cardiovascular disease

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New Cholesterol Guidelines From A Neurologist’s Perspective

Siddharth Sehgal, MD

The American Heart Association’s annual premier conference “Scientific Sessions 2018” concluded on Monday. This meeting showcases the latest advancements and discoveries in the field of cardiovascular medicine and is attended by clinicians and researchers from across the world.

Being a vascular neurologist, I have attended the International Stroke Conference organized by the AHA several times, however, this was my first time attending Scientific Sessions. I was able to attend the conference via Live Streaming while sitting in my office in Burlington, Massachusetts.

There are a lot of overlaps between cerebrovascular and cardiovascular disease and I was particularly interested in attending the sessions pertaining to stroke prevention and brain health. One of the most anticipated presentations was the release and discussion of the new AHA/ACC Cholesterol Clinical Practice Guidelines.

Some key takeaways from the updated guidelines:

  • The guidelines continue to underscore the role of lifestyle and dietary habits in addition to lipid lowering medication use to treat cholesterol disorders. There is emphasis on the concept of shared decision making with the patient which should include discussion of their individual risk and the treatment options to reduce that risk.
  • Addition of Ezitimibe and subsequently PCSK-9 inhibitors is now recommended in patients who cannot achieve target LDL levels despite maximum tolerated statin doses. There is some concern about the cost effectiveness of PCSK-9 inhibitors, but these medications are expected to become cheaper in the future.
  • Risk enhancing factors are introduced as part of a personalized approach to risk assessment prior to initiating statin therapy. These include persistent elevation of LDL>160 mg/dL, history of pre-eclampsia, family history of premature atherosclerotic cardiovascular disease, history of chronic kidney disease and chronic inflammatory disease, among others.
  • There is a recommendation for expanding use of calcium score as part of the risk assessment, especially in patients where risk benefit analysis is uncertain.

 

In addition to the guidelines for medications and lifestyle changes to treat cholesterol disorders, I especially enjoyed Dr. Laurence Sperling’s talk about the safety of statins.

Patients should be prescribed statins again at a lower dose or modified drug regimen if the reason for discontinuation was mild side effect symptoms. Although rare, but some patients do develop severe myopathy with statin use. These patients should be prescribed alternate non-statin therapies to achieve the target cholesterol levels. There has not been any proven benefit of Co Q10 to prevent or treat statin associated muscle symptoms. Despite the increased risk of diabetes mellitus with statins, it is recommended to continue the drug in patients who may be at risk or develop new onset DM. These patients should be counseled about the net clinical benefit of these drugs for long term cardiovascular event prevention. It appears reasonable to initiate statin therapy in the presence of an appropriate indication despite a history of stable liver disease. In patients without hepatic disorders, there is no clinical benefit of routine creatine kinase and liver enzyme measurements.

Very often patients have questions and concerns about initiating and continuing their statin medication. I believe that these data and recommendations further reinforce my personal practice to encourage patients to continue their statin medication as the risk benefit ratio remains favorable despite mild side effects.
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Yoga CaRe: When Evidence-Based Science Meets Ancient Wisdom

Abhishek Sharma, MD

Yoga can be vaguely defined as group of ‘mind-body’ exercises. Though exact timing remains debatable, origin of yoga can be traced back to more than 3,000 years ago when it was first mentioned in ancient Indian text ‘Rigveda’. Yoga is among one of six fundamental ‘Darshanas’ of Hindu philosophy. Various yoga practices were integral part of Indian sages’ routine, who taught and propagate various yogic practices across ancient India.

In western society, yogic practices involving ‘Asanas’ (stretching/body posture), ‘Pranayama’ (breathing exercise), and Meditation have become popular as mean of reducing stress and improving physical well-being.  Several small studies have reported beneficial effects of yoga in primary and secondary prevention of cardiovascular disease (CVD) [1-3]. Yoga based cardiac rehabilitation program post coronary artery bypass graft surgery has been reported to be associated with improvement in left ventricle function, lipid profile, stress reduction and quality of life [1, 2]. However, studies reported beneficial effects of yoga have been limited by small sample size, lack of adequate control, and non-uniform methodologies. Thus, utility of yoga based rehabilitation program in patients with pre-existing CVD remains uncertain.

Against this background, group of Indian physicians conducted a multi-center randomized controlled trial, to evaluate effectiveness of yoga-based cardiac rehab (yoga-CaRe) in patients with acute myocardial infarction. Dr. Dorairaj Prabhakaran from Center for Chronic Disease Control (New Delhi, India) presented the results of this study in a late-breaking science session at the American Heart Association 2018 Scientific Sessions. Study randomized 3,959 patients with acute MI patients from 24 Indian centers to 14 weeks of either Yoga-CaRe or enhanced standard care (ESC). Patients in Yoga-CaRe group underwent 13 sessions of yoga (3 health rejuvenating exercises, 15 postures, 5 breathing techniques & 5 meditative techniques) under trained yoga instructor guidance. ‘Asanas’ (body posture) in Yoga-CaRe group were carefully selected to avoid significant tachycardia.  ESC was comprised of 3 educational sessions (before discharge from the hospital and subsequently at weeks 5 and 12) and printed leaflet delivered by nurse or another member of cardiac care team either individually or in groups to avoid contamination. At 42-month follow up, compared to ESC, patients in Yoga-CaRe had numerically fewer composite endpoint events (death, nonfatal MI, nonfatal stroke, or emergency cardiovascular hospitalization) in the intention-to-treat analysis; however this difference was not statistically significant. The secondary endpoint of self-rated quality of life, and rate of patient return to pre-infarct daily activities were better in Yoga-CaRe group at three months. As per Dr. Prabhakaran ‘.. it (yoga) improve quality of life and made patient return to pre-infarct activities as quickly as possible….wherever people adhere to yoga i.e they attend more than 10 sessions there was reduction in composite end point particularly in death..’

Despite been a class I recommendation cardiac rehabilitation remains highly underutilized in post MI patients.  Situation is even worse in underdeveloped countries where structured cardiac rehabilitation post MI is almost nonexistent due to limited resources. In this context, results of this study are very relevant as yoga is relatively inexpensive and can be delivered by trained instructor to group of patients without further straining already overburden health care system. As pointed out by Dr. Prabhakaran ‘Yoga is feasible, and it can be ambitiously scaled up in term of cardiac rehabilitation..’. This could have far reaching benefits in low- and middle-income countries with limited health staff and resources, and high CVD burden.

However, due to lack of standardized physical exercise component in control arm of Yoga-CaRe trial, it remains unclear if yoga offers any additional benefits over traditional exercise performed for equal duration. Further, Yoga-CaRe enrolled relatively younger patients (mean age ~53yr) and predominately males (>85%). Thus, potential role of yoga in post MI elderly and females patients remains unexplored. Future, large-scale studies addressing these limitations and evaluating yoga based cardiac rehab in other CVD like heart failure would be useful in testing utility of these age old ‘mind-body’ exercises in modern world.

 

References:

  1. Raghuram N, Parachuri VR, Swarnagowri MV et al. Yoga based cardiac rehabilitation after coronary artery bypass surgery: one-year results on LVEF, lipid profile and psychological states–a randomized controlled study. Indian Heart J. 2014 Sep-Oct;66(5):490-502.
  2. Amaravathi E, Ramarao NH, Raghuram N et al. Yoga-Based Postoperative Cardiac Rehabilitation Program for Improving Quality of Life and Stress Levels: Fifth-Year Follow-up through a Randomized Controlled Trial. Int J Yoga. 2018 Jan-Apr;11(1):44-52.
  3. Yeung A, Kiat H, Denniss AR, Cheema BS et al. Randomised controlled trial of a 12 week yoga intervention on negative effective states, cardiovascular and cognitive function in post-cardiac rehabilitation patients. BMC Complement Altern Med. 2014 Oct 24;14:411.
  4. Prabhakaran D, et al “Effectiveness of a yoga-based cardiac rehabilitation (Yoga-CaRe) program: a multi-centre randomised controlled trial of patients with acute myocardial infarction from India” AHA 2018.

 
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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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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.

 
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What to expect at Joint Hypertension 2018 Scientific Sessions – Treating Hypertension in 2018

Anberitha Matthews, PhD

Two AHA Councils, the Council on HAHA|ASH Hypertension Scientific Sessions 2018ypertension and the Council on Kidney in Cardiovascular Disease, have joined forces with the American Society of Hypertension to make Joint Hyptertension 2018 Scientific Sessions (#Hypertension18) among the most impactful. Dr. Karen Griffin, FAHA Vice Chair for the Council on Hypertension Scientific Sessions Planning Committee calls it the “premier scientific meeting on hypertension in the world”. Understandably so; it boast experts from areas of cardiorenal disease, cardiovascular disease, stroke, and genetics to make for a vast cross-disciplianry session with the up-to-date information on hypertension. This year’s meeting received 439 abstracts in 37 categories, over 125 expert peer reviewers, and more than 20 countries represented.

There will be several interactive sessions that will target the established researcher/clinician, early career, and everything in between. With the addition of the new concurrent session D-Track, Clinical Practice Clinical Science and Primary Care tracks, a dimension will be added for elucidate the research science/clinical practice as it relates to patient care. In light of all the sessions that are available one should not have a problem reaching the milestones set by the program coordinators (infra vide).

To point out a few conference highlights, there will be 24 oral sessions, 3 poster sessions, and travel award talks:

The Excellence Award for Hypertension Research (Saturday, September 8, 2018)

  • R. Clinton Webb, PhD, FAHA presents “A Study of the Innate Immune Response in Hypertension”
  • Paul K. Whelton, MB, MD, MSc, FAHA presents “Clinical Trials and Practice Guidelines: Evidence-Based Progress in Lowering Blood Pressure”

Conference Awards

  • 10 Council on Hypertension New Investigator Travel Awards
  • 10 Council on Kidney in Cardiovascular Disease New Investigator Awards
  • 4 New Investigator Travel Awards
  • 6 Hypertension Early Career Oral Award Finalists
  • 12 AFHRE Travel Award for Patient-Oriented or Clinical Research in Hypertension
  • 1 Clinical Science Investigator Award for Excellence in Translational or Clinical Hypertension Research
  • 3 New Investigator Awards for Japanese Fellows

25 Poster Presenters can potentially win the competition this year! Which has gone up significantly from the previous years.

I am excited to go to Chicago for #Hypertension18 this year. If there is anything you need to enhance your experience during your time at the conference contact the program officials (directions in the program book).

I look forward to meeting you all! If you see me around tweeting, introduce yourself. I love meeting new people and learning new things. After all, that is why we are all going, right? 🙂

#Hypertension18 Conference Learning Objectives:

  1. Discuss changes to the AHA/ACC guidelines for the management of hypertension and their clinical implications.
  2. Describe opportunities to improve blood pressure measurement in the clinical setting to provide more accurate results.
  3. Identify immune and inflammatory mechanisms that contribute to the development of hypertension and hypertension-related end-organ damage and discuss the research and clinical implications.
  4. Educate participants about medical approaches for the management of co-morbid obesity in patients with hypertension.
  5. Describe new and emerging strategies for treating resistant hypertension.
  6. Describe participants on the impact of value-based reimbursement on hypertension management and identify opportunities to improve its management.

 

Leave a comment or tweet @AnberithaT and @AHAMeetings if you have questions or are interested in something else specifically.

Follow me and @American_Heart @AHA_Research @AHAScience and @HyperAHA on twitter for more #HeartSmart information.

For meeting Tweets follow @AHAMeetings @HyperAHA @AHAScience #JAHAMeetingReports @JAHA_AHA for the latest on#Hypertension18!
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How the Immune System Favors Females in Pulmonary Artery Hypertension? Another Regulatory T Cell Story.

Dalia Gaddis, PhD

While it is commonly thought that cardiovascular disease is a man’s disease, CVD is the number one killer of women with the same number of deaths per year as cancer, diabetes and respiratory disease combined (according to 2015 statistical data from AHA). In addition, women exhibit different and more silent symptoms of heart attacks. There is a lot of interest in the difference between how males and females respond to CVD. A lot of emphasis is put on hormonal differences, but the immune system also seems to play an important role in this disparity. Females have a more robust immune system and therefore respond faster to infections providing more protection than in males. However, a more responsive immune system also means a more reactive immune system that can result in increased incidence of autoimmune diseases, such as rheumatoid arthritis and lupus.

Part of the difference in the immune system response in females can be attributed to the fact that multiple immune-related genes are expressed on the X chromosome. Since females have two alleles of the X chromosomes and males have only one, it is evident that females express more genes that regulate immune system functions. One of these genes is Foxp3, the key transcription factor for regulatory T cells, an adaptive immune cell which I have discussed before in a previous post. Regulatory T cells play an important protective role in CVD, especially in atherosclerosis and hypertension.

Pulmonary artery hypertension (PAH) is a fatal cardio-pulmonary disorder where the pulmonary arterioles narrow leading to a right ventricular fibrosis, heart failure and death. Regulatory T cells play an important role in this disease as animal models that lack regulatory T cells are more susceptible to PAH. Adding regulatory T cells back prevents the development of PAH showing the protective power of these cells. A recent study published in the journal Circulation Research, shows that in the absence of regulatory T cells, females rats are more prone to PAH than male animals due to a lower levels of PGI2, a pulmonary vasodilator, and the lack of the enzyme COX-2 that regulated PGI2. The researchers conducting the study show that by transferring regulatory T cells into these rats, these immune cells were sufficient to restore the levels of COX-2 and PGI2, as well as other immune inhibitory molecules PDL1 and IL-10. The authors suggest that regulatory T cells have both a direct and indirect effects on the arteries. The direct effects are exerted on the endothelial cells directly via COX-2 and PGI2, and the indirect effect is through the release of inhibitory molecules such as IL-10 and TGF, both of which would result in immune suppression and preventing inflammation. The results from this report suggested that females are more reliant on regulatory T cells for protection against PAH.

These new findings highlight the subtlety of immune regulation between females and males and further proves that in addition to hormonal differences, immune regulation disparities between genders that can alter the outcome of cardiovascular diseases. By understanding more about gender differences in CVD and the immune system, and figuring out ways to manipulate these subtle differences, scientists hope to achieve a more personalized and effective therapies to women versus men to combat CVD.

 

Dalia Gaddis Headshot

Dalia Gaddis is a postdoctoral fellow at the La Jolla Institute for Allergy and Immunology. She has a Ph.D. in microbiology and immunology. She is currently working on understanding the interactions between the immune system and atherosclerosis development

 
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Wonder and Skepticism: You Shake My Nerves and Rattle My Brain

Annie Roessler BS, PhD Candidate

Last week I stood beneath the stage lights in the cozy back corner of The Empty Bottle, a dive bar and music venue serving up good vibes in the Wicker Park neighborhood of Chicago. They scrawl the names of each night’s performers, often alternative bands, on the front door in chalk. On Wednesday evening the entrance broadcasted “Wonder and Skepticism,” a local series offering the chance to meet a real-life scientist. That’s me!

Annie presenting at The Empty Bottle in Chicago

The Empty Bottle has two things going for it: slinging grad student stipend-friendly adult beverages and occupying an address within walking distance to my apartment. When the organizers of Wonder and Skepticism invited me to share my research, I accepted with great enthusiasm.

That’s how I found myself and my PowerPoint slides on the same stage where Alt-J played in 2012 for a measly $15 cover (last month they slayed the crowd at Chicago’s Huntington Bank Pavilion). Giving a talk about your research at a bar is a peculiar experience. On the one hand, it was a delightful challenge to distill five years of intense bench work on the molecular mechanisms of cardiac phenomena into a fifteen-minute talk that any non-scientist could understand. On the other hand, I had a stamp of a bicycle and held a cheap domestic IPA.

As I scanned the audience, I realized that the people seated in front of me were just as early in their careers as I was in mine, but we’re doing totally different things with our lives. Take their attendance as evidence that my peers are genuinely curious about the cool things that scientists are up to. Scientists make up a small percentage of the labor force; perhaps the job seems unconventional, even glamorous, from the outside. It sure feels that way sometimes, especially when I’m gowned up in PPE. That would win anybody’s attention.

I came armed with a strategy. I made the talk relatable – which is too easy, unfortunately – as the leading cause of death worldwide, cardiovascular disease likely touches many of my listeners in some way. I addressed some common mysteries, like when one might use the defibrillator bolted on the wall. I incorporated the strange and unusual, such as how the FDA recalled half a million pacemakers last year because of hacking fears. To assess engagement levels and adjust my cadence as needed, I checked the audience for visual feedback, like head nods or raised eyebrows, and I kept my ears perked for verbal cues, like some low hemming and even a gasp from the back row.

The thing is, frequent correspondence occurs between student and PI, or PI and funding agency, or within departments. These conversations are important and ensure that we’re doing high quality, worthwhile science. However, the whispers inside the ivory tower often fail to reach the ears of people who pay for it via their tax dollars or charitable donations, the same people who will benefit the most from its mission. I think that keeping a steady dialogue with the public should be a scientist’s responsibility, just as much as publishing a peer-reviewed article or attending a conference. Talking about my life with my neighbors for 15 minutes took little effort – after all, I’d been practicing my elevator speech every waking moment for the past five years of grad school. Plus, I had fun. At the end of the night, I added my name to the walls of the green room, feeling like a rock star and grateful that I could share my story.

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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A Marathon of Conferences

Anberitha Matthews, PhD

collage of images from conferenceThe months of March and April were filled with a whirlwind of conferences. I had the pleasure of traveling to several meetings across the U.S. including the Wonder Women Confidence Conference (WWCC) in Stone Mountain, GA on April 18th, NIDDK NMRI workshop in Bethesda, MD on April 11-13th, Experimental Biology (EB) in San Diego, CA on April 20-26th, and Society for Cardiovascular Angiography and Interventions (SCAI) San Diego, CA on April 25-28. All these meetings had commonalities that included networking, publishing, funding, and of course, science.

My favorite part of attending scientific meetings is the science. I sit in on various talks that are related to things of interest to me, even if they are outside my area of research. Being an introvert, I find comfort in focusing on sessions that surround science and ways to gain the funding to move my research forward. My weakness is networking. I find it difficult to reach out to others and sustain a relationship of collaboration, mentoring, and professional socialization. This year at WWCC and NMRI, I had conversations with women who shared their thoughts on building a solid network. For example, networking is multifaceted that include mentoring, encouraging, challenging, counseling, advising, sponsoring, and affirmations; thus finding a supportive, like-minded network of individuals in the hypercompetitive world is vital. Although people are encouraged to build a network based on hierarchical relationships, it is now being emphasized to form relationships that can be sustained over an entire career. For example, Dr. Martin Frank has been a member of the American Physiological Society for over 20 years. During EB, there were people, including myself, that reflected on the benefit of him being a part of their network over the course of their entire career. Some networking opportunities can be found at National Research Mentoring Network (NRMN) and strategies on how to build a network in the 2016 article by McBride et al.

Some common aphorisms in science are “Publish or Perish” and “Fund or Fail”. EB lets you join conversations on the expectations of publishing. There were sessions that fully covered publishing ethics by American Journal of Physiology (AJP) that are similar for most journals including the Journal of the American Heart Association (JAHA). According to a talk given pertaining to funding by a representative from NIGMS, publication history is imperative in an application for funding. Publications give reviewers a snapshot into an investigator’s productivity and how they use their grant funds. Additionally, seminars explaining how to choose where to publish including section seminars from various vendors including: AHA as well as the American Kidney, Physiology, Nephrology, and Genomics Societies. The most noteworthy session for me was about blogging as a top way to communicate science to a large audience. Increasing people are using social media, such as Twitter, Facebook, Instagram, and SnapChat to share scientific information quickly in 150 characters or less. However, a Nature article suggests, although blogging is not for everyone, it is still a viable way to promote collaborations and share crucial information to the scientific community succinctly. Dissemination of research is a good way to advance the writer’s career, which is contrary to the thought that social media is phasing out blogging. Additionally, publishers shared ethics information, such as authorship, author responsibility, communicating with journals, rigor and reproducibility, transparency and data sharing. All now benchmarks of what reviewers are looking for in a publication.  Since the NIH is looking for these things in grant applications, I would recommend looking for a workshop that covers these topics in detail either online or face-to-face.

As a researcher, it was also important for me to present my research at conference. My poster presentation at EB focused on NADPH oxidase-dependent ROS in renal cells. My research interest is elucidating the relationship CVD has on renal dysfunction in the presence of endogenous oxidative stress. During the poster session, I spent time speaking with researchers ranging from high school and undergraduate students spanning to late career investigators sharing information pertaining to the impact increased oxyradical stress have on the mechanistic pathways that lead to cardiorenal disease (CRD). During our dialog, I met with people that I had known previously, such as Dr. Robert Mallet from UNTHSC, my mentor from the STAR Fellowship program (pictured); Drs. Manuel Navedo from UC Davis, Layla Al-Nakkash from Midwestern University, and Adebowale Adebiyi from UTHSC (postdoc mentor), my mentor from previous EB years (pictured). During sessions and after hour socials, connected with Marsha Matyas and Dr. Marty Frank from APS, publishing mentors (pictured) and the amazing group at the Porter Physiology Development & Minority Travel Award committee as well as new investigators to potentially form collaborations. The people in my network may not speak with me daily or even monthly, but they are my support when I am working through the processes of designing research experiments, data analysis, identifying funding sources, writing grant applications, and writing for publication. While in San Diego, I took a detour to the Manchester Grand Hyatt Hotel where the SCAI Sessions were held to speak with clinicians working with cardiac devices. Being that I am interested in securing a career in industry, SCAI provided the opportunity to network with general cardiologist, pediatric cardiologist, cardiovascular surgeons and biomedical companies that produce the devices used in cardiac repair.

Not any of us builds a career alone. It takes knowing the area of study, networking with people that has solidified a career in that area, finding a mentor that will sponsor you in advancing your career, as well and publishing the data that was generated with the funding that supported the research. In an arena of diverse scientist and clinicians, all studying various CVDs, it is important to find the thing that drives your passion and people to help support that passion. Working together, we can fight the hard fight of cardiovascular disease. Keep reading updates of heart health guidelines on AHA New.

Anberitha Matthews, PhD is a Postdoctoral Fellow at the University of Tennessee Health Science Center in Memphis TN. She is living a dream by researching vascular injury as it pertains to oxidative stress, volunteers with the Mississippi State University Alumni Association, serves as Chapter President and does consulting work with regard to scientific editing.
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Innovative Pathways To Antioxidant Therapy

Anberitha Matthews, PhD

disease potentially cause by oxidation

Cardiovascular disease (CVD) has been responsible for increased mortality and morbidity rates in our society for generation with no end in sight. There is a paradigmatic shift in medical practice as it pertains to treating CVD, rather than physicians and scientist looking at this as a single organ disease, we are now considering the pathophysiological condition to include genetic inheritance and lifestyle that imparts changes to the heterogeneity of molecular, cellular and organs systems.

It is well accepted that a number of risk factors contribute to the onset of CVD to include poor nutrition, lack of physical activity, hypertension, obesity, diabetes and certain forms of cancer. My research has focused on the role reactive oxygen species (ROS) have played on the onset on CVD due to increased vascular inflammation. ROS is a common term that is used to address the highly regulated enzymatic process that can be either antimicrobial or damaging to an organ system. Oxidative stress has been thought to be a balancing act between oxidants and antioxidants, but the mechanism of using high antioxidant foods have not rendered any changes in oxidative outcomes. There is new research that is being conducted by Cortese-Krott et al. (2017) that is identifying a new and integrative biology concept known as redox regulation. In their study, they have defined various chemical interactions of reactive sulfur species, reactive nitrogen species, and ROS along with downstream biological targets as reactive species interactome (RSI). This group suggest RSI serves to sense multiple stressors and adjust metabolic needs accordingly. This model identifies thiols as an important source of ROS in addition to the cysteine redox switches.

More research is necessary to determine whether efficiency of these new developments; however, we cannot evade the concept of ROS leading to an enhanced immune response that contributes to the disease process. It is my opinion, that this new development will open a new mechanistic pathway to understand the pathophysiology that leads to CVD and increase the intersystemic approaches that are used to treat the chronic inflammatory response that leads to CVD.

Anberitha Matthews, PhD is a Postdoctoral Fellow at the University of Tennessee Health Science Center in Memphis TN. She is living a dream by researching vascular injury as it pertains to oxidative stress, volunteers with the Mississippi State University Alumni Association, serves as Chapter President and does consulting work with regard to scientific editing.
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Surviving A Deadly Heart Attack

Anberitha Matthews, PhD

With cardiovascular disease (CVD) being the leading cause of mortality and morbidity among the western population, it is not a long shot for one to think almost everyone knows someone that has encountered heart disease or the symptoms thereof. Not surprising that I had the opportunity to meet these people whom I am now writing.

 

Heart month heart image

There was a cardiologist at a well-known and respected institution that suggested, her patient, a 60 year old man with two occluded arteries and only a functioning aorta (widow maker) had on average 10 years to live. The patient had one silent heart attack and one where he sought medical treatment. During that time the cardiologist attempted to place a stent to reopen the artery, but had no success due to the “amount of scarring.” Which is why the patient was left with two arteries occluded. I am left to wonder, with all the research that is being conducted to extend life and improve cardiac health including but not limited to pharmaceuticals and the surgical techniques, why is there nothing that can be done other than sending this patient home with a bleak outlook on the next several years of his life. That patient is still alive and doing well, thanks for asking. That is not an isolated case of patients being sent home hopeless. I came across a story on Facebook (2014) about a 58 year old lady that was on hospice for the last four years. She presented to the hospital in full cardiac arrest. The emergency medical team was performing compressions until she arrived at the hospital; thankfully they were able to revive her. She previously suffered 3 heart attacks resulting in 2 triple bypass surgeries, but after that 4rd heart attack in August 2010 the doctors said there was nothing they could do to improve her [cardiac] health. Before you are alarmed, she had multiple chronic illnesses by this time: 3 myocardial infarction (MI), congestive heart failure, diabetes, breast cancer (resulting in double mastectomy), hypertension, and renal failure. Since she was not a good candidate for dialysis, she had a poor prognosis. She was taken off all her medications (from a cocktail of 19 pills to 4, which were for CVD symptoms and a morphine tablet for pain) and the end of life care team made worked diligently to make her comfortable until she passed.  The medical providers alerted the family that she could pass on at any time. That was in 2010, it is now 2018 and she is STILL alive and well! Both patients are.  So, what allowed this Facebooker to live so long with no major arteries? How is this even possible? Is it a case of faith/a miracle alone (which is what the Facebook post suggest) or something that can be medically/scientifically explained? What about the man from the former story? Is 10 years the best he could hope for or is the case with the latter possible in his case? Is there anything we can do pharmaceutically to drive the system toward the former?

the vascular endothelial growth factor graphic

In a 2018 study by Manavski et al, it was suggested that angiogenesis after ischemia is due to clonal expansion of endothelial cells. Indicating there is, indeed, a scientific rationale for the revascularization of the aforementioned hearts. After an MI there is significant scar tissue leading to the inability for the heart to provide the necessary oxygen and nutrients to other organ systems, known as ischemia. The newly ischemic environment potentiates the growth of new vessels to compensate for the loss of cardiac output due to the MI. These vessels are said to be generated through a mechanism known as angiogenic sprouting; in excess this pathological growth that can promote tumor formation. The signaling molecule vascular endothelial growth factor (VEGF) is hallmark in the formation of new vessels, but it is also highly expressed in cancers. Before we get off track, let’s think about the mechanisms in play in an MI. monocytes are attracted to an insult in the vessel, they differentiate into macrophages, those macrophages take up oxidized low density lipoproteins, and since they cannot process them, they die (undergo apoptosis). In ischemia macrophages promote the development of collateral vessels, but in tumors macrophages (M2) produce proangiogenic factors while educating the macrophage as what phenotype to take on – Tumor or cardiac. There are signals in the body that include VEGF and Ang1 that keep endothelial cells inactive to promote vessel stabilization. Furthermore, an oxygen sensor helps the endothelial cells to normalize and readapt to oxygen supply to the organ tissues. There are a battery of enzymes that play a role in vessel maturation which is too exhaustive for this blog, but mainly sprouting is impaired by inhibition of VEGF and S1P receptor signaling is the stabilizer for the vasculature.

In conclusion, having a heart attack is not necessarily a death sentence. Even when all the arteries to the heart of occluded. It is not the norm, but the human body is an overwhelmingly amazing in compensating for the loss of some pathways. Our bodies have system in place with mechanism to support life even when the answers evade medicine and science. With the passion to conduct research, we are finding ways to make our heart health better daily. As we explore mechanistic pathways to reduce oxidative stress, inflammation, and other underlying pathways, it is up to each individual to maintain a healthy heart by following the guidelines set in place by the American Heart Association. As for the patients above, they are working with their medical teams to maintain a healthy life. May I suggest you all continue to seek your physicians’ advice on how to improve/maintain your heart health?


Anberitha Matthews, PhD is a Postdoctoral Fellow at the University of Tennessee Health Science Center in Memphis TN. She is living a dream by researching vascular injury as it pertains to oxidative stress, volunteers with the Mississippi State University Alumni Association, serves as Chapter President and does consulting work with regard to scientific editing.