AHA FIT – The Early Career Voice

Afraid of What’s in Vaccines? Here Are 5 Things You Ingest or are Exposed to Everyday Without Thinking Twice About Their Effects on Your Body and Heart Health

March 7, 2022February 22, 2022 Kyla Lara-Breitinger, MD

The American divide regarding the COVID-19 vaccine is a passionate topic for everyone. This article is not intended to prove to readers why getting vaccinated for COVID-19 is safe but to provide some insight on the daily decisions we don’t think twice about that have both theoretical and established health consequences.

The beef you eat and the milk you drink: Many farm-raised cattle are injected with artificial growth-promoting hormones such as oestradiol, progesterone, testosterone, zeranol, trenbolone and melengestrol to promote rapid meat production. Recombinant bovine growth hormone (rBGH) is a genetically-engineered synthetic hormone used to increase milk production in cattle, which then communicates to your liver to increase the production of Insulin-Like Growth Factor-1 (IGF-1). Although no systemic studies have directly researched the health effects of these hormones in the body, associations with DNA damage, infertility, premature puberty and risk for breast, prostate, colon, and lung cancer have been found retrospectively^1,2.
Ultra-processed foods: How often are you eating chips, bagels, pizza, soda, and other highly-processed food items without thinking twice about how they are manufactured? Based on the NOVA system classification, ultra-processed foods go beyond the addition of salt, sweeteners, or fat and include artificial flavors and preservatives that increase the shelf-life in your kitchen cupboards, preserve the texture of foods and increase their palatability to leave you craving for more. More and more studies are being published linking these foods to heart disease, heart attacks, and death from cardiac causes³.
Aspirin, Tylenol, and Ibuprofen: You likely reach for these common analgesics in your cabinet when you have pain, inflammation, or fever to alleviate the symptoms you are suffering from. However, there are risks and rare side effects associated with taking these drugs that include serious allergic reactions, kidney damage, bleeding, heart attacks, and stroke⁴. This is not meant to scare you into never taking these medications but to bring to light the many decisions we make that are more likely to benefit us rather than harm us.
Air pollution: How often do you grab your smartphone to check the air quality for the day? If the quality is less than ideal, how often does that impact whether you go outside? Poor air quality has been associated with heart disease, long-term respiratory problems, stroke, and low life-expectancy^5,6. However, the benefits of staying physically active outside, experiencing life events, socializing to improve mental health, and anything else that provides meaning in our lives by being outside likely outweight many of these risks.
The sun: Everyday, UV radiation from the sun and our atmosphere produce reactive oxygen species that cause direct DNA damage. This can lead to skin aging, skin cancer, and eye damage. Despite these risks, the benefits the sun provides to our planet and existence outweigh the risk and allow us to appreciate the positives⁷.

Every decision we make involves a conscious or subconscious risk assessment rooted in our values. As physicians, we are committed to providing medical advice based on whether the benefits outweigh the risks for our patients. While I can and will validate your concerns and fears, I hope that in the future you might consider seeing the forest for the trees.

References:

https://www.jswconline.org/content/68/4/325
http://ifrj.upm.edu.my/25%20(01)%202018/(1).pdf
https://www.jacc.org/doi/10.1016/j.jacc.2021.01.047
https://link.springer.com/article/10.1007/s12325-019-01144-9
https://link.springer.com/content/pdf/10.5487/TR.2014.30.2.071.pdf
https://www.sciencedirect.com/science/article/pii/S1875213617301304
https://link.springer.com/article/10.1007/s13273-017-0002-0

“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.”

Social Media Advice for Early and Mid-Career Professionals from #AHA21

November 15, 2021November 15, 2021 Jessica Monterrosa Mena

The schedule of events as a first-time attendee to AHA Scientific Sessions can be overwhelming! As an early career blogger, I decided to attend sessions to get advice from professionals on managing social media presence in “Social Media in Cardiology- Managing Misinformation as Fellows in Training”. It was reassuring to take part in a lively discussion with many participants asking questions ranging from, “How do I start developing my social media presence” to “How do I deal with mansplaining?” We were lucky enough to have experienced panelist give their insights.

There are many benefits to taking part in social media as an early career professional. It can be used as a platform to find role models and mentorship or start project and publication collaborations. These connections can be established by simply joining broad dialogues, tagging experts in a conversation, or sending a direct message to interesting people. Establishing a social media persona can also include creating a place to ask questions, sharing expert consensus, and guiding dialogue in a specific discipline. As field experts and early career scientists, we are uniquely positioned to gather cutting edge information and share our knowledge with broader audiences. In order to be successful in these endeavors, choose your social media platform carefully. Understanding the age-group audience predominating that specific platform can inform the type of content you decide to post and will influence how you frame your ideas.

While participating in an environment that is not curated can allow you the freedom of sharing pictures of your dogs along with scientific news, panel experts also reminded us that everything on social media lives forever. The downsides of social media include hostility, mansplaining, and being discredited and turned into a meme. Not everything you post can be edited, and typos can be an annoyance for yourself and others when conversations are picking up speed. However, when your post turns out to be factually wrong or misguided, a public apology might ensue. Being transparent about how you gathered information and why you are sharing it with others can help establish and maintain trust in quickly developing online discussions.

Things can also get tricky when dealing with misinformation or with patients asking for medical advice. Many patients seek to educate themselves by seeking information online, and practitioners have a responsibility to educate and be effective leaders in this online space. In fact, social media training is becoming a desirable and valuable skills set for many early and mid-career professionals. Professionals can use social media to spread scientific evidence for the greater good but will also need to develop an approach for responding to misinformation. When engaging in difficult conversations, be explicit about the limits of what you are offering and avoid driving more traffic to misinformation pages. Be cautious when engaging with misinformation posts; give others the benefit of the doubt but stay concise in your responses and only provide the correct information. If you are unable to engage in a meaningful discourse you can move on, or if you are so inclined you can call out, block, ignore, or mute hostile people. There is a balance between the benefits you gain from social media and the time you spend online. Overall, to make social media a positive part of your career, make sure to set boundaries, build trust, and be accurate about what you post. Social media can be an effective way to build your professional persona, make meaningful connections, and communicate science if you develop the right approach.

This program is part of the FIT Program at #AHA21. The panelists Danielle Belardo MD, Amir Goyal MD MAS, Martha Gulati MD MS FAHA, Virginia Bartlett, and was moderated by Christina Rodrigues Ruiz, MS and Sasha Prisco MD, PhD.

“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.”

Climate Change is a Biomedical and Healthcare Crisis

August 9, 2021August 5, 2021 Mo Al-Khalaf, PhD

One thing that has been on my mind, and surely it must have crossed yours recently, is the fact that our planet’s climate, and the environment, are having an increasing impact on how healthcare and society functions. The frequency of extreme weather events is plain to see and often experience (heatwaves, fires, storms, floods, droughts, etc.). Important to note: these events, if isolated and thought of separately, have happened throughout history, stretching back decades and centuries. However, when seeing them collectively, the absolute increase in number of events, and the frequency of “extreme” weather, that’s the key to seeing our current problem more clearly.

Climate change, coupled with environmental degradation and pollution, have been thought of as issues for politicians to deal with, and for manufacturers and large-scale industry to rein in, and for energy generators and tech companies to innovate away from its abuse. And while all these points are very true and totally valid, I will rhetorically ask: which segment of the population do you think is at the forefront of dealing with climate change and the environment? I’d argue that healthcare systems are the first line of defense and most immediately impacted.

Our environments and the climate we live in are major factors in determining our individual health status. Our bodies, or organs, tissues, and down to our cells, are each tasked with doing whatever is needed to continue functioning in the environment and climate we exist in. humans and all species have developed, over many generations on the evolutionary timescale, a lot of impressive mechanisms that help them survive, and thrive, in the wide range of environments and climates that exist on this planet. Additionally, we’ve learned and advanced medical and societal innovations, which also assist us individually and collectively, in living and contributing to life on this planet. However, there are limits to what the body can handle, and currently limits to what biomedical advancements have been achieved in assisting life beyond certain conditions.

Our bodies and our knowledge cannot overcome prolonged extreme heat, or cold, or dehydration, or unrelenting chronic assault of pollution, or any of the many factors that our changing climate and degrading environment challenges those bodies at greater and more extreme frequency. Biomedical researchers and active healthcare professionals must continue to support actions designed to lower the negative impact of climate change and deterioration of our environments (local and global). Health impacts must be front and center in all discussions related to combating climate change. Some conversations about climate change can make it sound that the most affected people will be individuals living near coastal lines, or in faraway patches of land on earth that are not easily located or well known to most North Americans, Europeans, and people living in more developed nations. This is simply a false viewpoint. Climate change and the deterioration of the environment is already leading to more death and more debilitating lifestyles in every corner of the map.

These past few months, the Covid19 pandemic, has shown the world what a fast-expanding global health crisis can do to negatively impact how the world functions. Climate change and the constant deterioration of our living environments will be even more impactful than Covid19. Biomedical researchers and professional healthcare members have a major role to play in shaping the change narrative, and implementation of key actions to protect humanity from the worst outcomes of a hard climate, and a detrimental environment where we live. The world has been warned about climate change for decades, but maybe it needed a global healthcare crisis like the Covid19 pandemic to demonstrate a bit of, and stimulate our imagination to see, how bad things can get. Let’s hope the 2020’s is the decade that finally sets the world on the right direction to preserve what we have left. It might be our last chance.

Personal and Community Advancements are Interlinked

February 4, 2021February 4, 2021 Mo Al-Khalaf, PhD

When it comes to advancing your professional career path, it can feel like it’s a very singular and personal journey, built on sequential sets of decision-making opportunities that ultimately only affect you. Today in this blog, I aim to share the many angles that emphasize a viewpoint that shows advancing your own professional career is in fact a community building effort, and it is very possible that those decision-making moments, challenges to overcome, and opportunities to pursue, can ultimately affect a host of individuals that are interconnected with you, on a professional, and personal level.

Let’s start by pointing out the fact that currently all of the science and health sectors are significantly being affected by the Covid-19 global pandemic. These are special circumstances that bring about unique challenges and pressures on the decision-making processes that early careers (and actually, careers of all stages) have to tackle. Part of the unique situation that we’re all dealing with is the mixture of increased separation and distance within professional working groups (either in actual physical space, or with the addition of a larger work-from-home element), coupled with the shared connection that so many of us are basically dealing with very similar stresses (the novelty of the situation; the larger than normal burden on physical and mental health; the uncertainty of short/long term professional plans, etc.).

These challenges are all coming on top of the already known and understood stresses and pressures involved in trying to pursue advancements in a professional career path. So questions can come up in our mind every once in a while, such as “Should I delay, or reduce my strive to grow professionally for now? Should I hold on to what I have, make sure I ride out the storm? How can I think of professional advancement at this time, when so many are dealing with extraordinary challenges?”. These are valid and excellent thoughts to have, and to try to find actual answers for. Each one of us faces a few similar, and many distinct, sets of factors that contribute to our decision making process regarding our current and future professional paths.

When it comes to professional advancement, sometimes looking after your own self interests also serves as looking after the interests of the many communities that you belong to. Moving forward in a career path allows for a number of positive changes to happen simultaneously:

The professional space that you occupied can be now filled by someone else.

Moving forward professionally frees up the junior position that you previously held (and managed to succeed in, allowing for the advancement to happen). Now someone else can come in this space, learn and have an opportunity to advance in their future, in a way similar to what you’ve done. Bonus community points: Now you are able to be a direct, or indirect (formal or informal) mentor to this new individual, or at the very least a useful contact and advisor.

Your new position will benefit from having you join.

Remember that advancing your career, getting the “new job”, is not just a win for you, but also for the job itself! Progressing through your career path means you’ve gained skills and experiences that will be of value to the new community and position you’ve moved into. This is also a reminder to always look inward towards what you can provide for the new career, not just look for what the new career provides you. Obviously there is a learning curve to every new professional position, but your unique collection of skills and experiences is just as important to integrate into this new path.

Science and healthcare serve the local, national and international population.

As an early career scientist, I always anchor my thoughts around this basic truth. My career progression depends on my ability to contribute to the advancement of knowledge and innovation, geared towards serving the needs of the global population. In my case specifically, my job focuses on reducing the burden of cardiovascular disease, and finding new ways to promote and sustain a longer healthier life. For me, professional advancement allows me to expand my reach and work towards affecting more people in a way that contributes to their health and global knowledge. When it comes to your professional path, make sure to evaluate and appreciate your own current and future contributions to the communities you’re part of.

So my take home message today is: advancing your own professional career path is in fact not just an act of singular self interest, but an opportunity to help progress the community you are leaving and the community you are joining. The current global pandemic has brought on some additional challenges and stresses that must be acknowledged and appropriately taken into account. All of these factors play a role, but should not dissuade anyone from striving towards advancing one’s professional career.

2020 Was “Challenging and Creative” According to Dr. Harrington, How Would You Describe It?!

January 26, 2021January 26, 2021 Barinder Hansra, MD

Everyone has different feelings about 2020 but I think it’s safe to say we have all taken the time to reflect on this past year and are filled with a new sense of hope for 2021. I sat down with Dr. Robert Harrington (past AHA President) to get his unique perspective on 2020 and what he looks forward to in 2021.

Dr. Robert Harrington, Immediate Past President, American Heart Association

Reflecting on 2020:

What went well in 2020 from the AHA? At the beginning of the pandemic, the AHA took a conscious effort to adapt as an organization. The AHA quickly pivoted its science and provided rapid response grants. Approximately 700 applications were submitted and the AHA fueled about 20 grants focusing on COVID research. The AHA also was seamlessly able to create a COVID registry based on our extensive experience with “get with the guidelines.” The organization continued to focus on being a voice for our patients with cardiovascular disease and wanting to bring quality evidence to clinicians – a few examples that come to mind include the debating of stopping ACE inhibitors and the effects of QT prolongation medications in patients with COVID.

What was the biggest change/disruption, how did you deal with it? As an academic clinical researcher, not being able to travel to meetings and conferences was very challenging. The meetings provide key networking that helps keep projects going but now we have less person-to-person contact. As AHA president, I wasn’t able to travel abroad to represent our organization and continue to build on our existing international relationships. Another change we also had to consider was how the pandemic and social distancing would affect the AHA 2020 sessions. Fortunately, our virtual platform was a success and we were continued to deliver pivotal science.

Looking forward to 2021:

How do you define success in 2021? Taking lessons on how to do things differently, for example, shifting to an online platform for fundraising and reviewing grants was successful. We were able to continue to do the work entrusted to us. We have embraced this shift in culture to help our organization grow and continue to be successful. We are also very exciting to see what will be discovered from the COVID registry.

What do you look forward to in the field of cardiology in 2021? The pandemic has fostered a lot of creativity. I think continued exploration in digital technology for patients with be key. Can we better control blood pressure, medication adherence, glucose control, etc via digital technology. This is an area of science and health care that is exponentially growing and it will be exciting to see what else we are able to develop.

Quick Tips for FIT:

How should FIT/Early career clinicians approach 2021? As we move back towards “normal” times, people need to take time off and decompress. We will find relief and gratitude we have gone through such a tremendous pandemic. It’s important to recognize burn-out and even more important for all of us to rejuvenate.

What do you think will cause the most stress and how can FIT/EC navigate it for a better future? My observation this past year (and during my time as an EC professional) it is the constant balance between professional vs personal life. During the pandemic, school closures and lack of elder care for example, have been a huge stressor on professionals. I hope we learned how to do things differently going forward to foster a better environment.

The memories of 2020 are still fresh in our minds but after speaking with Dr. Harrington, I too am more hopefully for a brighter, better, and as productive 2021. We have seen a tremendous growth in our community, compassion, and desire to help each other grow. So, good riddance to 2020 and cheers to 2021!

Building Your Brand: Research Career Planning and Scientific Writing

December 28, 2020December 17, 2020 Zain Ul Abideen Asad, MD, MBBS

AHA 20 had a fantastic session titled “Building Your Brand” and it provided excellent insights on how to be a successful researcher in academic medicine. Panel participants Dr. Erin Michos, Dr. Louise McCullough, Dr. Andrew Landstrom, and Dr. Pradeep Natarajan shared their stories on how they got involved in research and the lessons they learned along the way. While the session focused on fellows in training, I will present my viewpoint on how these general principles are applicable to early-career physicians (ECP). Based on this session, I have developed a step by step approach.

When is the right time to get involved in research?

No doubt, it is good to start as early as possible, but it is never too late. Residency is the ideal time to get involved in the research. This head start allows you to explore different areas of research, find what interests you, and at the same time allows ample time to acquire skills needed to conduct research. For ECP, this means if you already started research during your training you are on the right track. If you were not exposed to much research during training, you can always start now.

Step#1: Start now.

How to get started?

The significance of finding the right mentor cannot be over-emphasized. It is important to meet different potential mentors and get to know them. This allows you to assess overlapping areas of interest, learn how research shaped their careers and most importantly get inspiration from their journey. For an ECP, it is important to work with different mentors that can develop you in different areas of research. These mentors can be across different institutions in the country.

Step#2: Find your mentoring team.

What skills are needed and how to acquire them?

“Writing” and “Statistics” are the two most important skills needed for any type of research. There are multiple ways to acquire these skills depending on how much time you want to invest. Most of these skills can be acquired by taking online classes or a degree program. Most academic programs offer classes in scientific writing, epidemiology, biostatistics, clinical trial design, and grant writing. For an ECP, if you think you will be doing research throughout your career, consider getting additional training through a master’s degree in clinical and translational sciences or in some cases a PhD.

Step#3: Acquire scientific writing and statistical skills.

What are the effective strategies for manuscript writing?

Writing the first draft is challenging but it is important to write it quickly and not worry about perfection. Start by writing the methods, followed by results, and leave an introduction and discussion to the end. Feedback from your mentor and collaborators will improve the paper.

Step#4: Write the first draft quickly, following this order: methods, results, introduction, discussion.

Quality or Quantity?

While it is ideal to always conduct high-quality and novel research projects, in-reality all such projects need research funding. Therefore, early in your research career, it is important to be productive and complete some less extensive projects starting from case reports, review articles, and retrospective studies. This allows you to practice the skills you acquired and get some confidence that you carried an idea from start to finish. It will build your research profile and make you a competitive candidate for grant funding in the future.

Step#5: Publish something even if it is a case report or a retrospective study.

How to build a brand?

Once you have found your mentoring team, acquired writing and statistical skills, and published at least one manuscript, it is time to develop a focus. You cannot build a brand without a focus. The first step is to find an area of research that you truly find fascinating and it typically includes ideas that you cannot stop thinking about and questions that give you an epiphany. Often, the most important research questions arise from your clinical work. Second, see if these ideas are vital from a clinical, research, and public health standpoint (significance). Third, see if you have the right environment (research team, institutional support, skills) needed to turn this idea into reality (feasibility). Often, we have to spend many years exploring different research interests and acquiring more skills (grantsmanship) before we arrive at an idea that we see ourselves developing into a brand (niche). For ECP, if you are busy clinicians with an interest in research, try your best to align your clinical interests with your research interests. Once you have established your niche, it is extremely important to stay focused so that all your time and energy is spent on developing your brand.

Step#6: Develop your niche, advance your skills, align clinical work with research, stay focused, avoid distractions.

What personality traits are needed?

A key trait is showing persistence despite multiple failures as it is not uncommon to have your first manuscript rejected by a journal or multiple journals. Having the persistence to learn from this experience, improve your manuscript and resubmit, is necessary. For mentees, it is important to develop a “can-do attitude”, be authentic, honest and follow through on commitments.

Step#7: Develop persistence, learn from failure, be a good mentee.

I hope you found these steps useful for building your brand in research. “The game has its ups and downs, but you can never lose focus of your individual goals and you can’t let yourself be beat because of lack of effort.” (Michael Jordan)

This session will be available on-demand until January 4^th, 2020, and AHA Partners have FREE access to Scientific Sessions 2020 OnDemand Extended Access through 2021.

DAPA-CKD: Is SGLT2i the ANSWER? Will the guidelines change?

November 19, 2020November 19, 2020 Noora Alhajri, MD, MPH

Over the past years, series of clinical trials prove the beneficial effect of glucose cotransporter 2 (SGLT2) inhibitors in reducing the risk of cardiovascular events in people with type 2 diabetes mellitus. The results from these trials were consistent, significant, and demonstrated a considerable reduction in heart failure hospitalization among patients who used SGLT2 inhibitors, whereas the benefit on atherothrombotic events such as myocardial infarction and stroke was moderate.

Similar findings from The Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation trial (CREDENCE) were obtained for patients with type 2 diabetes mellitus and chronic kidney disease who are exceptionally at higher risk for cardiovascular disease. In CREDENCE trial, Canagliflozin reduced the risk of chronic kidney disease, cardiovascular death or hospitalization, myocardial infarction, and stroke. Although diabetes is not the only cause of chronic kidney disease, and people with chronic kidney disease are still at increased risk for cardiovascular disease, regardless if they had a preexisting history of cardiovascular disease or not. Therefore, its essential to implement guidelines that recommend the use of certain therapeutics as routine treatment for primary and secondary prevention of cardiovascular disease in patients with chronic kidney disease, regardless of their diabetes status.

During #AHA20, I enjoyed attending the online session by Dr. John McMurray, where he shared scientific breakthrough results from the Dapagliflozin And Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) Mega-Trial. The session reported the results of the effect of dapagliflozin on prespecified kidney and cardiovascular outcomes in patients with chronic kidney disease with and without diabetes. The DAPA-CKD trial was a randomized, double-blind, placebo-controlled, multicenter trial, where adults with or without type 2 diabetes, with estimated glomerular filtration rate (eGFR) between 25 and 75 ml/min/1.73 m², and a urinary albumin-to-creatinine ratio (UACR) between 200 and 5000 mg/g were eligible for DAPA-CKD trial. In this trial, patients were randomized to dapagliflozin 10 mg once daily or placebo with follow up at 2 weeks, 2,4, and 8 months and at 4 months intervals thereafter. The primary composite outcome was the time to the first occurrence of any of the following: > 50% decline in eGFR, onset of end-stage renal disease, or death from kidney or cardiovascular disease. Moreover, secondary outcomes were: 1) kidney composite outcome identical to the primary endpoint with the exception of death from cardiovascular death 2)( a cardiovascular composite outcome consisting of hospitalization for heart failure or death from cardiovascular causes; and 3) death from any cause.

Effects of dapagliflozin on prespecified clinical outcomes according to the baseline history of cardiovascular disease.

The DAPA-CKD trial found that among patients with cardiovascular disease who received dapagliflozin, the primary composite outcome occurred in 11.2% participants, while the primary outcome occurred in 17.2% in participants who were in the placebo group, (HR 0.61; 95% CI, 0.47-0.79) and the corresponding numbers in people without cardiovascular disease were 7.9% and 12.9% respectively, (HR 0.61; 0.48-0.78).

The DAPA-CKD trial also found that for both the primary and secondary prevention patients, the event rates favored dapagliflozin for all components of the primary and secondary outcomes, although reduction in cardiovascular risk was not statistically significant.

DAPA-CKD Figure

Additionally, among patients with cardiovascular disease, cardiovascular death or hospitalization for heart failure occurred in 9.3% of participants in the dapagliflozin group and 12.8% of participants in the placebo group, (HR 0.7; 0.52-0.94) and the corresponding numbers for patients without cardiovascular disease were 1.8% and 2.7% respectively, (HR 0.67; 0.40-1.13). The observed reduction in cardiovascular risk for these two groups was driven by reduction in heart failure hospitalization which occurred in 4.1% of participants in the dapagliflozin group and 7.3% participants in the placebo group with cardiovascular disease and the corresponding numbers for patients without cardiovascular disease were 0.3% and 1.0% (HR, 0.31; 0.10-0.94) respectively. These results show that dapagliflozin reduced the risk of adverse kidney outcomes irrespective of baseline cardiovascular disease status. Moreover, the mortality benefit from dapagliflozin as demonstrated from the DAPA-CKD study supports the findings of the DAPA-HF trial. In summary, dapagliflozin reduced the risk of kidney failure, death from cardiac disease or hospitalization for heart failure, furthermore, it prolonged survival, in people with chronic kidney disease, irrespective of the presence of a concomitant cardiovascular disease.

What is next?

The data from DAPA-CKD trial for dapagliflozin effect on patients with cardiovascular disease and chronic kidney disease is clear, but we have so much work to do. Is Dapagliflozin the answer? How would this change the guideline directed medical therapy (GDMT) for the care of patients with an increased heart failure, cardiovascular or chronic kidney disease risk, regardless of their glycemic status?

References:

Effect of Dapagliflozin on Clinical Outcomes in Patients with Chronic Kidney Disease, With and Without Cardiovascular Disease. John J.V. McMurray , David C. Wheeler , Bergur V. Stefánsson , Niels Jongs , Douwe Postmus , Ricardo Correa-Rotter , Glenn M. Chertow , Tom Greene , Claes Held , Fan Fan Hou , Johannes F.E. Mann , Peter Rossing , C. David Sjöström , Robert D. Toto , Anna Maria Langkilde , and Hiddo J.L. Heerspink for the DAPA-CKD Trial Committees and Investigators
Presented by Dr. John J. V. McMurray at the American Heart Association Virtual Scientific Sessions, November 13, 2020.
Heerspink HJ, Stefánsson BV, Correa-Rotter R, et al., on behalf of the DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients With Chronic Kidney Disease.N Engl J Med 2020;383:1436-46.
Presented by Dr. Hiddo J.L. Heerspink at the European Society of Cardiology Virtual Congress, August 30, 2020.
Rationale and protocol:Heerspink HJ, Stefansson BV, Chertow GM, et al., on behalf of the DAPA-CKD Investigators. Rationale and protocol of the Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial. Nephrol Dial Transplant 2020;35:274-82.

WELLNESS MATTERS

September 17, 2020September 18, 2020 Sherry-Ann Brown, MD, PhD

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA

WELLNESS

The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. The terms in this definition inspire similar words such as continuous (state), whole (complete), tangible (physical) and intangible (mental), as well as togetherness or community (social).

PANDEMIC WELLNESS

Indeed, during the pandemic, we often say or hear, “We are all in this together”. The global community has rallied around each other to get through the coronavirus disease of 2019 (COVID-19) well. In the midst of a nation in turmoil with pandemics juxtaposed (coronavirus and racial and ethnic inequities), we find ourselves in the middle of it all as physicians.

SAFETY & WELLNESS

Along with everyone else in medical authority, we encourage those around us and all we serve to distance physically more so than socially. We want people to remain social, to enhance wellness. Yet, we need that socialization to be safe and physically distant, to foster tangible wellness.

WELLNESS NOT CANCELLED

We encourage everyone to recognize that conversations, relationships, love, songs, reading, hope, joy, getting outdoors, music, family, and self-care should not and will not be canceled. This is the good stuff. The intangible components of wellness.

WELLNESS HEROES

So many of us in health care are sacrificing this period of our lives or in fact our very lives so that our patients can be whole. This altruism that led us here is continuous and indestructible by the #rona. Many of us turn to visual wellness inspired by COVID-19 to help capture the essence and sentiments of these challenging times. Art and other forms of creative expression of what’s inside of us or in society can motivate us to see more, be more, and serve more.

These matters at hand are crucial to help maintain our state of complete physical, mental, and social well-being. If we are honest with ourselves, we recognize that most of us live at best in a state of incomplete well-being. Yet, we can stand together against cancellation of our will and empower each other on this journey to wellness. It’s never been a destination. It’s always been a process that we continue to learn daily.

Lessons I’ve Learned as Chair

June 12, 2020June 12, 2020 Mo Al-Khalaf, PhD

Being a recent graduate just entering the professional stage of one’s career is an especially turbulent time. This is magnified for ones that had a prolonged academic journey, such as advanced medical training, pursuing master’s/doctoral degrees, and any other unique situation that can lead to a long journey of being an official student on paper (because unofficially we’re all students of life, until the end!).

However long and winding road one takes, there comes a time when the stage is set to exit being a student and enter the professional field. This stage is simply known as Early Career (using the naming convention most widely used, including at the American Heart Association). This part of a career journey has the uniqueness of blending learning many new life skills, and professionally performing up to the standards expected from achieving the academic endpoint one has reached (MD, PhD, or any other).

One way a young professional can advance their learning curve and become professionally savvy and focused is by seeking and actively participating in committees within organizations related to their working field. Committees provide a platform where members interact regularly, discuss and plan actions related to the work environment, provide community-building opportunities, and essentially expose their members to a variety of learning experiences that are highly beneficial, both directly and indirectly, in progressing their early career professional journey.

Here I present my personal experience as an example. I have recently concluded my term as Chair of the trainee committee in my institute, and have recently been granted full employment status as part of the reorganization of the employment structure here. I’m now exactly placed in the “Early Career Professional” stage of my journey. Being part of a committee provided me with many extra layers of understanding on how everything functions within the institution. My long academic stage provided me with skills and experiences within the realm of science, laboratory research and academic scholarship, but precious few glimpses of structures and professional actions outside the lab and classroom settings.

(Image from Pixabay.com CC0)

Working within a committee, and chairing a committee in my personal example, comes with its own learning curve, which can be a daunting thought for an already overwhelmed young professional (or senior student or trainee). But the rewards are plenty, and the effort is worth it at the end. Committee membership can be a rich source for personal and professional education. Some lessons are generalized for everyone to gain, other lessons are more individually centered, for each person to uniquely grow from. Some of the many lessons I’ve learned recently I’ll share here.

I’ve learned how a budget in an institutional structure is managed (which is different from how a personal household budget is done). I’ve learned the names of so many other professionals within the organization outside of my daily interactions. I’ve learned more about the administrative structure of the place where I work in. I sat in meetings that shape the direction of the future of the institution. I learned about leadership, and even more about teamwork. I learned the great value and appreciation for creating a close-knit community within a professional organization. As human beings, we have been creating and living in villages for thousands of years, and nowadays the professional network one works in can be part of that village. Here as well is where one can find opportunities to increase the equity, diversity, and inclusiveness of the professional community within the institution or organization. I had first-hand experience in this. Providing support and a platform for the under-represented can create an entry point for the larger effort required within the whole organization, institution and wider society. We should use all the tools at our disposal (and create new tools when necessary) to continuously provide better results for members of our community that are under-represented or marginalized.

My pitch here at the end to you is to seek out, create when possible, and accept opportunities, to be active in your work organization, and professional societies, during your early career stage (and moving forward). My personal endorsement goes to being an active member of a committee at your institution, and then to expand into national and international societies that exist in your professional field. There is much to learn, a community to join, to build, and a lot to gain towards advancing your professional path, and maybe, the society as a whole.

Taking a public stand for social justice

June 10, 2020June 10, 2020 Sasha Prisco, MD, PhD

My heart is broken after the recent events and the loss of George Floyd’s life in Minneapolis, my beloved home over the last couple of years, along with many other recent tragedies that highlight the racial injustices in the United States. Like many, I hope that these events will lead to fundamental changes and improvements in our society.

I admire the institutions, organizations, companies, leaders, and my colleagues who are making public statements in support of efforts to lead to social justice. I think that it is important to acknowledge that as a society, we are now expecting many organizations, institutions, companies, and leaders (political, academic, organizational, etc.) to take a public stand against racism, a topic that many organizations and businesses previously shied away from making public comments on. This is a positive shift in our culture. One of the initial ways to lead to long-lasting change is to acknowledge that there is a problem. My home institution, the University of Minnesota was quick to make a public statement condemning racism and social injustices after George Floyd’s death. As researchers and healthcare providers, we know that there are health inequities, magnified by the COVID-19 pandemic which my fellow AHA blogger, Dr. Anika Hines (@DrAnikaLHines) recently discussed.

Furthermore, as healthcare providers and researchers, we are often leaders in our communities and are able to provide a voice to those who are disadvantaged. Another fellow blogger, Dr. Elizabeth Knight (@TheKnightNurse) recently wrote about the importance of advocacy by healthcare providers. Racism and social inequalities are public health issues. Many organizations that we are a part of have made public statements for social justice. The American Heart Association and American College of Cardiology have made a joint statement with the Association of Black Cardiologists against racism and social inequities. Similarly, the American Medical Association and Association of American Medical Colleges have also made public statements condemning racism and advocating for change. Additionally, many healthcare providers across the country have kneeled and protested for #WhiteCoatsforBlackLives over the last couple of days. When the organizations and institutions that we are a part of take a public stand against racism and social injustices, we then feel supported in our efforts.

I encourage trainees to pay attention to which organizations and institutions are making statements against racism and social injustices and are committed to making changes.

Be an active ally. Listen and learn. Be kind. Be safe.