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Looking back at AHA21: reflection from a vascular neurology trainee

It has been just over a month since the American Heart Association Scientific Session 2021 concluded and I am elated to be a part of the Early Career Blogger program with a sponsored free access to the scientific sessions which also included the media pass!

My first thought after glancing at the schedule was, there is content for everybody to view and learn from, this includes researchers to nurses to clinical providers. Healthcare is vast and this session emphasizes that we do it as a community!

The virtual platform was very well organized which made it easy to navigate between the live sessions, posters, resuscitation science symposium and quality of care and outcomes sessions. I was truly fascinated by the quality of posters and presentations, with each one being unique. As an attendee, I had the option to pre-select the sessions of my choice, and add them to my calendar to keep track. The sessions covered topics from basic to clinical research and also included the most recent clinical trial updates. Apart from this, they discussed the role of social media on promoting cardiovascular health, emphasis on Diversion, Equality and Inclusion and Women’s Health.  The sessions were very concise, with the most updated content and were moderated very well. The platform made it easy to ask questions without interrupting the presentation. Despite challenging times of a pandemic, there were many groundbreaking research, which tells us, science doesn’t stop and we are always learning and discovering to contribute to the betterment of quality of life and health.

As we evolve, disease pathologies evolve, making them complex; There is always an overlap between systems, and we can never delineate one system from another and that’s when a platform like the American heart association brings the scientific community together and this year, to your computer screen, which helps researchers and clinicians learn and apply science to their practice.

As a vascular neurology trainee, I particularly enjoyed the sessions focusing on cerebrovascular health and the broad overlap between cardiovascular and cerebrovascular diseases. Some of the topics that drew my attention were, stroke epidemiology including the effect of hypertension on future brain health, gender-based outcomes after left atrial appendage occlusion, stress cardiomyopathy after aneurysmal subarachnoid hemorrhage, and case fatality associated with cardioembolic strokes, Atrial Fibrillation in 2021: Prepare for New Directions. Impact of COVID-19 on Cardiovascular Diseases, Secondary Stroke Prevention Guidelines: What Cardiologists Need to Know, Controversies in Stroke Management and Prevention and Updates in Stroke: Careers & Future Directions in Vascular Neurology (was privileged to blog on this session) to name a few. And it was not limited to listening to the lectures but felt even better when I apply it to patient care.

Apart from the scientific content, there were many educational discussions lead by seasoned panelists centered around, factors influencing various career vectors which addressed issues, events, and influential colleagues/mentors that contributed to their career choices with emphasis directed towards Early career attendees. The AHA journal editors gave us an insight on, What They Are Looking For? How to Publish? Opportunities for FIT’s to Be Involved and provided tips and advices for trainees to advance their career in publishing. One session that meant a lot to me was brought together by the ATVB Women’s Leadership Committee (WLC) who shared their own experiences on identifying and getting involved in volunteering activities such as, becoming a member of the early career committee, WLC program committee, leadership committee, as well as serving as a blogger etc. which were discussed in great detail.

It has only been a couple of months since being an AHA Fellow In Training and some of the perks that I’m already enjoying are, being able to engage with colleagues and mentors from around the world, volunteer opportunities with the AHA/ASA and gain national exposure, creating a pathway to Fellowship of the American Heart Association (FAHA), and making an impact in building healthier lives, free of cardiovascular disease and stroke.

The icing on the cake is the incredible opportunity to view all of the material with the on-demand access which is easy to access and can be viewed at your own pace. (https://ahasessions.heart.org/).

 

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

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Moving from ‘Luck of the Draw’ to making BLS and Defibrillator availability basic

The AHA ReSS council had a fascinating 2021 meeting, including trials making us reassess the optimal temperature for patients following cardiac arrest (TTM2) and those investigating the potential new application of existing meds repurposed to cardiac arrest (e.g. Tocilizumab [IL-6 inhibitor] to reduce cytokine storm post-arrest, LPC-DHA to improve mitochondrial function). What really put these clinical trials into perspective was the plenary session, featuring actual survivors of sudden cardiac arrest discuss their experiences with the frustrating lack of established resources as they journey to find the new normal for their lives.

Perhaps the most memorable part of AHA 2021 was the harrowing account of Dr. Kevin Volpp, a cardiology and behavioral economics researcher at the University of Pennsylvania, reflect on his own sudden cardiac death experience. The morning of July 9, 2021 started as just a regular day. Volpp traveled to Cincinnati, Ohio to watch his daughter, Anna, play in a squash tournament. While dining with Anna, her Coach (Gina Stoker), and her Coach’s boyfriend (John White) the night before, Volpp suddenly became unresponsive, slumping his chair into the arms of White. Coach Stoker called 911. White, who is himself a squash coach at Drexel University, laid Volpp flat, could not find a pulse, and initiated bystander CPR. EMS arrived four minutes later. Ultimately, he received 14 minutes of CPR with three shocks from the automated external defibrillations before his circulation was restored. He was rushed to University of Cincinnati Hospital, where he was found to have a 99% blockage in his LAD artery, which was opened and stented (1).

Volpp, who had a strong family history of premature heart attacks, had been undergoing primary prevention measures including CAC screening, medications, and well exceeding the AHA’s minimum recommendation for weekly exercise, as he was training with Anna for an Ironman 70.3 triathlon (1). Sudden cardiac death does not always occur in those with a strong family history with plaque in their arteries. During his 3rd year of internal medicine residency, Dr. Anezi Uzendu suffered cardiac arrest while he was playing basketball, with no prior family history. Fortunately, through high quality CPR and persistent resuscitation (receiving a total of 13 defibrillation attempts before he was revived!)(2), he eventually recovered and completed both general and interventional cardiology fellowships.

Ultimately, the prompt recognition and initiation of the cardiac chain of survival that allowed Drs. Volpp and Uzendu to have good outcomes. Coach White credited Drexel University’s requirement that Coaches keep their training in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) active (1). BLS is the use of high-quality chest compressions (2 inches deep at 100-120 beats per minute) to maintain adequate circulation to the brain, before additional help can arrive to provide higher level of care (ACLS). Out of hospital cardiac arrest and recovery is far from normal across the country, occurring in less than 8% of individuals (3). Acknowledging the critical nature of illnesses causing cardiac arrest, why do so few survive? Low rates of education and implementation of bystander CPR and AEDs, two of the most important interventions linked to improving survival  by as much as 3-fold (3). These interventions are not independent, as defibrillator effectiveness increases, with increasing quality of CPR (optimal depth & speed) administered (4). In 2014, Dr. Monique Anderson and colleagues at Duke University found that, only 1.29-4.07% of the US population is certified in BLS—a shockingly low statistic for the number one cause of death in America (heart disease) (3, 5). Unfortunately, disparities are more likely in racial minority, older, rural, and Southern communities (5). Dr. Maryam Naim and colleagues found similar disparities in a pediatric population (6). Not surprisingly, average rates of bystander in America CPR are only 38.2% (7), with significant geographic variation (10-65%) (8) and lower rates of proper technique (compression depth of 2 inches and pace of 100-120 beats per minute (9). These findings are compounded by the fact that almost 90% of cardiac arrests occur in or near the home (10).

What’s the best method of increasing this? Anywhere from 71.5% to 85.3% of American high school seniors have their driver’s license (11). Many obtain this through taking driver’s education class in school. One long term solution would be providing BLS courses to all high schoolers, with the option to advance to ACLS certification for those interested. While logistics can be debated, this would increase the proportion of individuals ready to perform by stander CPR from the 70% of Americans who don’t feel prepared (10) to adequately administer CPR. For adults, there are many available BLS courses available. The AHA Knowledge Booster App is a fun and interactive resource for those who want to learn more, but don’t know where to start. There are several Spotify playlists of songs with a tempo of 100-120bpm (12-14), but “Staying Alive,” by the Bee gees seems to be the most enduring. Dr. Uzendu founded an organization—Make BLS Basic—that focuses on increasing bystander CPR rates in minority communities (15).

Increasing bystander CPR rates is only half of the prehospital equation. When bystanders perform CPR and use a defibrillator, the survival to hospital discharge approaches 50-60%, with improved survival and neurological outcome with earlier defibrillation of shockable rhythms (3). The meager rates of Automated External Defibrillator (AED) availability in public spaces are similarly shocking. In a Cleveland Clinic survey, only 27% of Americans reported an AED in their workplace. After his experience, Volpp posed the question, should national chains be required to install AEDs, given that most adults spend 15-20 (pre-pandemic) minutes a day in a restaurants or bar (1). To be sure, AEDs require maintenance (replacement of defibrillator pads & batteries) and untrained lay providers may struggle to use them effectively (3). Several cost-effectiveness analyses have found a benefit of widespread dissemination of public AEDs (16-18), though not all are as optimistic (19, 20).   AED Laws vary by state (21); there has also been federal legislation (22). The Sudden Cardiac Arrest Foundation states a goal of having an AED accessible within 90 seconds of any public area that people congregate (e.g. schools, state & federal buildings, casinos, etc.). We are far from this important goal.

I think the ultimate questions are: Should one’s survival following cardiac arrest depend on being with the right person at the right time or where you live, shop, eat, or pursue leisure? Will we accept the status quo? How can we improve rates of bystander CPR and AED availability to give everyone an equitable chance at surviving these life-threatening events, and a new lease on life? How can we better support SCA survivors during their recovery? Looking forward to answering these questions at future meetings.

 

References:

  1. Avril T. “A Penn professor’s heart stopped at restaurant that had no defibrillator. Few are equipped with the lifesaving devices.” Philadelphia Inquirer. 2021. https://www.inquirer.com/health/aed-defibrillator-restaurant-cardiac-arrest-20211213.html
  2. Uzendu A. From “delivered to the cath lab alive” to Interventional Cardiologist on call in 5 years. God is good. #CPRSavesLives. In: @DrUzendu, editor. 2021. https://twitter.com/DrUzendu/status/1465120531317989382
  3. Brady WJ, Mattu A, Slovis CM. Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest. N Engl J Med. 2019;381(23):2242-51.
  4. Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation. 2006;71(2):137-45.
  5. Anderson ML, Cox M, Al-Khatib SM, Nichol G, Thomas KL, Chan PS, et al. Rates of cardiopulmonary resuscitation training in the United States. JAMA Intern Med. 2014;174(2):194-201.
  6. Naim MY, Griffis HM, Burke RV, McNally BF, Song L, Berg RA, et al. Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Study From CARES. J Am Heart Assoc. 2019;8(14):e012637.
  7. Promotion OoDPaH. Increase the rate of bystander CPR for non-traumatic cardiac arrests — PREP‑01. In: Promotion OoDPaH, editor.: Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/emergency-preparedness/increase-rate-bystander-cpr-non-traumatic-cardiac-arrests-prep-01/data
  8. Brown LE, Halperin H. CPR Training in the United States: The Need for a New Gold Standard (and the Gold to Create It). Circ Res. 2018;123(8):950-2.
  9. New Cleveland Clinic Survey: Only Half Of Americans Say They Know CPR [press release]. Newsroom: Cleveland Clinic, February 1, 2018 2018. https://newsroom.clevelandclinic.org/2018/02/01/new-cleveland-clinic-survey-only-half-of-americans-say-they-know-cpr/
  10. CPRBlog [Internet]. www.heart.org: American Heart Association. [cited 2021]. https://cprblog.heart.org/cpr-statistics/
  11. Ranzetta T. Question of the Day: What percent of high school seniors have a driver’s license? : Next Gen Personal Finance; 2019 [Budgeting]. Available from: https://www.ngpf.org/blog/budgeting/question-of-the-day-what-percent-of-high-school-seniors-have-a-drivers-license/.
  12. American Heart Association. Hands-Only CPR’s ‘Keep The Beat’ 100BPM Playlist: Spotify; 2015. https://open.spotify.com/playlist/18uMyHJHboUUCCwbtwdj3k
  13. nyphospital. Songs to do CPR to: Spotify. https://open.spotify.com/playlist/7oJx24EcRU7fIVoTdqKscK
  14. seigfriedb. CPR playlist (110 bpm). https://open.spotify.com/playlist/67BxVmgXqjr2lQqXKsyLxw: Spotify.
  15. Uzendu A. Make BLS Basic http://www.makeblsbasic.org2019 [Available from: http://www.makeblsbasic.org.
  16. Andersen LW, Holmberg MJ, Granfeldt A, James LP, Caulley L. Cost-effectiveness of public automated external defibrillators. Resuscitation. 2019;138:250-8.
  17. Nichol G, Huszti E, Birnbaum A, Mahoney B, Weisfeldt M, Travers A, et al. Cost-effectiveness of lay responder defibrillation for out-of-hospital cardiac arrest. Ann Emerg Med. 2009;54(2):226-35.e1-2.
  18. Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. 2010;55(16):1713-20.
  19. Atkins DL. Realistic expectations for public access defibrillation programs. Curr Opin Crit Care. 2010;16(3):191-5.
  20. Pell JP, Walker A, Cobbe SM. Cost-effectiveness of automated external defibrillators in public places: con. Curr Opin Cardiol. 2007;22(1):5-10.
  21. Roszak AR. CPR / AED Laws: Sudden Cardiac Arrest Foundation; [Available from: https://www.sca-aware.org/about-sudden-cardiac-arrest/cpr-aed-laws.
  22. State Laws on Cardiac Arrest and Defibrillators National Conference of State Legislatures [cited 22 Dencee. Available from: https://www.ncsl.org/research/health/laws-on-cardiac-arrest-and-defibrillators-aeds.aspx.

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

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Mental Health at the Forefront of Cardiovascular Health Discussions at AHA21

Mental health was a big topic of conversation at AHA21, a fitting topic when pandemic related stress, clinician burn out, and depression seem to be at an all-time high. As a graduate student myself, I was interested in attending sessions that touched on depression, wellness, and work-life balance topics. A Health and Tech panel session titled, “Mental Health and Cardiovascular Disease,” addressed how depression and languishing mental health can heighten the risk of cardiovascular diseases and cardiovascular events. This is because chronic stress activates our sympathetic nervous system and promotes changes in heart rate, blood pressure, and stress hormone levels. While there is a diverse array of known factors that influence depression, clinicians are now taking on the challenging task to measure how mental health contributes and modulates cardiovascular health outcomes.

Clinicians often connect patients with resources and educate patients about chronic disease self-management. However, when patients are coping with chronic physical conditions, mental health conditions can go unrecognized and may further impact health outcomes. As stated in the panel conversation, an astonishing 22% of people with heart disease struggle with depression as well. Properly identifying patients with depression is particularly important as mental health challenges that accompany traumatic health crises can interfere with cardiovascular disease treatments, often managed with lifestyle changes and adherence to strict medication regiments. Clinicians who are willing to attain mental health training to recognize mental health symptoms may provide more useful resources to patients. For example, routine mental health screening during visits were discussed to be a powerful tool that can help clinicians assess depression and anxiety symptoms and facilitate patients getting comprehensive assessment and specific resources that may improve overall health outcomes.

Digital solutions may also be effective tools for managing mental health and heart-healthy behaviors in the future. There is biotechnology in the works that may help patients track physiological reactions to daily stressful experiences, and individual step count and heart rate variability data may one day help clinicians make better informed decisions. One digital intervention program in the works in the works is Happify Heart and Mind, tailored to address lifestyle changes that would benefit individuals with heart disease risk factors. Clinical trial data presented at this session showed that depression, anxiety, and overall wellbeing was improved in patients who used Happify compared to traditional psychoeducation. The take-away question to walk away with after this session is to reflect on who would benefit the most from digital solutions. While scientists can leverage technology to touch on the complex relationship between mental health and cardiovascular health, these solutions need to be adapted to cross the digital literacy divide. Patients who face social inequities would stand to benefit most from personalized and adaptable comprehensive interventions, and clinicians can help connect the most underserved patients with digital resources and support programs.

Resources:

https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/how-does-depression-affect-the-heart

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

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A Reaffirmation on Medical Conferences

It is safe to say that AHA Scientific Sessions 2021, conducted virtually from November 13th to 15th was a big hit. The ease and flexibility of attending the Sessions from the comfort of my couch made me forget my initial concerns of missing out on the in-person experience. It will be interesting to see how the pandemic, and seeping of Zoom into our lives, change the future of medical conferences. Regardless of time and place, conferences will continue to be an important feature in medicine, especially in a constantly evolving field like cardiology. Here I discuss some of the reasons that drive us to attend medical conferences, and why we should continue to do so.

(Image from Creative Commons)

Present your work

Disseminating your research can be as important as the scientific process itself. Conferences are an excellent forum to present your findings in a timely manner, especially since publication can be a very long-drawn-out process. Presenting abstracts at conferences helps trainees build their CVs to reflect their interests and scholarly work. Although it can be nerve-wracking, presenting at conferences forces you to communicate about your work effectively. Addressing questions from experts and incorporating the feedback received can help with framing the manuscript for publication.

Keep up-to-date with the latest science

Undoubtedly the release of new study data creates the loudest buzz during medical conferences. Audiences gather to witness the release of trials that will influence clinical practice. You have the opportunity to interact with the investigators and address questions relevant to you and your patients. When not in the late-breaking sessions, there are poster/ presentation sessions to attend. You can also learn about the latest innovations from the industry and try your hand at new technologies showcased by vendors.

Get inspired

Even when not presenting, attending scientific conferences is an active process. Reviewing the latest trials and abstracts promotes critical thinking and sparks ideas. You notice the gaps in knowledge and may be inspired to address that in your research. You can learn from others’ successes and mistakes.

Learn/ refresh your knowledge

Medical conferences are a good place to catch up on the existing knowledge and earn CME points. Most conferences have workshops or skills-training sessions incorporated within the schedule. Lectures from distinguished speakers can provide you with a high-level review of a topic. Panel discussions bring together opinions from trainees, established clinicians, and researchers and can give a sense of what the coming years will bring to the field.

Form connections

Networking has become crucial for a career in medicine, whether in academia or private practice. Conferences are arguably the best place to establish and foster contacts with people at different stages of their careers. You have the opportunity to meet experts who you look up to, introduce yourself, and take advice. Your name might stick with potential employers, increasing your chances of landing a position in the future. For trainees, it may translate into gaining lifelong mentors or sponsors. Conferences are also a good place to meet peers, share ideas and experiences, and potentially set up collaborations.

Share the passion

Finally, there is a special joy in nerding along with others who nurture the same passion for medicine as you. People from different countries and at varying stages of their careers are brought together during the conferences. Knowing that there is a whole community of people with similar interests can motivate you for long after the conference is over.

All in all, attendees come out of a conference smarter, inspired, and excited for the next conference.

Below is a list of the upcoming major conferences in Cardiology. Hope to see you there!

 

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

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Cut from the same clot? – High-risk primary prevention vs secondary prevention in CVD

Atherosclerotic cardiovascular disease (CVD) prevention has been traditionally divided into primary or pre-event prevention and secondary or re-event prevention. The AHA 2021 joint session with the American Society of Preventive Cardiology entitled “Blurred Lines-Overlap in High-Risk Primary Prevention vs Secondary Prevention” challenged this traditional concept. The session tackled the case of a high-risk patient where using stricter treatment approaches, usually applied in secondary prevention, might be more relevant for her primary prevention. The invited speakers gave an overview of the different treatment options currently available for high-risk primary prevention and highlighted the knowledge gaps in the field.

It is well established that most cardiovascular events (CVE), such as myocardial infarction (MI) and stroke, occur in patients with prior no symptoms. When it comes to predicting CVE, it has been shown that the plaque burden (calculated by Coronary Artery Calcium (CAC) score for example) is a better predictor than the severity of stenosis. This is because the type and certain features of an atherosclerotic plaque can render it more vulnerable regardless of the stenosis degree.

 

The lines between primary and secondary prevention become blurry when studies such as the one recently conducted by Peng and colleagues demonstrated that primary prevention individuals with very high CAC score (~900) had a similar rate of CVE compared to stable treated high risk secondary prevention patients such as those in the FOURRIER trial. These results show that high-risk primary prevention population might benefit from intense management. Additional risk factors can be taken into account when optimizing the treatment while keeping in mind that not all high-risk primary prevention patients are the same despite presenting with a high CAC score. Before selecting a treatment strategy for a high-risk patient in primary prevention, it is important to evaluate the severity of the patient’s risk factors and act on them accordingly.

Reducing LDL-C levels, ideally below 70 mg/dl, is a good starting point. This can be done using intensive statin therapy or adding ezetimibe or a PCSK9 inhibitor for patients with additional risk factors who do not achieve LDL-C targets. It is of note that PCSK9 inhibitors can reduce Lp(a), triglycerides and ApoB levels which are known to increase CVD risk. The ongoing VESALIUS trial is evaluating the effect of using the PCSK9 inhibitor evolocumab on CVE in primary prevention high-risk patients with no history of myocardial infarction or stroke. For patients with high triglyceride levels, the results of the REDUCE-IT trial demonstrated a reduction of CVE (CV deaths, MI and stroke) when using icosapent ethyl, an EPA derivative. In this trial, 1% of patients had an increase in atrial fibrillation and atrial flutter which can be managed considering the advantageous reduction in stroke risk. However, the REDUCE-IT trial was conducted in a prevalent secondary prevention population and the benefit in high-risk primary prevention needs to be further investigated.

Metabolic syndrome is another risk factor than can be monitored in high-risk primary prevention as it increases the risk of CVE and type 2 diabetes. SGTL2 inhibitors have been shown to reduce CVE in patients with heart failure and reduced ejection fraction offering a benefit of using this anti-diabetic drug class in a non-diabetic population. About a third of the patients enrolled in the CANVAS trial were high-risk primary prevention and had a reduction of CVE while using SGLT2 inhibitors. The REWIND trial on the other hand, which enrolled about 69% of high-risk primary prevention patients, showed that GLP1-RA, another class of anti-diabetics, decreased the occurrence of CVE. However, SGLT2 and GLP1-RA are not yet FDA approved for high-risk primary prevention and the current alternative is managing lifestyle. Patients with metabolic syndrome can be advised to improve the quality (Mediterranean and DASH diets) and quantity (1600 to 3000 calories) of their diet and encouraged to include a fasting period of 14 hours per day to improve their blood pressure and atherogenic lipids profile.

In addition to controlling lipids, blood pressure and pre-diabetes, aspirin can also be considered for high-risk patients in primary prevention but only in those with low bleeding risk as shown by the recent data from the Dallas Heart Study (DHS).

References

  1. Van Venrooij FV, Stolk RP, Banga JD, Erkelens DW, Grobbee DE. Primary and secondary prevention in cardiovascular disease: an old-fashioned concept? J Intern Med. 2002;251(4):301–6.
  2. Mortensen MB, Dzaye O, Steffensen FH, B øtker HE, Jensen JM, R  ønnow SNP, et al. Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis. J Am Coll Cardiol. 2020 Dec 15;76(24):2803–13.
  3. Peng AW, Dardari ZA, Blumenthal RS, Dzaye O, Obisesan OH, Iftekhar Uddin S m., et al. Very High Coronary Artery Calcium (≥1000) and Association With Cardiovascular Disease Events, Non–Cardiovascular Disease Outcomes, and Mortality. Circulation. 2021 Apr 20;143(16):1571–83.
  4. Arbab-Zadeh A, Fuster V. From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019 Sep 24;74(12):1582–93.
  5. Amgen. A Double-blind, Randomized, Placebo-controlled, Multicenter Study to Evaluate the Impact of Evolocumab on Major Cardiovascular Events in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke [Internet]. clinicaltrials.gov; 2021 Dec [cited 2021 Dec 10]. Report No.: NCT03872401. Available from: https://clinicaltrials.gov/ct2/show/NCT03872401
  6. McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995–2008.
  7. Wilkinson MJ, Manoogian ENC, Zadourian A, Lo H, Fakhouri S, Shoghi A, et al. Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome. Cell Metab. 2020 Jan 7;31(1):92-104.e5.
  8. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2019 Jan 3;380(1):11–22.
  9. Ajufo E, Ayers CR, Vigen R, Joshi PH, Rohatgi A, de Lemos JA, et al. Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease. JAMA Cardiol. 2021 Feb 1;6(2):179–87.

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

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Fruits, Vegetables, Wholegrains, Plant proteins, and your Heart

Cardiovascular diseases (CVD) are the leading cause of death in Western countries and accounts for 17.3 million deaths/year globally1. In the United States, one in every three deaths are caused by CVD, and more than 130 million adults are projected to express CVD by 2035 clinically1. The unhealthy diet and physical inactivity, obesity, stress, smoking, and alcohol consumption are major risk factors for CVD development1. Nutrition has been reported to be the most preventable risk factor of CVD death1,2. Further, a healthy diet is crucial for managing body weight, diabetes, and hypertension1,3. Therefore, it is essential to identify foods and dietary patterns beneficial for cardiovascular health.

AHA 2021 Dietary Guidance to Improve Cardiovascular Health was presented for the first time by Dr. Alice Lichtenstein, a lead scientist at Tufts University, at #AHA21 scientific sessions and was recently published in Circulation4. AHA suggests that instead of emphasizing one food/nutrient, one should focus on dietary patterns that are the sum of all foods and beverages consumed4. The dietary habits can be adapted to personal preferences, ethical/religious practices, and life stages so that healthy patterns can be followed in the long run4. A heart-healthy diet promotes a healthy planet, meets essential nutrients and fiber requirements, and benefits stroke, type 2 diabetes, kidney disease, and cognitive function4. AHA 2021 Dietary Guidance is organized in following ten features:

 

  1. Adjust energy balance to achieve and maintain healthy body weight.
  2. Include plenty and a variety of fruits and vegetables.
  3. Pick food made with whole grains rather than refined grains.
  4. Choose healthy protein sources, mostly plants, fish, and seafood, and low-fat/fat-free dairy products. If meat or poultry is desired, replace red and processed meat with lean cuts and unprocessed form.
  5. Use liquid plant oils rather than tropical oils and trans-fat.
  6. Choose minimally processed foods.
  7. Minimize consumption of beverages and foods with added sugars.
  8. Consume food prepared with no or little salt.
  9. Limit intake of alcohol. If you do not drink alcohol, do not start.
  10. Adhere to this guidance regardless of where food is prepared or consumed,

 

However, is it easy for everyone to follow a heart-healthy diet? Our food environment is an essential element when we talk about diet quality and can make it difficult for people to adhere to heart health guidelines. Although diet quality improved from 1999 to 2012, disparities are evident based on race/ ethnicity, education, and income5. Dr. Maya Vadiveloo, assistant professor at the University of Rhode Island, explained that the food environment mainly consists of:

  1. Regulatory environment (federal, state, and local practices, and food marketing).
  2. Physical environment (places we eat, live, and acquire food).
  3. Social environment (family and peers).
  4. Individual choices.

She further explained that several state and federal policies, structural racism, neighborhood segregation, unhealthy built environments impede the adaption to a healthy diet. Furthermore, availability, price, and varied access make choosing unhealthy and processed food easier4. Federal food assistance programs, including Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are not universally effective and only cover a fraction of the monthly household supply4. Food companies tend to target low-income and racial minorities households. High processed food and beverages are telecasted more on TV, digital media, and print advertisements4. Dr. Vadiveloo concluded her talk by discussing the concept of precision nutrition which includes the evaluation of genetics, microbiome, dietary intake, and socioeconomic and physical environment to determine the most fruitful dietary plan to prevent and treat disease.  Increased access to affordable housing, enhancing access to supermarkets and green space, and increased access to online food delivery can help achieve dietary goals. She emphasized the power of artificial intelligence, which is unfortunately used for promoting unhealthy food. Still, it can help design personalized dietary interventions, population-level diet quality, and help people choose healthier and medical tailored diets when they buy groceries.

Following this, Dr. Lawrence J Appel, professor at John Hopkins University, explained how a multisector approach including government (regulatory and agriculture policy), health care sector, private sector, and health advocacy organizations is needed to change the default of food sector/eating. Dr. Appel focused on how policy changes can help individuals to eat healthily. In the US, processed and restaurant foods are significant sources (>70%) of sodium6FDA generated guidance for food manufacturers and restaurants to reduce salt in their processed, packaged, and prepared foods to achieve a 12% reduction in sodium and slash rates of heart diseases7WHO has generated public food procurement policies that require food and beverages served/sold in a public setting to promote a healthy diet8indirectly influencing manufacturers to reformulate their products. Although not common in the US, several other countries have front-of-pack warning labels (nutrient specific labels, nurtiscore and guideline daily amount) and health taxes on sugary drinks and salty food. Currently, only New York City requires restaurants to post a warning label next to the menu that contains more than 2300 mg of sodium and applies to restaurants with more than 15 locations nationwide. He concluded his talk by the importance of advocating and supporting policies that improve the health of patients and the broader community.

The last talk of the session was by Dr. Anne N. Thorndike from Massachusetts General Hospital and Harvard Medical school. Dr. Thorndile explained how clinicians and the healthcare sector could help implement 2021 dietary guidelines. She suggested that clinicians emphasize overall nutritional patterns and ask patients about barriers to access and consuming a healthy diet. Further, a clinician can deliver simple patient-centered guidance consistently over time by encouraging fruits/vegetables, plant proteins and oils, whole grains and discouraging the use of added sugars, processed meat, and excess alcohol. Further, hospitals employ approximately 6 million people and treat 750 million people annually. Therefore, many patients are exposed to cafeteria food. Hospitals can opt for traffic-light labels to promote healthy eating where green light suggests choosing often, yellow light means choosing less often, and a red light indicates a better choice available.

There is plethora of scientific evidence present that have helped in building 2021 AHA dietary guidelines. However, we need a multisector approach which will help imply the dietary goals to a larger population.

Reference

  1. Casas R, Castro-Barquero S, Estruch R, Sacanella E. Nutrition and Cardiovascular Health. Int J Mol Sci. Dec 11 2018;19(12)doi:10.3390/ijms19123988
  2. Mozaffarian D, Ludwig DS. Dietary guidelines in the 21st century–a time for food. JAMA. Aug 11 2010;304(6):681-2. doi:10.1001/jama.2010.1116
  3. Lacroix S, Cantin J, Nigam A. Contemporary issues regarding nutrition in cardiovascular rehabilitation. Ann Phys Rehabil Med. Jan 2017;60(1):36-42. doi:10.1016/j.rehab.2016.07.262
  4. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. Dec 07 2021;144(23):e472-e487. doi:10.1161/CIR.0000000000001031
  5. Rehm CD, Peñalvo JL, Afshin A, Mozaffarian D. Dietary Intake Among US Adults, 1999-2012. JAMA. Jun 21 2016;315(23):2542-53. doi:10.1001/jama.2016.7491
  6. Harnack LJ, Cogswell ME, Shikany JM, et al. Sources of Sodium in US Adults From 3 Geographic Regions. Circulation. May 09 2017;135(19):1775-1783. doi:10.1161/CIRCULATIONAHA.116.024446
  7. Edward E. New FDA guidance aims to drastically cut salt in food supply. NBC News. Accessed December 15, 2021. https://www.cnbc.com/2021/10/13/new-fda-guidance-aims-to-drastically-cut-salt-in-food-supply.html
  8. Public Food Procurement and Service Policies for Healthy Diet. WHO. Accessed December 15, 2021. https://apps.who.int/iris/bitstream/handle/10665/338525/9789240018341-eng.pdf

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

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2021 Chest Pain Guidelines from AHA21

2021 Guideline for the Evaluation and Diagnosis of Chest Pain was released in October 2021 and discussed in multiple sessions during AHA21. It was a collaboration between cardiologists, interventional cardiologists, cardiac intensivists, epidemiologists, and emergency medicine specialists. The team has focused on a symptom rather than a disease, making this approach unique. In the U.S, chest pain is the main reason for about 6.5 million emergency department encounters and the second reason patients seek medical attention in an emergency room. Only 5.1 % of ED visits with chest pain were found to have an acute coronary syndrome.  It is imperative to distinguish between life-threatening and benign causes. The new guideline has provided recommendations and algorithms for assessing chest pain based on contemporary evidence. This short blog will summarize the top take-home messages.

In the new guideline, authors refrain from using the term “atypical” chest pain. They have argued that this term may be misinterpreted as benign in nature. They have changed the atypical term to non-cardiac, which is more specific in addressing underlying diagnosis. The guideline emphasizes the uniqueness of chest pain in women. It is estimated that cardiac causes of chest pain are underdiagnosed in this population. Since women are more likely to present with accompanying symptoms, health care professionals should consider these symptoms while obtaining a history. An electrocardiogram should be obtained and reviewed for the presence of ST-elevation myocardial infarction within 10 minutes of ED arrival. Furthermore, in patients with intermediate to high clinical suspicion for acute coronary syndrome (ACS), a supplemental electrocardiogram on leads V7 to V9 is needed to rule out posterior MI. Cardiac troponin is a biomarker of choice for detecting myocardial injury. Authors recommend against the measurement of creatine kinase isoenzyme (CK, CK-MB) and myoglobin for diagnosis of acute myocardial injury.

The guideline panelists have revised the term coronary artery disease (CAD). Previously, CAD was defined as the presence of significant obstructive stenosis (i.e., ≥50%). This revision has broadened the term CAD to those with identified non-obstructive atherosclerotic plaques on prior anatomic and functional testing. This approach may prevent those with non-obstructive CAD from getting overlooked and deprived of optimized preventive measures. The guideline also provides recommendations on selecting optimal diagnostic testing for patients with chest pain. A health care professional should first consider the pretest likelihood of CAD before selecting a cardiac test modality. The guideline emphasizes the lack of need to pursue any diagnostic test in those with low CAD risk. A coronary artery calcium score may be appropriate for atherosclerotic cardiovascular disease risk stratification. In patients at intermediate-high risk of CAD, based on age (≥65 years of age vs. < 65 years of age) and suspicion of a degree of coronary obstruction, the guideline recommends further anatomical testing. Coronary computed tomography angiography is favored among patients at a younger age or less obstructive CAD suspicion, while stress testing is preferred among older patients or more obstructive CAD suspicion. The goal of CCTA is to rule out obstructive CAD or to detect non-obstructive CAD. If an evaluation is required, it will also provide further information about the anomalous coronary arteries, aorta, and pulmonary arteries. Ischemia-guided management is the goal of stress imaging. It can provide information when prior CCTA is inconclusive and about myocardial scar tissue and coronary microvascular dysfunction.

The term CHEST PAIN represents the take-home message of the guideline, as shown in the figure. Each alphabet has a meaning. C: Chest pain means more than a pain in the chest, H: High sensitivity troponin is preferred. E: seek Early care for acute symptoms. S: Share the decision-making, T: Testing not routinely needed in low-risk patients. P: use clinical decision Pathways. Accompanying: women may be more likely to present with Accompanying symptoms. I: Identify patients most likely to benefit from further testing. N: Noncardiac is in, and atypical is out. S: Structured risk assessment should be used.

 

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

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On Demand: Health Equity at #AHA21

As you may know, health equity was a major focus of the AHA 2021 Scientific Sessions, with numerous sessions that focused on cardiovascular health disparities, equity in treatment of cardiovascular disease and plenty of original health equity research. Here is a run-down of some great presentations about important topics in cardiovascular health equity from #AHA21, all of which are still available for viewing at your leisure ON DEMAND! [Please note that this list by no means comprehensive; there were many other amazing presentations which I did not have space to include here].

Fixing the Root Cause: Addressing Systemic Racism and Social Determinants of Health in Heart Failure [Oral Presentation]

This excellent and comprehensive presentation by Dr. Khadijah Breathett, MD, MS, FACC, FAHA, FHFSA showcases data from numerous studies that have found racial disparities in heart failure incidence or heart failure outcomes, vast racial disparities in access to advanced heart failure care (such as heart transplant or left ventricular assist devices), racial and gender bias in treatment of heart failure and strategies for advancing equity in treatment of heart failure. This presentation can be found in the Embracing the Melting Pot to Reduce Heart Failure: Genetics and Social Determinants of Health Session.

Association Between Community-Level Violent Crime and Cardiovascular Mortality in Chicago – A Longitudinal Analysis [Oral Presentation]

This study, conducted by Eberly et al, utilized data from the Illinois Department of Public Health and Chicago Police Department to examine the association between longitudinal changes over three time periods from 2000 to 2014 in violent crime and cardiovascular mortality rates (such as total cardiovascular mortality or coronary artery disease mortality) at the community level in Chicago, IL. They found that decrease in a community’s violent crime rates was significantly associated with a decrease in cardiovascular and coronary artery disease mortality rates. This study was presented in the Social Determinants of Cardiovascular Health Session.

Race, eGFR, and Cardiovascular Risk: A Tale of Modern Structural Racism [Oral Presentation]

This wonderful talk by Dr. Nwamaka Eneanya, MD, MPH, FASN provides a comprehensive overview of an incredibly timely and important topic. In this presentation, Dr. Eneanya establishes a clear throughline between structural racism, utilization of race in calculation of eGFR, resulting racial disparities in access to chronic kidney disease-related care (e.g. dialysis or kidney transplantation) and racial disparities in CKD-related outcomes, as well as recommendations for future non-race based approaches to define and manage chronic kidney disease. This presentation can be found in the Race, Bias and Barriers in the Cardiovascular Care of Patients with CKD Session.

Racial and Gender Differences in Lifetime Healthcare Costs Across Cardiovascular Risk Factors [Oral Presentation]

This study, conducted by Khera et al, utilized data from the Dallas Heart Study and the Dallas-Fort Worth Hospital Council Database from 2000 to 2018 to examine the relationship between factors such as race or sex and cumulative lifetime health care expenses. They found that lifetime health care expenses were substantially higher in Black individuals and men, and increased substantially with increases in cardiovascular risk factors, with many of these differences emerging after age 60. This study was presented in the Addressing Critical Questions of Health Equity and CVD Session.

Association of Cumulative Social Risk Score With Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA) [Oral Presentation]

This study, conducted by Hammoud et al, utilized data from the prospective Multi-Ethnic Study of Atherosclerosis (MESA) cohort to assign a social disadvantage score (SDS) to MESA Participants based on income level, education level, single-living status and perception of lifetime discrimination (e.g. mistreated by neighbors, mistreated by police, etc.). They examined association between SDS and atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality; they found that as social disadvantage score increased, so too did incidence of ASCVD and all-cause mortality. This research was presented in the Social Determinants of Cardiovascular Health Session.

Neighborhood Social Vulnerability is Associated With Major Adverse Cardiovascular Events and Deaths Among Patients Hospitalized with COVID-19: An Analysis of the AHA COVID-19 Cardiovascular Disease Registry [Poster presentation]

This study, conducted by Islam et al, utilized data from the American Heart Association COVID-19 Cardiovascular Health Registry to examine the association between neighborhood social vulnerability and major adverse cardiovascular events for patients hospitalized with COVID-19. They found that patients who resided in more socially vulnerable neighborhoods and were hospitalized with COVID-19 were more likely to experience adverse cardiovascular events during their hospitalization.

Income and Antiplatelet Adherence Following Acute Coronary Syndrome: An Administrative Claims Analysis [Oral Presentation]

This study, conducted by LaRosa et al, utilized data from a large and diverse health claims database to examine the association between household income status and antiplatelet adherence. They found that lower income status was associated with a greater likelihood of non-adherence with antiplatelet therapy after primary coronary intervention for acute coronary syndrome. This study was presented in the Social Determinants of Cardiovascular Health Session.

The Association of Social Risk Factors with Hypertrophic Cardiomyopathy Procedures and Mortality: US Nationwide Inpatient Sample, 2012-2018

This study, conducted by Johnson et al, utilized data form the U.S. Nationwide Inpatient Sample to examine the association between social risk factors, septal reduction therapy (e.g. septal myomectomy and alcohol septal ablation), ICD implantation and in-hospital mortality for patients with hypertrophic cardiomyopathy (HCM). They found significant heterogeneity in these outcomes by patient race, sex, income status and rurality.

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

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Equity, Diversity, and Inclusion: The Pillars of #AHA21

I was delighted to be selected as one of the American Heart Association (AHA) early career fellows in training bloggers for the year 2021-2022 during my first-year cardiology fellow. During 2019, the AHA conference was in Philadelphia and in-person. However, with the COVID-19 pandemic surge, we have learned how to attend virtual to hybrid conferences. Slowly, we have adapted to the new way of the virtual conference to be our harsh reality amidst an ongoing pandemic. The COVID-19 pandemic shed light on an essential aspect of healthcare. It brought forward the disparities in health care from enrollment of underrepresented patient populations in trials to the care of these patients.

The AHA has always emphasized equity, diversity, and inclusion (EDI) in the conferences and attempted to promote enrollment of the underrepresented population. The #AHA21 was a testament to these continued efforts visible in all sessions and specially planned sessions based on EDI. During the 3-day #AHA21, there were multiple exciting sessions.

Along with incredible live sessions regarding the ongoing groundbreaking research in the field of cardiology. There were multiple exciting on-demand sessions on EDI. Financial Toxicity and Cardiovascular Health Management and Outcomes by Dr. Krumholz from Yale School of Medicine was an incredible session raising important questions regarding the impact of the costly intervention on patients’ financial freedom, an aspect that is often ignored by the providers. Similarly, another session by Dr. Sharm from Johns Hopkins University discussed important concepts about monitoring of women with pregnancy complications or preterm deliveries discussed the important aspect of Cardio-Obstetrics, which has not been discussed much in the past.

With the pandemic, cardiac rehabilitation became challenging in the first place. However, with the evolution of the reach of virtual technology, Dr. Beaty from the University of California, San Franciso, discussed the innovative ways to encourage and involve patients in remote cardiac rehabilitation in older adults, women, and people of color as well. This kind of remote approach can potentially help in reaching all patient populations, thereby breaking the barriers of social determinants of health.

Not only #AHA21 provided a platform to practice with keeping social determinants of health. It also provided a platform for the fellows in training regarding how to navigate being a new parent in a special seminar. This was a heavily attended session with more than 100 participants where fellows shared their experiences of navigating through the challenges of being a parent during the fellowship. Everyone shared the nuances, tips, and tricks of being a parent during the fellowship, which was very powerful. These kinds of sessions can encourage more women to join cardiology and thereby close the leaking pipeline and bridge the gap.

The #AHA21 commitment towards motivating women in cardiology is also evident by the complete absence of MANELS in this 3-day conference and a testament to immediate past president Dr. Bob Harrington’s commitment towards #HeforShe campaign encouraging more women towards cardiology.

It’s heartwarming to see the success of #AHA21 and the fruition of EDI efforts of AHA extending from patient care, fellows in training to physicians.

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

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Covering #AHA21 as an Early-Career Blogger

It has been a month after the American Heart Association (AHA) Scientific Sessions 2021. Not only was this year my first time attending the conference, but it was also my first time ever covering a scientific meeting as an early career blogger. As a participant in the AHA Early Career and FIT Blogging program, the AHA sponsored my access to the conference and my media pass – so fancy!

My favorite aspect of Scientific Sessions was the balance between basic and translational scientific research. As an early-career PhD scientist who primarily works at the bench, it’s easy to limit myself to the day-to-day routine of basic science work. Attending Scientific Sessions gave me the opportunity to expand my viewpoint: from viewing posters on cellular signal transduction in the morning to attending clinical talks about the latest cardiovascular treatment breakthroughs in the afternoon, the conference really had it all. The opportunity to interact with clinicians and industry partners was particularly meaningful, as it broadens my perspectives on how our basic understanding of human physiology translates into tangible, impactful solutions for patients (check out my coverage of the effectiveness of non-statin therapies in reducing low-density lipoprotein C, the “bad” cholesterol, here). Most importantly, attending sessions on health equity allowed me to reflect on the current challenges of addressing health disparities and informed my research philosophy in my own work.

Being an early career blogger also allows me to network with other early career bloggers on social media (#SciTwitter, anyone?). Due to the diversity of session topics, it was impossible to attend every session. The AHA bloggers’ live tweets and coverage of different conference sessions, however, gave me a pleasant conference experience: if I missed a session, I could read their coverage and check out recorded sessions I might have missed. Beyond the conference, I remain connected to my fellow bloggers on multiple social media platforms, an invaluable opportunity for my own professional development.

The American Heart Association recruits early career bloggers every year for The Early Career Voice, the organization’s platform to amplify the contribution of early career scientists and clinicians. Be sure to apply to the program – we need your insights to shape our conversations on science, mentorship, and professional development!

“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.”