AHA18

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Funding the Business of Science: Strategies for Early Career Scientists

Allison Webel, PhD

During my graduate training, I learned how to write research proposals and manuscript, battle with the IRB, collect and analyze data, present my research in various settings, and handle regular (sometimes daily) rejection like a champ. I received excellent training from mentors who will always be my giants. However, as I have progressed through the early stages of my academic career, I have come to realize there are so many things about being an academic scientist that I never learned in graduate school.

The first thing is that, while science is (sometimes) a noble pursuit of generating new knowledge that will advance the human condition, it is also a business. I’ve never started a business nor have I considered myself entrepreneurial, but I believe in order to have a viable business model, one needs money to turn a great idea into something someone will pay for. It turns out that entrepreneurs and scientists have that common – this is why I was excited to attend the early career session on Sunday morning humorously titled, “WTF: Where’s the Funding?”

Even before we graduate with what we all hope is our terminal degree, we are primed by the academic enterprise to fund our work, and ultimately ourselves. For most of us it’s written into our first contracts. But after the glow of actually having a paying job wears off, we are left to agonize over the question, “How do we break into a system that is seemingly impenetrable to newcomers?” This was the very question this session addressed in an early career panel covering governmental, foundation, and industry-supported funding for early career scientists.

The panel started out acknowledging that the goal of every early stage investigator is R-level NIH funding, with its generous indirects and fabled prestige; however, it can be difficult for most of us to achieve this goal soon after completing our training. Against that backdrop this frank panel discussed how to  navigate two alternative funding sources industry funding and foundation funding. Jarett Barry, MD of UT Southwestern summarized these opportunities as “I think of industry, and even American Heart Association [foundation] funding as a pop off valve– a strategy used to complement traditional funding.” For many of us, a pop off valve is exactly what we need to keep our science going during the early, lean years. Further, these types of funding streams can help establish us as experts in our field and provide data needed to publish good papers and serve as preliminary data in future grants.

However, industry and foundation grants are not without their downsides. The panel agreed with Majken Jensen, PhD of the Harvard T.H. Chan School of Public Health, who said these grants are often smaller than federal grants, tend to favor academic celebrities, have low/no indirect rates and can be more heavily taxed by academic institutions, and (in the case of industry funding) can open us up to potential conflicts of interest. But science is a business and early career scientists need money to do their work, so with the limitations acknowledged the panel started to share strategies for obtaining foundation and industry funding.

  1. Develop a wide network and deftly use it. In addition to academic celebrities, science peers, and mentors, this needs to include industry and grant officials. The panel’s suggestions on how to accomplish this were fundamental: present at meetings and engage with people at the posters; strategically serve on panels and committees; and ask your mentors to introduce you to key people in funding organizations.
  2. Build a team of people at your institution who are supportive of your success. This team can include those academic celebrities who can open new opportunities for you. The committee acknowledged that while it can be intimidating to approach seasoned investigators and seek out their advice and mentorship, you need to do it. They will not come to you. You need to be prepared and persistent when asking for assistance, but it is worth it as having these allies can open amazing new doors.
  3. Write. Potential funders will look at your previous publications when determining whether or not to fund you. You need to have enough of a track record of high quality papers that will give them confidence that you will use their funding to do good science and improve the human condition.

In the end, all panelists had a common theme: if we boldly and strategically pursue all relevant funding opportunities, we can be successful.

This session left me optimistic about the future of not just funding my own research, but much of the incredible research of early career scientists. While securing funding is an exercise in endurance and humility, we don’t have to bang our head against the wall forever. If we learn from each critique, persevere, revise and repackage our ideas, and surround ourselves with an amazing team of our own choosing, eventually we will prevail.

 
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Hypertrophic Cardiomyopathy Comes in Different Shapes and Sizes

John Chen, MD

Scientific Sessions 2018 marks many firsts for me—my first time at Scientific Sessions and my inaugural blog post on the AHA Early Career Voice.  Both are tremendous opportunities.

I specifically sought out the Sunday morning session, “State of the Art in Hypertrophic Cardiomyopathy.”  As an internal medicine resident at Emory, I’ve had several experiences seeing patients with hypertrophic cardiomyopathy (HCM) in the outpatient clinic.  Unlike many other fields of cardiology, HCM is a niche dominated by young, otherwise healthy patients.  The title of this session alludes to how little we know about HCM, and how the practice of managing this complex condition truly is an “Art.”

Much of the session was an exercise in taxonomizing the umbrella term, “HCM,” splitting that pie from a number of interesting angles.  Dr. Sharlene Day divided HCM by obstructive phenotype: obstruction at rest, obstruction with provocation, and no obstruction.  Our approach to therapies has been driven by a focus on relieving obstruction, but strategies for treating symptoms in the absence of obstruction represents an open frontier.  Currently, the MAVERICK-HCM trial is studying the use of a cardiac myosin modulator in this patient population.

Dr. Jodie Ingles compared “familial” versus “non-familial” HCM.  The latter case, she argued, tends to involve men, present later, and portend a lower risk of cardiovascular events.  Discerning which cases of HCM is considered “familial” versus “non-familial,” and whether such a dichotomy truly exists, sparked much debate in the Q&A.

Drs. Elizabeth McNally, Adam Helms, and Jil Tardiff shared similarly thought-provoking insight, highlighting the heterogeneity of genotypes and phenotypes in HCM.  Multiple disparate mechanisms are responsible for producing sarcomere dysfunction, subsequent organic dysfunction, and finally clinical symptoms.  An appreciation for these finer details is necessary to guide a sophisticated approach to management.

 
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FIT Programming at Scientific Sessions 2018

Nosheen Reza, MD

One of the most exciting additions to this year’s Scientific Sessions is the weekend of programming targeted toward fellows-in-training (FIT) and early career members in the American Heart Association Early Career/FIT Lounge. The AHA FIT program was developed in 2016 and was established engage young healthcare professionals through meaningful educational opportunities that facilitate career growth and development. From 2016-2018, nearly 1,000 fellows from ACGME-accredited Cardiovascular, Vascular Neurology, or Pediatric Cardiology fellowships enrolled in the program and enjoyed perks like complimentary AHA membership and free access to the AHA family of journals. Earlier this year, the national AHA FIT Steering Committee reconvened with the goal to create a new and dedicated Scientific Sessions experience for FIT and early career members to network, relax, and learn.

In June, the AHA FIT Steering Committee, chaired by Dr. Ileana Piña, commissioned a FIT Planning Subgroup to create Sessions 2018 programming. Ten AHA FIT members from across the country answered the call for nominations and joined Dr. Jared Magnani on monthly conference calls to make the programming a reality. In the spring, FITs completed short surveys regarding their experiences at Sessions 2017 and shared their thoughts about their overall experience, how many FIT sessions they attended, and suggested topics for future programming. Our Planning Subgroup reviewed those surveys to inform the design of our focused and high-yield events. By October, we had come to consensus regarding the format and topics for our events, and we spent the month leading up to Sessions extending invitations to faculty and FIT panelists. Initially, we were unsure of how our programming and direct outreach would be perceived, but we were humbled by how supportive and enthusiastic our clinicians, scientists, and mentors were about our efforts. In the final two weeks, we led a social media campaign to advertise the event schedule and engaged medical students, residents, and FITs from across the country to join.

The first day of programming exceeded our expectations with almost all sessions being standing room only! Saturday kicked off with an introduction to the FIT program by our AHA liaisons. We then held back-to-back content session with leaders from sports and pediatric cardiology. Drs. Ben Levine, Rachel Lampert, and Eugene Chung shared their pathways to specializing in the care of the athletic patient and offered their thoughts on how FITs can pursue their interests in this field. Dr. Antonio Cabrera led a similar panel discussion with prominent pediatric cardiologists. We were then joined by Dr. Ivor Benjamin who spoke about his successful research career and imparted upon us the importance of finding mentors early in our careers. The most popular session of the day was our panel discussion for residents and medical students interested in pursuing cardiology fellowship. Drs. Eric Yang, Friederike Keating, Frederick Ruberg, and Vincent Sorrell led a lively conversation about the do’s and don’ts of the application and interview process and offered their viewpoints on what makes a stellar applicant. We finished the afternoon with an intimate breakout session with leading women in cardiology. Drs. Martha Gulati, Michelle Albert, Sharonne Hayes, and Erin Michos shared stories about the challenges they have experienced throughout their careers and offered inspiration for young trainees in STEM careers.

Looking ahead to post-Sessions, the program will continue to expand our AHA FIT membership and create innovative opportunities for FIT engagement within the AHA. Keep an eye out for our new FIT Insights Blog and AHA Early Career Blogs, opportunities to learn peer review through our Trainee Reviewer program, and more!

 

To keep up with all of the events in the Early Career/FIT Lounge, follow the hashtags #AHAFIT and #AHAEarlyCareerBlogger.

 
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High Sodium Consumption: The Next Public Health Endeavor?

Omid Amidi, MD

We hear it everywhere. “Don’t put too much salt on your food, it’s not good for you.” It is a statement that is so frequently said by doctors to their patients, by concerned family members to their loved ones, that it has almost become part of our culture. Off the top of my head, I can think of a dozen movies where the main protagonist gets the table salt taken away from them because they have high blood pressure.

With that said, as noted by the AHA’s “Common High Blood Pressure Myths” article1, adding table salt to your food is not the main culprit causing medical problems. It is the hidden sodium in our processed foods.

Recently, I took it upon myself to pay a closer look at my diet. Like many American, I eat out a lot. Given that most fast food restaurants are starting to note the calories within their food, I started to realize it was easy to keep up with the CDC-recommended calorie count of roughly 2,300 calories per day2. However, the one variable that always kept coming up high in my diet was sodium.

It’s not like I was eating hamburgers everyday either. I started to realize simple condiments pushed the sodium in my food to astronomical numbers. A serving of hot sauce, broth in my ramen noodles, even pickles, would cause my sodium intake to leap despite a low-calorie count. On restaurant menus, I always saw in small letters the warning that “guidelines recommend a 2,000 mg daily sodium consumption”, and next to it, I would find a food entrée that had twice that amount in a single serving. As a physician, I was recommending sodium restriction to all my patients as an easy treatment for their many comorbidities, and yet, I had a difficulty following my own recommendations. Sodium is everywhere and trying to keep its consumption in check is a challenge.

So why is high sodium bad?

Initially, clinicians attributed sodium’s harmful effects to its association with high blood pressure3. Multiple meta-analysis and randomized control trials have shown a strong positive correlation between high sodium intake and elevated systolic blood pressure. As we know, high blood pressure is associated with a myriad of health complications affecting the heart, kidneys, and the brain. Thus, given sodium’s relationship with the number one cause of cardiovascular related death worldwide, it would make sense that sodium restriction has become the first-line treatment for hypertension.

Yet, new research presented at this year’s AHA Scientific Sessions is suggesting that there may be more adverse effects associated with high sodium consumption than just its effect on blood pressure. During the “Cutting Edge in Cardiovascular Science” presentation at Sessions, Dr. Constantino Ladecalo of Weill Cornell Medicine presented evidence in mice studies correlating high sodium consumption to neurovascular and cognitive impairment in the absence of hypertension. Outlined in a paper published recently in Nature Neuroscience4, Dr Ladecola presented a molecular pathway that may connect the effect of sodium in the small intestine with reduced resting blood flow to the brain, leading to cognitive impairment. The “gut-brain connection” as so called by Dr. Ladecola, may be a new frontier in medicine.

While Dr. Ladecola and his team suggested that this molecular pathway may be a new target for prevention of cognitive impairment, to me, their findings reinforced the fact that we need to return to the basics in our treatment of cardiovascular disease: lifestyle changes and nutrition. Previous endeavors in public health have helped eliminate several illnesses that were common such as thiamine deficiency, so why not attempt the same with sodium? As the evidence builds against high sodium consumption, it may be time for us to take a more active look at how we can address it. Can we work together with major food distributors to reduce sodium in their food? Should chain restaurants inform consumers of the sodium value in their foods as they do with calories currently? I am not sure of the answer to these questions as they can be very difficult endeavors to focus on.

What are your thoughts on sodium?

  1. American Heart Association. “Common High Blood Pressure Myths” October 31, 2016 “http://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/common-high-blood-pressure-myths”
  2. Kotchen TA, Cowley AW, Frohlich ED. Salt in health and disease–a delicate balance. N Engl J Med. 2013;368(26):2531-2.
  3. Center for Disease Control. “Most Americans Should Consume Less Salt” June 11, 2018 National Center for Chronic Disease Prevention and Health Promotion , Division for Heart Disease and Stroke Prevention “https://www.cdc.gov/salt/index.htm”
  4. Faraco G, Brea D, Garcia-bonilla L, et al. Dietary salt promotes neurovascular and cognitive dysfunction through a gut-initiated TH17 response. Nat Neurosci. 2018;21(2):

 
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Sports Cardiology: Experts’ Advice for Trainees

Jeffrey Hsu, MD, PHD

As the AHA’s largest meeting of the year kicked off today in Chicago, the AHA Early Career / FIT Lounge, with its prime position at the main entrance to the exhibition hall, was the venue for the first ever Sports Cardiology session dedicated to early career trainees at Scientific Sessions. With the bustling crowd of Sessions attendees lining up alongside the FIT Lounge as they awaited registration check-in, many peered in to the first Early Career / FIT session of this year’s conference, in which an expert panel of Sports Cardiologists shared their insights on this emerging field within cardiology.

This session’s faculty panel consisted of:

  • Ben Levine – Professor of Cardiology and Exercise Sciences at UT Southwestern in Dallas, Texas
  • Rachel Lampert – Professor of Cardiology and Electrophysiologist at Yale University in New Haven, Connecticut
  • Eugene Chung – Associate Professor of Cardiovascular Medicine and Director of the Michigan Medicine Sports Cardiology Clinic in Ann Arbor, Michigan

Sports Cardiology Early Career / FIT Session at #AHA18 Scientific Sessions

Along with Dr. Beth Hill (@BethHillDO, Cardiology Fellow at Scripps Clinic), I was fortunate to moderate the discussion from this distinguished group. They shared their stories about their varied paths towards Sports Cardiology, which included influential encounters with athletic patients, personal experience as a high-performing athlete, and sheer passion for sports and exercise physiology.

As Sports Cardiology is a relatively nascent sub-specialty, there currently is no distinct path for interested trainees to follow. At this time, only one formal training program in Sports Cardiology exists – the well-established Cardiovascular Performance Program at Massachusetts General Hospital, directed by Dr. Aaron Baggish. However, with the recent publication of a Sports Cardiology Core Curriculum by the ACC Sports and Exercise Cardiology Council (Baggish et al., JACC 2017) and rising interest in the field among trainees (Afari, JACC 2017), the field appears primed for growth.

The panel offered many salient pieces of advice for trainees interested in pursuing a career in Sports Cardiology, which I have done my best to distill into the following points:

  • Choose What You Love: Fellows seeking to become Sports Cardiologists often ask which sub-specialty they should choose (i.e., EP, Imaging, Heart Failure) to best position themselves to enter this field. The panelists agreed that the answer is to choose the area that best suits one’s own interests. More importantly, they advised to not forget that Sports Cardiologists are, by definition, Cardiologists, and to not lose sight of the importance of a thorough grasp of General Cardiology when practicing as a Sports Cardiologist.
  • Seek Specialized Training in Exercise Physiology: “What distinguishes a Sports Cardiologist from a General Cardiologist?” Dr. Levine made the argument that Sports Cardiologists offer the extra expertise in exercise physiology and understand the physical demands imposed on the cardiovascular system by elite athletes. Assessment of athlete physiology must go “beyond the Bruce protocol.” Indeed, the 2015 AHA/ACC Guidelines specifically state that “the exercise testing protocol [of athletes] should be based on maximal performance rather than achieving 80% to 100% of the target heart rate to come as close as possible to the level of exertion achieved during competitive sport” (Zipes et al, Circulation 2015). Every effort should thus be made to recapitulate this degree and mode of exertion. Further, the elite athlete’s response to various maneuvers, such as tilt table testing, may be different, and a deep understanding of these nuances are incredibly important in this unique population.
  • Educate and Network: While there has been increasing awareness of the specialized cardiovascular care needs of the athletic population, it remains important for budding Sports Cardiologists to educate those providers in their network who tend to be the first contacts with athletes. This group includes primary care and sports medicine physicians, sports trainers, and student health centers, as these providers are often the first ones to hear about potentially concerning cardiac symptoms in athletes. Along these lines, athletes themselves can benefit from education on their own cardiovascular health, as they are not immune from disease regardless of their level of fitness. Trainees are encouraged to consider giving educational talks to athletes in the community (e.g., cycling and running clubs) and volunteer at athletic events to help disseminate these important issues.

While the session was filled with many more helpful tips for interested trainees, the panel’s ultimate recommendation was to make every effort to attend the ACC’s Care of the Athletic Heart meeting next year, which will take place in June 2019 in Washington, D.C. As a participant in last year’s Athletic Heart meeting, I strongly agree.

Overall, the panelists engaged the audience in an excellent discussion, and this topic served as an excellent segue for the eagerly awaited release of the AHA’s physical activity guidelines, which will be announced this Monday, November 12th at Scientific Sessions.

(Left to Right) Faculty Panelists: Eugene Chung, Rachel Lampert, and Ben Levine;
Session Moderators: Beth Hill, Jeff Hsu

 

For more information on the rest of my experience at #AHA18, please follow my Twitter feed (@JeffHsuMD) as well as the hashtag #AHAEarlyCareerBlogger.

 
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What Do The New Lipid Guidelines Mean For Patients?

Elizabeth Knight, PhD, DNP

One of the highly anticipated stories for Scientific Sessions 2018 was the new lipid guidelines. Following the reactions on Twitter during the session, I read a lot of opinions on CAC scoring and the pros and cons of its use to further stratify those at intermediate risk. Also trending – when to target LDL-C, now that thresholds are back on the table. These are the kinds of topics that typically get a lot of attention: which drugs, which targets, which tests? Conveniently, tests and prescriptions are also reasonably easy for clinicians to implement in practice.

In addition to my work as a nurse scientist, I’m a primary care provider who works with undeserved, often uninsured patients. CAC scores are, frankly, not highly relevant to my practice (at least until you can get them for $4 at Walmart). There were, however, two aspects of the new guidelines that caught my attention as a clinician serving this population. First, that it’s officially OK to measure non-fasting lipid levels. Second, that a clinician-patient discussion is recommended before initiating statin therapy for primary prevention. While these topics may seem entirely separate,  both are highly relevant to patient experiences of care. Primary prevention of ASCVD (or any condition) hinges on clinician-patient interaction because by definition, these patients are not yet sick. They have to buy in, and they do so (or not) based on their experiences with us as their care providers. Which dose of which medication to prescribe is irrelevant if a patient does not wish to take it.

The implications of non-fasting labs for patients are not hard to grasp, but this change will particularly impact patients who face barriers to care including transportation issues and the inability to take time off work. It’s a more impactful change that seems to remove a barrier to high-quality care, and I’m glad to see it.

The risk discussion, though not new, is more complex. Per the guidelines, it should include “a review of major risk factors (cigarette smoking, elevated blood pressure, LDL-C, hemoglobin A1C, and calculated 10-year risk of ASCVD); the presence of risk-enhancing factors; the potential benefits of lifestyle and statin therapies; the potential for adverse effects and drug–drug interactions; consideration of costs of statin therapy; and patient preferences and values”. Did you get all that? Now, imagine that you don’t have any medical or scientific background. You’ve been sitting in the waiting room for an hour, you skipped breakfast because you were getting fasting labs, and you are feeling a little nervous. Your doctor is talking fast because she’s running behind. Does this sound familiar? Is the review of major risk factors going well? Is it conducive to shared decision-making and buy-in?

My point isn’t that we can’t or shouldn’t have the conversation about risk, but that we need to find effective ways to have this conversation even though we face constraints on our time. A conversation, according to Merriam-Webster online, is an “oral exchange of sentiments, observations, opinions, or ideas”. Key word: exchange. The literature shows us different ways to communicate risk to patients, although we don’t have consistent data on what works and what doesn’t, and for whom. Yet even if we identify methods for us to best communicate the information, we still need to receive information from the patient and incorporate that into our ultimate shared decision. This is not easy. It will require a broader kind of work to improve. To effectively implement these guidelines will require work to understand how patients understand and how clinicians spend limited time. These guidelines use science to guide us in what to do– now we need science to help us learn how to do it.

Image: text from “Top 10 Take-Home Messages to Reduce Risk of Atherosclerotic Cardiovascular Disease Through Cholesterol Management” displayed by frequency via WordItOut (worditout.com)

 

Source: Grundy SM, et al. 2018 Cholesterol Clinical Practice Guidelines: Executive Summary
https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000624

 
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Scientific Sessions 2018 – You Should Be Here!

Anberitha Matthews, PhD

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

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

You should be here!

 
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New Technologies in the Health Innovation Pavilion

Annie Roessler BS, PhD Candidate

This morning I strayed from my usual hangout in the basic sciences sessions to investigate the hottest new products in the Health Innovation Pavilion at the Health Tech Competition. In this event, 8 highly talented applicant companies were allotted 3 minutes to pitch their company or product, followed by 5 minutes of Q&A from a panel of venture capitalists and AHA VIPs. Contestants were scored on novelty, innovation, potential patient outcomes, ability to address patient and provider needs, and strategy to launch and sell, among other criteria.

A focus emerged early in the competition: data aggregation. We’re seeing start-up companies developing digital platforms that collect massive amounts of patient data and process it to improve cardiovascular health outcomes. The target consumer varied from individual to hospital system, and the aims and applications stretched from prevention to detection and diagnosis. I particularly enjoyed hearing about Seqster’s software that integrates health records, DNA and fitness data in one place, though I thought all the panelists in the “real-life Shark Tank” had interesting and educational pitches.

The judges’ deliberations illuminated potential advances and pitfalls facing the field, and I think we need to ask ourselves a few things as both scientists and consumers. How might we respond if an adverse event is detected, and what are the consequences if something is missed? How efficient and accurate are the technologies? Who owns the data?

The pitch competition today demonstrated that health technologies hold great potential. It’s clear that as our tools evolve to improve patient health, the direction and guidance provided by our congregated cardiovascular experts, like those at Session 2018, will be invaluable.

 

Annie Roessler Headshot

Annie Roessler is a PhD Candidate at Loyola University in Chicago, IL. Her research focuses on the neurobiology and molecular mechanisms of electrically-induced cardioprotection. She tweets @ThePilotStudy and blogs at flaskhalffull.com
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Highlights of the 1st Annual Sex and Gender Conference at AHA18

Bailey DeBarmore

Walking into the Palmer House Hotel, the longest continuously operating hotel in the United States, you can’t help but pause in awe at the intricate décor and take in the most photographed ceiling in the world. I make my way to the Honoré Ballroom, named after Bertha Honoré Palmer, the wife of Palmer and an astute businesswoman and well-known Chicago socialite of her time, not knowing what to expect for the 1st annual Sex and Gender Influence on Cardiovascular Disease (CVD) conference.

Annabelle Volgman, medical director of the Rush Heart Center for Women, kicks off the evening by thanking the speakers and planning members, and encouraging photography and social media sharing. The many photos of the evening include Bertha Honoré’s portrait adjacent to the colorful and modern logo that, I think, will become a recognized image at future AHA Scientific Session meetings.

Dr. Annabelle Volgman welcomes attendees to the 1st Annual Sex and Gender Influences on Cardiovascular Disease at the Palmer Hotel in Chicago, IL (November 11, 2018).

 

Dr. Nanette Wenger of the Emory Women’s Heart Center starts the conversation with her presentation titled “Why is Mortality from Cardiovascular Disease Rising in Men and Women?” She flashes a graph of CVD mortality on the screen, highlighting the steep decline in the past decades, but the leveling off and reversal in recent years, particularly in women under the age of 55 years. The parallel rise in obesity and diabetes, as well as “non-traditional” CVD risk factors such as depression and perceived stress disproportionally affect women, she explains, and may be responsible for this reversal in CVD death rates. Summarizing the recent paper, “Defining the New Normal in Cardiovascular Risk Factors” by Dr. Donald Lloyd-Jones and Dr. Philip Greenland she points to a combination of health behaviors and ideal levels of total cholesterol, blood pressure, and fasting blood glucose, as key factors in achieving cardiovascular health.

“Behavior change,” she says, “is the ‘Holy Grail’ of heart health” and as “health professionals take back the role [of health educator] and address lifestyle behaviors” we will see favorable trends in biomarker targets we’re so interested in.

Later during the Q+A panel, when asked about the best way to approach behavior change with patients, she advises to first, “Give information – if your patient does not have the information, they can’t make a change. Then, let them start with what they would like to start with. Don’t give them 8-10 [health behaviors] to change – they will tune you out.” Dr. Gina Lundberg, co-director of the Emory Women’s Heart Center, chimes in that the clinician’s “approach to weight loss is similar to smoking cessation. Identify the obstacles in the patient’s way – money, time, desire – and often just identifying those hurdles will lead to improvement.”

Dr. Laxmi Mehta, director of the Women’s Cardiovascular Health Program at the Ohio State University Wexner Medical Center, adds that she includes an emotional appeal – “Where is the patient going and what do they want?” Seeing a child’s wedding or playing with their grandkids, developing rapport with patients and fitting your recommendations to their goals can start the health behavior change process, even in a 5 minute clinician-patient discussion.