Program helps prevent sudden cardiac arrest in children and teens.
Stuart Berger, UC Davis
By Tricia Tomiyoshi, UC Davis
A life-saving program that helps to prevent sudden cardiac arrest in children and teens has now arrived in California.
UC Davis Children’s Hospital in Sacramento has become the first California affiliate for Project ADAM (Automated Defibrillators in Adam’s Memory), a nonprofit organization dedicated to establishing comprehensive defibrillation programs in schools across the country. The program’s mission is to reach out to schools to ensure that automated external defibrillators (AEDs) are installed and that staff, faculty, students and families are trained how to use them and to perform CPR.
Stuart Berger, chief of the Division of Pediatric Cardiology at UC Davis Children’s Hospital, founded Project ADAM while he was working at the Children’s Hospital of Wisconsin in 1999. The program has since expanded to 10 states in its 15 years of operation and more than 85 lives have been saved in children and adolescents as well as adults.
“I’m very excited to bring Project ADAM to the Sacramento region,” said Berger. ”This has been such a wonderful community outreach project. It has brought the community together at multiple levels and it has saved lives. It would be wonderful to institute this program in every school in the state of California as well as in the entire country.”
The Sacramento Kings will host a night dedicated to heart health awareness on Feb. 20. A portion of proceeds from tickets purchased through this ticket link (using passcode: Kings) will be donated to the Sacramento Project ADAM.
Project ADAM was named in honor of 17-year-old Wisconsin high school basketball player, Adam Lemel, who died on the court due to an undiagnosed genetic heart condition. According to Berger, at least 100 to 200 children and teens experience sudden non-traumatic cardiac death each year in the U.S., although the exact number is unclear and this number could be an underestimate of the true incidence. Multiple studies, including the new National Institutes of Health and Centers for Disease Control and Prevention’s Sudden Death in the Young registry, have been designed to get more specific data about the incidence of this devastating problem.
Schools, organizations and community members interested in being a part of Sacramento Project ADAM are welcome to attend the next community meeting on Thursday, Jan. 29, at 5:30 p.m. at the UC Davis Health System Facilities Support Services Building, 4800 2nd Ave., Sacramento in Room 2030.
J. Nilas Young details a quarter century of establishing cardiac surgery sites in Russia.
J. Nilas Young, UC Davis
By Karen Finney, UC Davis
J. Nilas Young, UC Davis chief of cardiothoracic surgery, has published a landmark article on medical humanitarian aid, detailing his 25 years of experience establishing six cardiac surgery sites in Russia.
The article appears in the December 2014 issue of the prestigious Journal of Thoracic and Cardiovascular Surgery and is also available online.
Young’s UC Davis co-authors were pediatric cardiac surgeon Gary Raff and pediatric critical care physician James Marcin, and his collaborators included colleagues at the Mayo Clinic, Emory University, Childrens Hospital of Wisconsin, Nationwide Childrens Hospital and the Siberian Branch of the Russian Academy of Medical Science.
The article emphasizes the approach of Heart to Heart International Children’s Medical Alliance in developing sustainable medical aid programs with high-quality outcomes, scalability and efficacy. Although focused on a specific class of diseases (congenital heart diseases), the authors believe the model is applicable to other medical humanitarian projects, particularly those that involve complex surgical interventions.
In 2012, Young received the the World of Children Health Award — hailed as the “Nobel Prize for child advocates” — for his international humanitarian efforts to improve pediatric heart care (read the press release).
Clogged interstates aggravate clogged arteries, according to UC Irvine research.
Credit: Jess Wheelock, UC Office of the President
By Nicole Freeling, UC Newsroom
Anyone who has experienced Los Angeles gridlock likely can attest that traffic may cause one’s blood pressure to rise. But UC Irvine researchers have found that, beyond the aggravation caused by fellow drivers, traffic-related air pollution presents serious heart health risks — not just for rush hour commuters, but for those who live and work nearby.
Research by UC Irvine joint M.D./Ph.D. student Sharine Wittkopp contributes to evidence that the increased air pollution generated by vehicle congestion causes blood pressure to rise and arteries to inflame, increasing incidents of heart attack and stroke for people who reside near traffic-prone areas.
“While the impact of traffic-related pollution on people with chronic lung diseases is well known, the link to adverse heart impacts has been less described,” said Wittkopp.
UC Irvine M.D./Ph.D. student Sharine Wittkopp is investigating genetic factors that make some people more vulnerable to pollution’s negative effects. (Photo courtesy of Sharine Wittkopp)
Her research project, funded by the National Institute of Environmental Health Sciences, focused on residents of a Los Angeles senior housing community who had coronary artery disease.
Study participants spend the vast majority of their time at home, which meant they had prolonged exposure to traffic-related air pollution at the site. Because of their age and pre-existing heart conditions, they were thought to be more vulnerable to small, day-to-day variations in air quality.
“They are really in the thick of it,” Wittkopp said. “They are the ones that are going to suffer the most, and who are the least likely to be resilient.”
Up to now, most studies on the impacts of air pollution have focused on its effects over much larger populations, with difficulty capturing accurate exposures and short-term changes. Wittkopp and her team wanted to look at how daily fluctuations in traffic and air quality would affect those residing in the immediate vicinity of congested roadways.
The research team, led by adviser Ralph Delfino, associate professor and vice chair for research and graduate studies in the Department of Epidemiology at UC Irvine’s School of Medicine, set up air quality monitors at the residences of the study participants. They looked for daily and weekly changes in traffic-related pollution such as nitrogen oxides, carbon monoxide, and particulate matter.
What they found: “Blood pressure went up with increased traffic pollutants, and EKG changes showed decreased blood flow to the heart,” Wittkopp said.
Uncovering a genetic link
Just how susceptible a person is to these negative impacts appears to depend not just upon age and proximity to traffic, but also upon genetics, the research team found.
They uncovered what they believe is the first epidemiological evidence that a person’s mitochondrial DNA could affect their susceptibility to adverse health effects related to air pollution.
“When our cells are exposed to toxins, they respond by making more proteins that enable them to detoxify pollutants,” Wittkopp said. “We can actually monitor how the protein levels are going up and down and how the gene readouts change as people are exposed.” Looking at traffic-related pollution, they discovered that a person’s ability to produce the proteins that combat pollutants varied dramatically based on their DNA.
By identifying the genetic variables that place people at greater risk, health care providers could help account for these impacts and prescribe proactive treatments — such as antioxidants that reduce inflammation — that would make people less vulnerable.
But Wittkopp also stresses such treatment would simply be a Band-Aid on the greater problem.
Impetus to improve infrastructure, lessen exposure
“Understanding the health problems that traffic-related pollution causes helps us understand why we need to change things and improve our infrastructure to reduce exposure,” said Wittkopp, who believes this research can provide policymakers and the public with a fuller picture of the impact of pollution.
“This kind of information can help us quantify the cost of traffic-related air pollution in terms of health care costs, lives lost and quality of life diminished.”
While genetic factors may make some more vulnerable than others, Wittkopp points out, “There’s no one who’s not susceptible in some way. No one gets better when they are exposed to these pollutants.”
UC San Diego study finds higher risk for liver disease, high blood pressure, heart problems.
High blood pressure and nonalcoholic fatty liver disease (NAFLD) are two emerging health problems related to the epidemic of childhood obesity. In a recent study, researchers at the UC San Diego School of Medicine sought to determine the prevalence of high blood pressure in children with NAFLD, which places them at risk for premature cardiovascular disease.
The study, published in today’s (Nov. 24) edition of PLOS ONE, found that children with NAFLD are at substantial risk for high blood pressure, which is commonly undiagnosed.
“As a result of our study, we recommend that blood pressure evaluation, control and monitoring should be included as an integral component of the clinical management of children with NAFLD, especially because this patient population is at greater risk for heart attacks and strokes,” said Jeffrey Schwimmer, M.D., in the Department of Pediatrics at UC San Diego School of Medicine and principal investigator of the study. “Hypertension is a main cause of preventable death and disability in the United States in adults, but much of the origin occurs in childhood.”
NAFLD – the inappropriate storage of fat droplets inside liver cells – is the most common cause of chronic liver disease in the United States and affects nearly 10 percent of all children. Although children with chronic liver disease often have no symptoms, some children with NAFLD will have fatigue and/or abdominal pain. The initial evaluation for NAFLD is via a blood test and diagnosis is ultimately based upon a liver biopsy. The disease is most common in children and teenagers who are overweight and can develop in conjunction with other health problems, such as diabetes.
UC Santa Barbara professor co-authors paper that examines global impact of what we eat.
The world is gaining weight and becoming less healthy, and global dietary choices are harming the environment.
Those are among the findings of a paper co-authored by David Tilman, a professor in the UC Santa Barbara Bren School of Environmental Science & Management, and Michael Clark, a graduate student at the University of Minnesota, where Tilman also is a professor. In “Global Diets Link Environmental Sustainability and Human Health,” published today (Nov. 12) in the journal Nature, the researchers find that rising incomes and urbanization around the world are driving a global dietary transition that is, in turn, diminishing the health of both people and the planet.
“These dietary shifts,” they write, “are greatly increasing the incidence of Type 2 diabetes, coronary heart disease and other chronic non-communicable diseases that lower global life expectancies.”
The paper is the first to show the global links among the elements of what Tilman refers to as the “tightly linked diet–environment–health trilemma.”
“Previous analyses have looked at the effects of diet in individual countries, but we are the first to examine the global impacts on both human health and the environment of diet as it is now and as it is becoming,” he says. “We gathered information on dietary trends and environmental impacts for 90 percent of the global population. Our data let us see how diets, health and the environment have been changing and where they are going.”
“Some of what we found is not surprising, but the global implications are frightening,” Tilman adds. “Most of us have heard that some diets are healthier, that eating too many calories is bad for you and that red meat harms the environment. We were surprised at how rapidly and consistently diets were changing around the world, how massively this would impact global health and how much it would increase global greenhouse gas emissions and the destruction of tropical forests and other ecosystems.”
Unhealthful diets linked to urbanization
The links between urbanization, increased wealth and unhealthful diets are clear, Tilman explains. When a country industrializes, the transition from a traditional rural diet to one that includes more processed meats and more empty calories can occur quickly. “People move to cities, leaving behind their own gardens where they grew fruits and vegetables,” Tilman said. “They’re working in a factory 12 hours a day, six or seven days a week, so they need food that’s cheap and fast. The cheapest, fastest food you can get is filled with starch, sugar, fat and salt. Almost overnight, they go from a healthy diet to one that has way too many calories and leads to diabetes and heart disease.”
Also, because people tend to eat more meat as they become wealthier, much of the expected 100-percent increase in crop production that will be required by 2050 would be used to feed not humans but livestock. To do that, much more land will need to be cleared, with the result that more habitat will be lost, more species will likely become extinct and increased runoff of agricultural fertilizers and pesticides will degrade streams, rivers, lakes, groundwater and oceans.
Alternative diets offer health benefits
Tilman suggests that hope — and help — lie in the widespread adoption of alternative diets that offer substantial health benefits and could reduce global agricultural greenhouse gas emissions, reduce land clearing and resultant species extinctions and help prevent a variety of diet-related chronic noncommunicable diseases.
Comparing conventional American omnivorous diets to the Mediterranean diet, a pescetarian diet (in which fish is the only animal protein) and a vegetarian diet, the compiled research showed that the three alternatives to the omnivorous diet decreased Type 2 diabetes by 16 to 41 percent, cancer by 7 to 13 percent and morality rates from coronary heart disease by 20 to 26 percent. Moreover, the authors show that these alternative diets could reduce global greenhouse gas emissions from food production by about 40 percent below what they would be if dietary trends continued.
To reach their conclusions, the researchers gathered all published life-cycle assessments covering “cradle to farm gate” greenhouse gas emissions for production systems of food crops, livestock, fisheries and aquaculture — some 500 studies, of which about 220 were useful. They also gathered 50 years of data for 100 of the world’s more populous nations to analyze global dietary trends and their drivers, using that information to forecast future diets should past trends continue.
To quantify the effects of alternative diets on mortality and on Type 2 diabetes, cancer and chronic coronary heart disease, they summarized results of eight major long-term studies on diet and health. Finally, they combined those relationships with projected increases in global population to forecast global environmental implications of current dietary trajectories and calculate the environmental benefits of diets associated with reduced rates of chronic noncommunicable diseases.
“Better diets are the solution to these big problems,” Tilman says. “Only better diets can prevent a massive global epidemic of chronic noncontagious disease. These same diets would also protect the environment. Since big food companies produce so much of what is eaten, we need them to be part of this solution. By developing, producing and advertising foods that are healthy and tasty, these companies can help their customers, the earth and their bottom line. It is a niche waiting to be filled.”
Tilman wonders if unhealthy foods laden with fats or sugars might grow into a health issue somewhat like smoking. “Throughout history, foods that tasted good were almost always healthy but scarce. Now we have thousands of inexpensive manufactured foods that taste good because of an overabundance of sugar, fat or salt but are bad for us. What is the ethics of selling such foods now that we know how bad they are for heath and the environment?”
The research generated a number of nuanced findings about the environmental impacts of various dietary choices. The following are among them:
While the difference in greenhouse gas emissions for animal-based versus plant-based foods is well known, emissions per gram of protein for beef and lamb are about 250 times those of legumes; pork, chicken, dairy, and fish have much lower emissions;
Twenty servings of vegetables have fewer greenhouse gas emissions than one serving of beef.
Fish caught by trawling, which involves dragging fishnets along the ocean floor, can have three times the emissions of fish caught by traditional methods.
And among cereal grains, rice has five times the emissions per gram of protein as wheat.
These and other facts demonstrate that there are many diets that are both good for the environment and healthy.
While Tilman does not expect to see quick societal changes in diet, he hopes that the paper will be seen by the right people who can influence the food supply and that it “can encourage people to think about this challenge and have a dialogue it.”
Researchers highlight strong links between sugar and chronic disease.
By Kristen Bole, UC San Francisco
Researchers at UC San Francisco have launched SugarScience, a groundbreaking research and education initiative designed to highlight the most authoritative scientific findings on added sugar and its impact on health.
The national initiative is launching in partnership with outreach programs in health departments across the country, including the National Association of City and County Health Organizations and cities nationwide.
Developed by a team of UCSF health scientists in collaboration with scientists at UC Davis and Emory University School of Medicine, the initiative reflects an exhaustive review of more than 8,000 scientific papers that have been published to date on the health effects of added sugar.
The research shows strong evidence of links between the overconsumption of added sugar and chronic diseases, including Type 2 diabetes, heart disease and liver disease. It also reveals evidence linking sugar to Alzheimer’s disease and cancer, although the team assessed that more research is needed before those links can be considered conclusive.
Laura Schmidt, UC San Francisco
“The average American consumes nearly three times the recommended amount of added sugar every day, which is taking a tremendous toll on our nation’s health,” said Laura Schmidt, Ph.D., a UCSF professor in the Philip R. Lee Institute for Health Policy Studies and the lead investigator on the project. “This is the definitive science that establishes the causative link between sugar and chronic disease across the population.”
The initiative aims to bring scientific research out of medical journals and into the public domain by showcasing key findings that can help individuals and communities make informed decisions about their health. For example, SugarScience.org cites research showing that drinking just one can of soda per day can increase a person’s risk of dying from heart disease by nearly one-third, and can raise the risk of getting Type 2 diabetes by one-quarter.
More than 27 million Americans have been diagnosed with heart disease, which is the nation’s leading cause of death. Another 25.8 million Americans have Type 2 diabetes, caused by the body’s resistance to the hormone insulin coupled with the inability to produce enough insulin to regulate blood sugar levels. Of greatest concern is the rising number of children suffering from these chronic diseases.
Kristen Bibbins-Domingo, UC San Francisco
“Twenty years ago, Type 2 diabetes was unheard of among children, but now, more than 13,000 children are diagnosed with it each year,” said Kirsten Bibbins-Domingo, M.D., Ph.D., a UCSF professor of medicine, epidemiology and biostatistics, and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Diabetes is a devastating disease and we know that it is directly related to the added sugar we consume in food and beverages.”
Another rising concern is the impact of added sugar on Non-Alcoholic Fatty Liver Disease (NAFLD), which affects 31 percent of adults and 13 percent of children, and can lead to cirrhosis and liver failure.
“As pediatricians, we had evidence of the connection between sugar and diabetes, heart disease, and liver disease for years, but we haven’t had this level of definitive scientific evidence to back up our concerns,” said Robert Lustig, M.D., M.S.L., a pediatric endocrinologist at UCSF Benioff Children’s Hospital San Francisco and a member of the SugarScience team. “Our goal is to make that science digestible to the American public, and take the first step toward a national conversation based on the real scientific evidence.”
Robert Lustig, UC San Francisco
While there are no federal recommended daily values for added sugar, the American Heart Association recommends consuming less than 6 tsp. (25 g) for women and 9 tsp. (38 g) for men. Guidelines for children depend on caloric intake, but range between 3-6 tsp (12-25 g) per day. Americans currently consume 19.5 tsp. of added sugar, on average, every day.
Added sugar is defined as any caloric sweetener that is added in food preparation, at the table, in the kitchen or in a processing plant. It can be difficult for people to know how much sugar they are consuming, since roughly 74 percent of processed foods contain added sugar, which is listed under at least 60 different names on food labels.
The 12-member SugarScience team will continue to monitor scientific research about added sugar and will track findings at SugarScience.org. The initiative harnesses the power of UCSF’s extensive health sciences enterprise, which ranges from basic laboratory research to clinical, population and policy sciences, with an emphasis on translating science into public benefit. All four of UCSF’s graduate schools – dentistry, medicine, nursing and pharmacy – lead their fields in research funding from the National Institutes of Health, reflecting the caliber of their research. It also is aligned with the UC Global Food Initiative, which seeks to harness UC resources to address global food needs.
SugarScience is made possible by an independent grant from the Laura and John Arnold Foundation. It is supported by the Clinical and Translational Science Institute and the Philip R. Lee Institute for Health Policy Studies at UCSF.
Would potentially reduce the number of surgeries single-ventricle patients have to undergo.
A computer simulation showing how a clipped shunt would connect an artery off the aorta to the superior vena cava.
Engineers at the UC San Diego are proposing a new surgical intervention for children born with a single ventricle in their heart — instead of the usual two. The new approach would potentially reduce the number of surgeries the patients have to undergo in the first six months of life from two to just one. If successful, it would also create a more stable circuit for blood to flow from the heart to the lungs and the rest of the body within the first days and months of life.
Engineers ran computer simulations of the surgery and found it would reduce the workload on the patient’s heart by as much as half. It would also increase blood flow to the lungs and increase the amount of oxygen the body receives.
The surgery would introduce a radical change in the way infants with a single ventricle are treated. Currently, they undergo three surgeries by age three. Babies born with a single ventricle are severely deprived of oxygen, which makes their skin turn blue, and requires immediate medical intervention.
The research group, led by Alison Marsden, a professor of mechanical engineering, is working in collaboration with cardiothoracic surgeon Tain-Yen Hsia, of the Great Ormond Street Hospital for Children and UCL Institute of Cardiovascular Science in London. They reported their findings in an October issue of the Journal of Thoracic and Cardiovascular Surgery.
“Even when surgeries are successful, these babies live with a circulation that is very taxing on the one heart pump they have,” Dr. Hsia said. “So there is a need to find a better solution.”
Receives Get With The Guidelines award for treating heart failure patients.
UC Irvine Health has received the Get With The Guidelines– Heart Failure Gold Plus Quality Achievement Award from the American Heart Association. The recognition signifies that UC Irvine Health has achieved the goal of treating heart failure patients according to the secondary prevention guidelines recommended by the American Heart Association/American College of Cardiology.
This marks the fourth year the American Heart Association program has recognized UC Irvine Health with this quality achievement award. Get With The Guidelines–Heart Failure is a quality improvement program that helps hospitals to provide the most up-to-date, research-based guidelines with the goal of speeding recovery and reducing hospital readmissions for heart failure patients.
“We are dedicated to delivering the highest quality care and improving patient outcomes,” said Dr. Dawn Lombardo, director of the UC Irvine Health heart failure program. “The American Heart Association’s recognition of our commitment demonstrates that our patients can expect to receive the latest standards of care for treating heart failure.”
UC Irvine’s cardiology team earned the award by meeting specific quality achievement measures for the diagnosis and treatment of heart failure patients at a set level for a designated period. These measures include proper use of medications and aggressive risk-reduction therapies such as evidenced based beta-blockers, ACE/ARB inhibitors, Aldosterone Antagonist and anticoagulants for atrial fibrillation while patients are in the hospital. Before patients are discharged, they are educated on how to manage their heart failure and overall health, are provided referrals to our heart failure outpatient management program, and receive post discharge follow-up phone calls.
UC Irvine Health exceeded the national benchmarks in six of the nine Heart Failure Quality Measures for 12 consecutive months to achieve the Plus designation, and in all four of the Heart Failure Achievement Measures for two consecutive years to achieve the Gold designation.
UC Irvine Medical Center also received the association’s Target: Heart Failure Honor Roll for the first time this year, exceeding the national benchmark for 50 percent or more of eligible patients in all three care components – medication optimization, early follow-up and care coordination, and enhanced patient education.
Novel technology makes screening cheaper and much easier.
Engineers at UC San Diego have determined for the first time the impact of a ring-shaped vortex on transporting blood flow in normal and abnormal ventricles within the human heart. They worked with cardiologists at the Non-Invasive Cardiology Laboratory at Gregorio Marañon Hospital, in Madrid, Spain.
In order to make the study possible, researchers have developed a novel ultrasound technology that makes screening cheaper and much easier, making it possible to reach a large number of people and even infants. Intra-ventricular flow imaging is currently done with MRI scans, which is expensive and not suitable for patients with implanted devices such as pacemakers.
The findings could have an impact on the tests and measurements that physicians rely on to diagnose and treat two heart conditions: hypertrophic cardiomyopathy, in which the heart muscle becomes abnormally thick, and non-ischemic dilated cardiomyopathy, in which the heart’s ability to pump blood decreases as the organ’s main pumping chamber, the left ventricle, is enlarged and its muscle thinned.
Nearly one million Americans suffer from either one of these conditions.
So far, physicians only take into consideration the geometry of the left ventricle and the thickness and contractility of its walls when they assess how the heart fills itself with blood. But the way the blood flows into the heart’s chambers is important too, researchers argue. “This isn’t like toothpaste coming out of a tube,” said Juan Carlos del Alamo, professor of mechanical and aerospace engineering at the Jacobs School of Engineering at UC San Diego, who led a multidisciplinary team for this study, together with postdoctoral researcher Pablo Martinez-Legazpi and Dr. Javier Bermejo’s group of cardiologists at Gregorio Marañon Hospital.
They reported their findings in the Oct. 21 issue of the Journal of the American College of Cardiology.
Stuart Berger joins from Children’s Hospital of Wisconsin.
Stuart Berger, one of the nation’s premier pediatric cardiologists and the leader in a national campaign to prevent sudden cardiac arrest deaths in children and teens, has joined the faculty of the UC Davis School of Medicine as professor and vice-chair of the Department of Pediatrics and chief of the Division of Pediatric Cardiology.
Before joining the faculty, he was chief of pediatric cardiology and medical director of the Herma Heart Center at the Children’s Hospital of Wisconsin in Milwaukee and professor of pediatrics at the Medical College of Wisconsin. Under his leadership, Children’s Hospital of Wisconsin rose to become one of the top pediatric heart centers in the country, ranked #5 by U.S. News & World Report this year.
“We are excited to welcome Dr. Berger to UC Davis with his expertise, focus on quality outcomes and international reputation. We are eager to implement his vision for improving access to high-quality cardiac care for the children of Northern California,” said Robin Steinhorn, chair of the UC Davis Department of Pediatrics.
Berger’s clinical and research interests include congenital heart disease in fetuses, neonates, infants, children and adults; pulmonary hypertension; heart failure in children; sudden cardiac death in youth; and the resuscitation of children and young adults.
His commitment to assist youth who suffer sudden cardiac arrest led him to start Project ADAM (Automated Defibrillators in Adam’s Memory), named in honor of a high school basketball player who died on the court due to an undiagnosed heart problem. The national program aims to prevent sudden cardiac arrest in children and teens through education and life-saving programs, including expanding the availability of automated external defibrillators (AEDs), which help restore heart rhythm and improve survival from cardiac events. More than 85 lives have been saved so far through Project ADAM, which has been in operation for 15 years.
Berger received his medical doctorate from the University of Wisconsin Medical School in Madison and completed his pediatric residency at the University of Chicago Wyler Children’s Hospital and his fellowship in neonatology and pediatric cardiology at the University of Chicago. He is board certified in pediatrics and pediatric cardiolology.
Study is among the largest to compare survival benefits of these devices by race, ethnicity.
Gregg Fonarow, UCLA
Racial and ethnic minorities who receive implantable devices to treat heart failure derive the same substantial survival benefit from these therapies as white patients, new UCLA-led research shows.
While the American College of Cardiology and American Heart Association jointly recommend the use of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices for all eligible patients, minorities have not been well represented in clinical trials of the devices, and previous studies had shown that African American and Hispanic patients are less likely to receive these recommended therapies.
The current study — among the largest to compare the survival benefits of these devices by race and ethnicity — involved more than 15,000 patients at 167 cardiology and multi-specialty practices across the U.S. The research was coordinated by 10 academic medical centers, including UCLA
The findings are published in the current issue of the Journal of the American College of Cardiology.
Drawing on data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), the researchers monitored 15,177 heart failure patients over two years to measure the benefits of implantable device therapy on survival in community practice settings.
They found that ICD device therapy reduced the likelihood of death during the two-year period by 36 percent, with no significant differences by race or ethnicity. They also found a 45 percent reduction in mortality with CRT therapy, again without any significant differences in device benefit by race or ethnicity.
“This is among the largest studies to address the question of race- and ethnicity-specific benefits with ICD or CRT therapies in real-world practice,” said senior author Dr. Gregg C. Fonarow, who holds the Eliot Corday Chair in Cardiovascular Medicine and Science and directs the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA. “Our results are a reminder to physicians and patients that this proven life-extending therapy should be offered to all eligible heart failure patients without regard for race or ethnicity.”
Heart attack survivors who exceed 30 miles of running per week may lose the health benefits accrued by running less, according to new research by the Department of Energy’s Lawrence Berkeley National Laboratory life sciences researcher Paul T. Williams. His work appears in an upcoming issue of the Mayo Clinic Proceedings. Similar results were found for walkers who expended 46 miles per week, the energy equivalent of running 30 miles. The study was co-authored by Paul D. Thompson, cardiologist at Hartford Hospital in Connecticut.
The study included 2,377 subjects who reported having had a prior heart attack when they enrolled in the National Runners’ and Walkers’ Health Study. During the average 10.4 years of follow-up there were 376 deaths due to cardiovascular disease. The risk of dying from a cardiovascular disease decreased progressively through about 30 miles run or 46 miles walked per week. Those achieving this level were at 70 percent lower risk than those who neither walked nor ran. But at higher exercise levels, the risk of a cardiovascular death was about 2.6-times greater. This wiped out all of the risk reduction accrued below 30 miles run or 46 miles walked, so much so that cardiovascular disease mortality in these patients was similar to those that hardly exercised.
“The results are surprising,” said Williams. “Our previous research has shown that heart disease risk factors and the risk for nonfatal heart attacks improved with greater running distance through at least 40 miles per week, with no indication that things got worst at higher mileages. Like other medical treatments, there appears to be a level that can be excessive.” Williams cautions that his findings were specific to heart attack survivors.