population health risk of vaping-related disease among adolescents depends on the prevalence and frequency of vaping. Many adolescents experiment with vaping or may vape only occasionally or socially, conferring in possible low health risk. But as informed by evidence from cigarette use, vaping for 20+ days per month may suggest a degree of dependence and greater health risks. Youth may also multiply their risk by smoking other substances like marijuana. Collectively, continued research into the cardiopulmonary health consequences of vaping in youth needs to weigh the contribution of marijuana smoking or vaping with e-cigarette use.

Primary care and public health strategies should protect young people and limit unnecessary exposure.

The AHA scientific statement concludes with several major recommendations for reducing and preventing youth vaping:

 

  • Developing better measures to reduce youth access, including strict age verification at places of sale
  • Prohibiting the marketing of e-cigarettes to youth
  • Education of healthcare stakeholders, students, and their parents regarding realistic concerns about e-cigarette use

The recommendations do come with some controversy. Dr. Neal L. Benowitz mentions in his commentary of the scientific statement that “to limit access [among youth] could be even stronger if e-cigarette sales were limited to adult-only tobacco specialty stores.” He also offers that AHA’s recommendation to ban e-cigarette flavors, including menthol, is concerning because it would “reduce use by smokers wishing to switch, particularly since tobacco flavorings are constant reminders to former smokers of cigarette smoking.”

In conclusion, there is still plenty that we do not know yet about the effects of e-cigarettes and vaping on cardiopulmonary health. Evidence is building and suggests that efforts need to be taken to reduce possible long-term risks, especially for youth and those who were previous non-smokers. The evidence is not nearly as rich as the generations of work done to understand the harms of cigarette smoking. Still, clues taken from that long history help set the framework of the approaches and guidelines needed to protect public health. Although risk reduction is highly recommended, the evidence is still in its infancy. It is crucial to recognize that the science and guidelines regarding e-cigarettes and youth is a challenging process. The key to this process will be balancing the concerns about health risks to youth with the potential benefits of smoking cessation in adults.

References:

Wold LE, Tarran R, Crotty Alexander LE, Hamburg NM, Kheradmand F, St. Helen G, PhD; Wu JC; on behalf of the American Heart Association Council on Basic Cardiovascular Sciences; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; and Stroke Council. Cardiopulmonary consequences of vaping in adolescents: a scientific statement from the American Heart Association [published online ahead of print June 21, 2022]. Circ Res. doi: 10.1161/RES.0000000000000544

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/OSH-E-Cigarettes-and-Youth-What-HCPs-Need-to-Know-508.pdf

https://professional.heart.org/en/science-news/cardiopulmonary-consequences-of-vaping-in-adolescents/Commentary

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/images/e-cigarette-aerosol-can-contain-harmful-ingredients-desktop-700.jpg?_=45193

Fadus, M. C., Smith, T. T. & Squeglia, L. M. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend. 201, 85–93 (2019).

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/OSH-E-Cigarettes-and-Youth-What-HCPs-Need-to-Know-508.pdf

https://www.uclahealth.org/vitalsigns/immediate-health-concerns-about-vaping-are-real-but-long-term-effects-are-not-yet-fully-understood

https://www.ajmc.com/view/review-highlights-need-for-stricter-health-policies-amid-rising-e-cigarette-use

Lyzwinski, L.N., Naslund, J.A., Miller, C.J. et al. Global youth vaping and respiratory health: epidemiology, interventions, and policies. npj Prim. Care Respir. Med. 32, 14 (2022). https://doi.org/10.1038/s41533-022-00277-9

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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PET or MRI, that is the question – Part 2

In our previous blogs, we discussed ASL MRI to image abnormal blood vessels in Moyamoya patients. We looked at a study that compared MRI and PET images of normal and healthy people. In this blog, we will look at the application of ASL MRI on adult Moyamoya patients.

According to the latest study by Dr. Moss Zhao (AHA Postdoctoral Fellow, 2021), ASL MRI can detect impaired blood flow and circulation in Moyamoya patients without any radiation or contrast agents.

In this study, Dr. Zhao’s team enrolled nearly 30 adult Moyamoya patients without acute stroke or tissue infarcts in the brain. They scanned the brain of these patients using the advanced ASL MRI technique (multi-delay ASL) that were tested successfully on normal and healthy people before. Similar to the study designed in the previous blog, Dr. Zhao’s team collected both ASL and PET images from the Moyamoya patients at the same time before these patients underwent their bypass surgery. The results from this study were convincing that ASL can replace PET to characterize the pathophysiology of Moyamoya disease patients. The image in this blog shows the vessel occlusion and its impact on blood flow in a Moyamoya patient.

Another advantage of ASL is the elimination of contrast agents. In many MRI exams, patients need to receive a contrast agent (such as gadolinium) to enhance the image quality. However, the contrast agent can cause side effects and deposit in the brain. Although there is no evidence suggesting its impact on health, we should minimize the use of these contrast agents. In the same study, Dr. Zhao’s team also demonstrated that the advanced ASL can create images without contrast agents and that doctors favored the new ASL technique over the conventional contrast-based imaging method.

Taken together, ASL MRI will become more accessible to radiologists to diagnose Moyamoya disease without causing side effects to patients. The technique will allow safe, affordable, and fast for imaging to identify patients with a higher risk for stroke.

Image source: JCBFM

 

REFERENCE

https://doi.org/10.1177/0271678X221083471

 

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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The Power of Mentorship

As many of us are finalizing our application for fellowship this summer, it’s also a wonderful time to reflect on the journeys that brought us here. It’s no small feat to complete undergraduate training, medical school, and internal medicine residency and have all of that hard work culminate in this application for cardiovascular fellowship training. I’m excited and often blown away by the creativity and successes of my fellow applicants.

One aspect of this journey I’ve reflected on most deeply has been mentorship. I cannot state how important it is to find the right mentors in a process like this one. There is no one-size-fits-all, as we are all unique personalities with individual interests and aspirations. For those hoping to apply in the future, what I found to be most important is finding people you want to model yourself after.

A difficult part of this process can be the first step! How do you approach those you might be interested in working with? I met my research mentor prior to starting my residency, via Twitter. I was looking up people involved in women’s cardiovascular disease at my new institution, and a few names quickly rose on the list. My mentor had posted on Twitter recently about the importance of women in cardiology and creating an inclusive and equitable environment moving forward. Her studies span women’s cardiovascular disease but also advocate for women in research and the academic sphere. I knew this was someone I wanted to work with. I messaged her on Twitter and was met with the warmest welcome. I share this story to encourage young trainees to be proactive in searching for mentors. Take that first step, send that email, and explain why you want to work with them. My research mentor is a fierce advocate for young women trainees. At a recent CV conference in Chicago, I experienced first-hand how she uplifted medical students, residents, postdocs and made us all feel like we belonged in this space. I’m certainly grateful for trailblazers like her who are changing the face of cardiology.

You will also find wonderful mentors via clinical rotations! As an intern in the CCU, I was blown away by our CCU director. He is the kind of teacher you want to show up for. It’s not out of fear but out of respect that you want to be overly prepared for rounds in the morning, so you don’t disappoint. Together, we talked to patients about their pacemaker settings and their heart transplant status, and I found my joy for interpreting swan numbers every morning. Once again, I found someone I wanted to be like one day. He brought so much energy and enthusiasm that the whole team was excited to learn. He created a learning environment that encouraged us to ask questions and never be afraid. Most of all, he reminded us that everything is in the service of our patients. You want to seek out those invested in your growth as a trainee and those who excite you about a future in cardiovascular medicine.

Each mentor can bring something very different in shaping you and influencing the physician you will become one day. I encourage all young trainees and medical students to find people in their field who keep them excited, humble, and always striving for growth. Don’t be afraid to ask these teachers about their journeys and advice regarding your own career trajectories. In my experience, they are usually more than happy to help. From a practical standpoint, talk to residents and fellows in your program about who may be a good fit based on your interests and goals. Medical training is a long journey with many phases, and I have found most of us are very happy to pay it forward.

There have been countless mentors who have brought me to this point and I could write a novel about each of them and what they mean to me. For now I will say, if you are early in your career don’t underestimate the importance and impact of finding the right mentors. Doing so intentionally and thoughtfully both as a mentor and mentee can create environments that encourage people to reach their full potential. If you’re a young trainee reading this, be mindful about finding your village. They will shape who you become one day, don’t be afraid to reach out and introduce yourselves. You can find mentors in non-traditional settings as well in the era of digital education and MedTwitter. Create a network, talk to people at large conferences, and reach out to those you have worked with clinically. If you’re in the position to uplift others, investing in those who will come after you means everything to us. We are so grateful for all you do.

 

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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The controversy over alcohol consumption: Is it good or bad for your heart?

If you go to a party or a professional event, you won’t be surprised to find that alcoholic beverages are served. In fact, in most cases, it’s even expected. Alcohol consumption has been present throughout human history. So do its effects. Excessive drinking has been linked to many health risks, including high blood pressure, heart diseases, stroke, liver diseases, and digestive problems. However, the health effects of light-to-moderate drinking are still in dispute (1). Early evidence showed that light-to-moderate drinking is associated with beneficial effects such as reductions in coronary artery diseases and even in total mortality. This view has been challenged by a few recently published epidemiological studies, which show no direct relationship between the beneficial effects on the heart and light-to-moderate drinking (2).

What is light/moderate drinking?

According to National Institute on Alcohol Abuse & Alcoholism, moderate drinking is up to four alcoholic drinks for men and three for women in any single day and a maximum of 14 drinks for men and 7 drinks for women per week. Below that range would be considered light drinking.

Why is there a discrepancy in health risks reports on alcohol consumption?

The obvious:

Confounding factors such as social-economic status, age, genetics, ethnicities, behavior and types of alcoholic beverages play big roles in influencing health effects. It’s not hard to imagine that a wealthy family has more medical resources and more options of choosing a healthy lifestyle, which has lower risks of cardiovascular diseases compared to a low social-economic status family that even consumes the same amount of alcohol. The alcohol metabolism rate differs in different age groups and different populations. The certain population lacks an enzyme, alcohol dehydrogenase, which metabolizes alcohol, that has adverse health effects when drinking alcohol. These confounding factors are important when conducting an epidemiology study. Not all alcoholic drinks are created equal. Bioactive phytochemicals, for example, polyphenols have beneficial effects which can be found in wines. Cocktails usually contain a large amount of sugar, and high sugar consumption are linked to many cardiovascular disorders. It’s hard to tease out the causal effects of light-to-moderate alcohol consumption and the health effects. Moreover, most of the reported works of literature are observational, which leads to more complications when trying to interpret the data.

The less obvious:

Epidemiological study design has evolved rapidly in recent decades. Early studies were focused on interpreting results from limited resources. The lack of enough participants and missing specific details make it impossible to make a causal connection between alcohol consumption and health risks. In 2007, researchers started to encourage epidemiological studies to use large, prospective, and randomized trials when trying to understand the health effects of drinking (3). A recent review just published in Circulation: Heart failure questioned the relationship between alcohol intake and cardiomyopathy and heart failure (4). After analyzing current evidence, they suggest that there is no consensus on the absolute amount alcohol intake which causes cardiomyopathy and heart failure. Another group showed that low alcohol intake has no health benefits, and moderate alcohol intake is associated with adverse effects in heart (5).

To drink or not to drink. There is no one-size-fits-all solution. The jury is still out when it comes to the health effects of light-to-moderate drinking. Monitor your health and consult with your doctor regularly. If it’s not good for you, your body will tell.

REFERENCE

  1. Piano, M. R. (2017). Alcohol’s Effects on the Cardiovascular System.Alcohol Research : Current Reviews38(2), 219–241.
  2. Biddinger, K. J., Emdin, C. A., Haas, M. E., Wang, M., Hindy, G., Ellinor, P. T., Kathiresan, S., Khera, A. v, & Aragam, K. G. (2022). Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease.JAMA Network Open5(3), e223849–e223849.
  3. Kloner, R. A., & Rezkalla, S. H. (2007). To Drink or Not to Drink? That Is the Question.Circulation116(11), 1306–1317.
  4. Andersson, C., Schou, M., Gustafsson, F., & Torp-Pedersen, C. (2022). Alcohol Intake in Patients With Cardiomyopathy and Heart Failure: Consensus and Controversy.Circulation: Heart Failure0(0), 10.1161/CIRCHEARTFAILURE.121.009459.
  5. The abstract ‘Moderate alcohol consumption is associated with progression of left ventricular dysfunction in a European stage B heart failure population’ will be presented during the session ‘Heart failure is a complex syndrome: look at comorbidities’ which takes place on 22 May at 09:40 CEST at Moderated ePoster 1.

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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My First Year As An Attending – What I have learned

After many years of training, it finally happened, I was going to be an attending. The goal we all strive for – to take the training wheels off, practice what we learned, and provide the best care possible for our patients. I spent months leading up to my first week on service incredibly nervous and found myself reviewing guidelines, trials, and any other resource to help me succeed – safe to say, I was psyching myself into a frenzy.

Like many of us, the fear of failure is an incredibly motivating factor but perhaps not the healthiest mindset. I’d like to share my journey as a first-year attending and what I learned in hopes of helping others who are finally taking off the training wheels.

Day 1 as attending, celebrating great news our patient was undergoing heart transplant.

1. Your department wants you to be successful. It may feel like you are alone as an attending, but your department invested a lot of time and resources for you to join. They want you to succeed and encourage open lines of communication. The senior members in both my departments (cardiology and critical care) expected me to call them when I was struggling with a challenging case, needed clarity on how to navigate the new system I was working in, and to touch base on how I was doing. I have called my colleagues on the weekends and at odd hours to ensure I was providing the best care for my patients – and the best part, they did not once make me feel inferior or as if I was doing a bad job.

2. Push your socializing boundaries. When I started working for UPMC, I only knew the handful of people who interviewed me. Many of my colleagues knew who I was through the continued updates from our division leadership regarding new hires but to me, everyone was a stranger. The best way I can describe it is as a year of continued blind-dating. I would meet faculty members, make small talk, and then move on.

I, therefore, made it a mission to get to know as many people as possible. I would introduce myself to all of the nursing staff in the mornings when I would see patients. This gave me a chance to get to know my CICU/CTICU team and get updates on the patients. When I would meet other attendings (in cardiology and critical care), I would introduce myself and get their phone number. I took the same approach for attendings who were consulting on my patients so I could continue to develop relationships across the health care system.

I’m fortunately a very social person, so this was not a terribly big challenge but if you are a bit shyer, this may very well feel uncomfortable and awkward. Keep in mind, that your colleagues want to get to know you (as you are the newest hire) but you have to get to know an entire division’s worth of faculty. Plus, if you throw in the trainees it becomes an even bigger task.

Supporting Go Red For Women with the entire CTICU Team

3. Don’t be afraid to ask for help. In order to be successful, don’t be afraid to ask for help, whether that is related to patient or personal care. Being a new attending has numerous challenges but asking for help isn’t one of them. I remember a difficult case being evaluated amongst our cardiogenic shock team to discuss the possibility of placing a patient on ECMO. I wasn’t sure the best course of action as I was the attending in the CTICU that week and my input would be heavily weighed. I immediately reached out to our CTICU Medical Director to hop on the call. He was able to give his insight on the case, which helped us determine a better clinical course. I was able to debrief with him afterward and learned for the next time I would encounter a similar situation.

4. Don’t forget your past mentors. Many of us will start working as hospitals we have never stepped foot in. Our past relationships are of incredible value. I still text and call my mentors for advice. They are a great objective 3rd party to speak to.

5. Enjoy the process. Being an attending is hard but remember the years of training you have completed getting to this point. We became physicians to accomplish a variety of goals (research, clinical care, etc) and we are well trained for it.

Although the training wheels may have come off and I am no longer considered a trainee, I make sure I am diligent in growing and learning at every opportunity. I’ve learned so much in my first year as an attending and can’t wait to see what else is in store.

 

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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Lilly’s MounjaroTM (Tirzepatide): A New Sheriff in Town

The prevalence of diabetes is increasing at an alarming rate, with more than 34 million Americans suffering from diabetes1. Patients with type 2 diabetes make up 90% to 95% of total diabetes cases1. Type 2 diabetic patients either do not produce enough insulin or develop insulin resistance, resulting in elevation of their blood glucose levels2. The U.S. Food and Drug Administration (FDA) recently, as an adjunct to diet and exercise, approved Eli Lilly and Company’s MounjaroTM (tirzepatide) injection (under the skin, once a week) for Type 2 diabetic patients to control hyperglycemia.  Mounjaro will be offered in 6 different doses, 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg, in an auto-injected pen with a pre-attached hidden needle. However, Mounjaro has not been designated to use in Type 1 diabetic patients and is not yet tested for patients with pancreatitis or children under 18 years of age3.

Mechanism of Action of MounjaroTM (tirzepatide):

Eli Lilly and Company’s new drug is a dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor. GIP and GLP-1 are incretin hormones that are released from intestine upon ingestion of food. GLP-1 stimulates the release of insulin from beta cells of pancreas, increases the number and volume of beta cells, and decreases the levels of glucagon, a hormone also released by pancreas that instructs the liver to release stored glucose in the circulation2. Similarly, GIP also fuels insulin release, promotes beta cell production, and prevents destruction of beta cells2. In Type 2 diabetes, patients do not respond properly to incretin hormones. Mounjaro battles this issue by triggering the activation of GIP and GLP-1 receptor2.

Side Effects of MounjaroTM (tirzepatide):

The most common reported side effects, in at least 5% of patients, are nausea, diarrhea, reduced appetite, vomiting, constipation, indigestion, and abdominal pain. Mounjaro may cause severe side effects including hypoglycemia, pancreatitis, allergic reaction, kidney problems, gallbladder problems, and changes in vision. Further, a warning regarding thyroid cancer is issued; therefore, Mounjaro is not advised to use in patients with personal or family history of Medullary Thyroid carcinoma or Multiple Endocrine Neoplasia Syndrome Type 23.

SURPASS clinical trial program of MounjaroTM (tirzepatide):

The SURPASS trials evaluated the efficacy and safety of Mounjaro for Type 2 diabetes as a monotherapy and as an add-on to other standard care medications. Mounjaro was compared as other injectable medicines like semaglutide (GLP-1 mimic), insulin glargine and insulin degludec. Throughout the five global SURPASS studies, Mounjaro exhibited reduction in A1C among participants having Type 2 diabetes from an average of 5 to 13 years3.

  • SURPASS-1 (NCT03954834): A 40-week study tested the efficacy and safety of three different doses of Mounjaro (5 mg, 10 mg, and 15 mg) as monotherapy in comparison to placebo in Type 2 diabetic patients (naïve to injectable therapy and utilizing diet and exercise alone). Researchers reported that tirzepatide reduced A1C by 1.8% (with 5 mg) and 1.7% (with 10 mg and 15 mg) as compared to 0.1% with placebo. Further, participants lost weight on an average of 14 lb. (5 mg), 15 lb. (10 mg), and 17 lb. (15 mg) whereas participants in placebo group only lost 2 lb3,4.
  • SURPASS-2 (NCT03987919): In this 40-week study, participants were divided in 1:1:1:1 ratio to receive 5 mg, 10 mg, or 15 mg tirzepatide or 1 mg of semaglutide. Mounjaro reduced A1C by 2.0% (5 mg), 2.2% (10 mg) and 2.3% (15 mg) and semaglutide reduced A1C by 1.9%. In a key secondary endpoint, participants in Mounjaro group lost weight by a mean of 17 lb. (5 mg), 21 lb. (10 mg) and 25 lb. (15 mg) in comparison to 13 lb. reduced by semaglutide3,5.
  • SURPASS-3 (NCT03882970): A 52-week study compared the efficacy of previous doses of Mounjaro to insulin degludec (insulin analogue) as an add on to metformin with and without SGLT2 inhibitors. The trial reported 1.9% (5 mg), 2.0% (10 mg) and 2.1% (15 mg) reduction in A1C in patients receiving tirzepatide as compared to 1.3% reduction in patients receiving insulin degludec. Interestingly, participants on Mounjaro lost 15 lb. to 25 lb. depending on the dose, but participants taking insulin degludec gained an average of 4 lb3,6.
  • SURPASS-4 (NCT03730662): A 104-week study compared the efficacy of Mounjaro (5 mg, 10 mg, 15 mg) to insulin glargine in Type 2 diabetic patients with increased risk of cardiovascular disease. Researchers observed a 2.1% (5 mg), 2.3% (10 mg) and 2.4% (15 mg) reduction in A1C in patients receiving tirzepatide as compared to 1.4% reduction in patients receiving insulin glargine. Participants on Mounjaro lost weight (14 lb. with 5 mg, 20 lb. with 10 mg, and 23 lb with 15 mg), whereas insulin glargine group gained 4 lb3,7.
  • SURPASS-5 (NCT04039503): In this 40-week study, the efficacy and safety of Mounjaro as an add on drug to insulin glargine was compared to placebo. An average of 2.1% (5 mg), 2.4% (10 mg) and 2.3%* (15 mg) reduction was observed in Mounjaro group as compared to 0.9% in placebo group. Further, Mounjaro, as an add on drug, reduced body weight by 12 lb. to 19 lb. as compared to placebo group, where participants experienced 4 lb. weight gain3,8.

REFERENCE

  1. National Diabetes Statistics Report. Accessed January 14, 2022. https://www.cdc.gov/diabetes/data/statistics-report/index.html
  2. FDA approves trizepatide: A potent new drug for type 2 diabetes. Accessed May 20, 2022. https://www.medicalnewstoday.com/articles/fda-approves-tirzepatide-a-potent-new-drug-for-type-2-diabetes
  3. FDA arrpvoves Lilly’s MounjaroTM (tirzepatide) injection, the first and only GIP and GLP-1 receptor agonist for the treatment of adults with type 2 diabetes. Accessed May 20, 2022. http://lilly.mediaroom.com/2022-05-13-FDA-approves-Lillys-Mounjaro-TM-tirzepatide-injection,-the-first-and-only-GIP-and-GLP-1-receptor-agonist-for-the-treatment-of-adults-with-type-2-diabetes
  4. Rosenstock J, Wysham C, Frías JP, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet. 07 10 2021;398(10295):143-155. doi:10.1016/S0140-6736(21)01324-6
  5. Frías JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med. 08 05 2021;385(6):503-515. doi:10.1056/NEJMoa2107519
  6. Ludvik B, Giorgino F, Jódar E, et al. Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial. Lancet. 08 14 2021;398(10300):583-598. doi:10.1016/S0140-6736(21)01443-4
  7. Del Prato S, Kahn SE, Pavo I, et al. Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial. Lancet. 11 13 2021;398(10313):1811-1824. doi:10.1016/S0140-6736(21)02188-7
  8. Dahl D, Onishi Y, Norwood P, et al. Effect of Subcutaneous Tirzepatide vs Placebo Added to Titrated Insulin Glargine on Glycemic Control in Patients With Type 2 Diabetes: The SURPASS-5 Randomized Clinical Trial. JAMA. 02 08 2022;327(6):534-545. doi:10.1001/jama.2022.0078

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”

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Join the race against the clock: Controlling for age in cardiovascular disease

The race against aging has already started. People who want part of this race see the limitless opportunities humans will have if aging is taken out of the equation. Humans will be able to live longer with their loved ones, go back to University when they are 70 years old to study this long-dreamed profession they always wanted to try or take the time to go through every single item on their bucket list, no matter how long the list is. Others are worried about what awaits them at the finish line of the race and what sacrifices will have to be made along the way. They argue that aging is the core of our existence and the reason why we make the choices we make every day. If humans don’t age, will they still find a reason to live and would this type of life be worth living? Regardless of people’s scattered opinions, the remaining question to be answered in our race against the clock is: Can we age disease-free?

As humans began to live longer dying less of problems such as hunger, wars and infections, they were faced with a new type of problem: chronic diseases. As we age and get exposed to different environmental and lifestyle factors, a set of biological and functional changes in our bodies lead to the development of chronic diseases such as cardiovascular diseases (CVD), diabetes, cancer, dementia, arthritis, and the list goes on. Notorious for being the ‘number 1 killer in the world’, preventing CVD has been one of the top priorities in our fight against aging. Age is the best predictor of CVD death, and despite years of research and large amounts of funding spent on biomarker discovery, there are currently no better predictors of CVD death than the age of a person and these are some of the reasons why.

Large blood vessels tend to become stiffer over time as they accumulate more collagen (due to an increase in TGF-b activity leading to collagen synthesis from smooth muscle cells) and lose their elastin content (because of higher metalloproteases and cathepsin activity). This leads to a chronic increase in systolic blood pressure which is worsened by the rise of catecholamines levels usually seen during aging. Both phenomena contribute to left ventricular dysfunction and hypertrophy due to the increase in myocardial oxygen demand. Calcification is another hallmark of aging that also contributes to vessel stiffness and induces stenosis. As we age, skeletal calcium is released and tends to accumulate in the vascular structures.

Apart from leading to vessel stiffness, aging causes the vascular endothelial cell (EC) barrier to become dysfunctional. ECs play a crucial role in maintaining vessel integrity and homeostasis by balancing vasodilatory and vasoconstricting functions and by aligning the vessels with an anti-thrombotic surface. Disruption of this protective barrier over time is characterized by ECs undergoing oxidative stress, reduced nitric oxide (a potent vasodilator) production, increased expression of adhesion molecules (ICAM and VCAM) and secretion of inflammatory chemokines (CXCL8) and cytokines (IL-1b and IL-6). The initiating event of atherosclerosis development starts with endothelial dysfunction which gives way for monocyte infiltration and subsequent foam cell formation contributing to plaque development.

At the molecular level, changes affecting the genome and epigenome are a fundamental feature of aging. With age, the clonal diversity of hematopoietic stem cells decreases resulting in the predominance of one clone. In recent years, clonal hematopoiesis of indeterminate potential (CHIP), which occurs as a result of mutations in transcriptional regulators (DNMT3A, TET2 and ASXL1), was found as a novel CVD risk factor, thereby linking genetic mutations in hematopoietic stem cells, aging and CVD. The number of endothelial progenitor cells also decreases over time which reduces angiogenesis capacity and capillary density leading to microvascular disease (such as peripheral artery disease).

The shortening of chromosome telomers is another molecular change related to aging. As cells replicate, telomeres get shorter until cellular senescence is triggered. Cellular senescence is a cellular protective mechanism that activates NK cells to remove cells with defective genetic material via apoptosis. It has been shown that patients with reduced leukocyte telomere length have increased risk of atherosclerosis. An atherosclerotic plaque, rich in inflammatory cells and trans-differentiated smooth muscle cells, is a dense hypoxic environment characterized by the presence of reactive oxygen species which also induce DNA damage and senescence.

Current therapies for atherosclerosis target some of the pathways of aging highlighted above. While statins are known to reduce plaque lipid content and inflammation, in parallel, they tend to increase calcification leading to vascular stiffness. On the other hand, anti-hypertensive treatments offer benefits beyond reducing CVD mortality, but also decreasing dementia. Recently, novel therapies targeting aging in CVD have focused on stem cell therapy. However, clinical trials using cell therapy to improve left ventricular dysfunction or to reduce cardiovascular events have shown no or modest benefit. This may be because autologous cell therapy of stem cells that already have an ‘aging’ phenotype is not ideal, and these cells may require ex vivo reprograming to improve treatment efficiency.

 

Since many age-related diseases have similar underlying molecular mechanisms driving them, the future for treating chronic diseases will rely on targeting the mechanisms of aging rather than treating the disease itself. Some of the best ways to slow down aging is by being active, controlling blood glucose levels, opting for diets rich in antioxidants and fibers and introducing low calorie intake periods during the day. However, this usually requires a substantial effort and serious lifestyle changes on our behalf. But, since research on anti-aging therapies and senolytic drugs is booming, it might be possible to slow down aging by taking one or two pills a day without ever needing to change the routines that we are so comfortable with.

References

  1. Paneni F, Diaz Cañestro C, Libby P, Lüscher TF, Camici GG. The Aging Cardiovascular System: Understanding It at the Cellular and Clinical Levels. J Am Coll Cardiol. 2017 Apr 18;69(15):1952–67.
  2. Quyyumi AA, Vasquez A, Kereiakes DJ, Klapholz M, Schaer GL, Abdel-Latif A, et al. PreSERVE-AMI. Circ Res. 2017 Jan 20;120(2):324–31.
  3. Brouilette SW, Moore JS, McMahon AD, Thompson JR, Ford I, Shepherd J, et al. Telomere length, risk of coronary heart disease, and statin treatment in the West of Scotland Primary Prevention Study: a nested case-control study. The Lancet. 2007 Jan 13;369(9556):107–14.
  4. Koopman JJE, Kuipers RS. From arterial ageing to cardiovascular disease. The Lancet. 2017 Apr 29;389(10080):1676–8.
  5. Jaiswal S, Libby P. Clonal haematopoiesis: connecting ageing and inflammation in cardiovascular disease. Nat Rev Cardiol. 2020 Mar;17(3):137–44.
  6. Antonangeli F, Zingoni A, Soriani A, Santoni A. Senescent cells: Living or dying is a matter of NK cells. J Leukoc Biol. 2019 Jun;105(6):1275–83.
  7. What is the Age of My Heart? – Calculate Your Own Heart Age • MyHeart [Internet]. MyHeart. 2015 [cited 2022 May 16]. Available from: https://myheart.net/articles/what-is-the-age-of-my-heart-calculate-your-own-heart-age/

“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 health matters. If you think you are having a heart attack, stroke, or another emergency, please call 911 immediately.”