- Good afternoon, everybody.
And hank you for tuning
in to our Google+ Hangout,
airing live from the
American Heart Association
Scientific Sessions.
I'm Katti Gray, contributing editor
for dailyrx.com, and
I'll be your moderator
for today's panel.
Today, we're here to talk about
knowing your risk for heart disease,
including the about the latest studies,
the details of that, from
the scientific session.
So, let's get started with our
distinguished members of the panel.
Our leading guest, of
course, is Dr. Donna Arnett.
She's president of the Heart Association.
She will introduce the other
two guests for the afternoon,
and we'll fire away with
questions from there.
We'll take your questions
toward the end of the session.
Dr. Arnett?
- Thank you, Katti, it's
a delight to be here.
I'm joined by two illustrious guests,
Dr. Amit Khera, from UT Southwestern,
and Dr. Penny Kris-Etherton,
from Pennsylvania.
- And absolutely one other
reminder, those of you
who are tuned in, we are
tweeting live at #AHA14.
Before we get into the latest news,
let's just start with a few basics.
If y'all would lay for us what remain
some of the continuing
risk for heart disease,
elevated blood pressure,
that type of thing,
and give us a sense of
where we are in terms
of managing and controlling
those as a general public.
- Well, Katti, I'll
lead off by saying that
heart disease and stroke
are the number one and number
four killers of Americans,
so these two diseases remain
a really important of
concern for the U.S. public.
The good news is that 80%
of cardiovascular disease
and stroke is preventable by following
a very simple prescription.
We call it here, at the
American Heart Association,
Life's Simple Seven.
Really, it's knowing your
numbers, for your blood pressure,
your cholesterol, and your glucose levels,
and keeping those within
the normal limits.
And really adhering to four behaviors
that can maintain your health
throughout your lifetime
and prevent cardiovascular disease.
That's being a non-smoker,
having a healthy weight,
eating a good diet, and
exercising regularly.
With those activities,
you can reduce your risk
of heart disease, stroke,
and not only those two,
but cancer and diabetes as well.
- What sort of headway
are we making in terms
of applying those in the
lives of everyday people?
How far are we going in that direction?
- We're starting to
see bends in the needle
in areas of obesity with some policies
and activities that have
been taking place in schools.
I'll ask Penny, what do
you think we're doing
in terms of bending the curve here?
- I think that we've
made a lot of progress
in meeting some of the metrics
for our (mumbles) protection.
But, I think in terms of diet,
and nutrition is my area of expertise,
we really have a long way to go still.
- And Amit, what do you think?
- I'll add to that.
I think we've changed the conversation,
away from thinking about lowering death,
but how do we improve
cardiovascular health
in our population?
And really, looking population-wide,
across the different metrics.
We changed the way we think
about cardiovascular health.
- If y'all would just dig
a little deeper into that,
if there is some distance to go in terms
of helping people to
transform their eating habits,
what would be that distance?
And are there, across
the demographic of people
who live in this country,
are there particular areas of challenge?
Where would those areas be, and with whom?
- Let me lead off, and then
I'll ask our nutrition expert
from Penn State to answer
that question as well.
Really, diet is.
We at the American Heart Association
don't recommend a specific diet.
We really ask you to work
with your healthcare provider.
Certainly, we do know that diets rich
in fruits and vegetables,
and low in sodium,
and filled with the good kind of fat,
which I'm sure Penny will talk about,
those are diets that we know,
in addition lowering caloric intake
if you're overweight and
trying to lose weight,
are the healthiest ways to do that.
- The American Heart
Association recommends
a dietary pattern that's rich
in fruits and vegetables,
whole grains, lean proteins,
that's low in sodium, low in added sugars.
It contains skim milk,
low-fat dairy products,
and lean protein sources.
So, in terms of how Americans are doing,
we fall way short in meeting
those particular recommendations.
We're eating way, way,
way too much added sugar,
and way too much sodium as well.
Saturated fat is high, too.
In order to decrease risk of heart disease
through a healthful diet.
- And you asked about the demographic.
Something that we hear a lot
is that people are concerned
that these diets rich
in fruits and vegetables
are hard to maintain on low budget.
Would either of you like to comment on
the ability to do that?
- I'd like to just jump in
and say that if people choose
seasonal fruits and
vegetables, it's a lot easier
to follow current recommendations.
You don't have to break a budget
meeting these current recommendations.
I think understanding how to shop wisely
is one way get those.
- I also want to bring
up societal context.
When one component,
sodium, which we've been
so focused on, we have to remember that
much of it is in things that we eat,
where bread, which is one
of the major contributors
cumulative to sodium.
A lot of work with the
American Heart Association,
working with the industry,
working our partners
to try to reduce sodium,
so that the easy choice
is easier to make in
terms of reducing sodium.
- One interesting aspect
of this week's research
has been on trans fat consumption,
and it's link to poor
memory, or to memory loss,
phrased another way,
among working-aged adults.
So the question is this,
precisely who are those
working-aged adults,
what does it cost them in the workplace,
and is there any discussion of how to get
employers on the bandwagon,
and to see that association,
perhaps, between productivity
and work, et cetera?
- The study that was
done is very interesting.
There were 1,000 men studied,
researchers looked at
their trans fat intake, and basically,
those that had the highest
trans fat intake had
the worst memory recall on
a word memory recall test.
They recalled 10% fewer words
than compared with people
who had a low trans fat intake.
In fact, for every one
gram of trans fat intake,
there was about a one word memory loss,
which is pretty significant.
We've known for a long time trans fats
are really bad for heart disease risk,
and then diabetes as well.
Now we're learning that they're
equally bad for the brain.
- Is there any discussion at the benefits
for employers to be aware
of these associations,
and how to have a sort
of good eating campaigns
in their own workplaces?
- Amit, do you want to talk about that
from a policy perspective,
and what we are doing
with workers' rights?
- Sure. Workplace wellness
is very important,
as you know that the
vast majority of adults
are in working environments.
The ability to impact
people where they work
has an incredibly impact on health.
Now, specifically with trans fats,
a lot of things have happened
of late in the last few years.
One is mandatory labeling,
so people can now
actually have an idea of
what they're consuming.
In a few cities, we have trans fat bans,
where people are essentially not allowed
to add them in restaurants.
But that's not far-reaching or far enough.
I think, when you add what we already know
about cardiovascular disease,
lipids, heart disease, and obesity,
now that we've begun to think
about cognitive effects,
perhaps we'll have more of a ground swell
about doing more from
a policy perspective.
- Could I just ask, Penny,
if you were an employer,
how would you get rid of trans fats?
What's an easy way to
get rid of trans fats
in the workplace?
- Just require trans fat free foods
in every eating establishment.
- Where do you get these trans fats from?
- Well, trans fats are in
a lot of different foods.
Although, they're mainly
in processed foods.
The food industry has
made fabulous progress
in decreasing trans fats.
We used to consume about
2.5% of our calories
from trans fat.
Now, when you look at the CDC website,
we're way down to less than 1%.
That means they're are consuming about .6%
of their calories from trans fats.
However, in looking at that website,
what you see is that
with a number of foods,
there are very low amounts of trans fats.
So there's still margarines
out there that are
high in trans fats, a lot of
them don't have trans fat.
Another major trans fat
is microwave popcorn.
So, I think it's really
important for employers
to check the food labels of the foods,
make that they do contain
zero grams of trans fat
when they're putting them
in eating establishments
and vending machines.
- If we could change course just a tad.
We look at household eating habits.
Some of this week's research also linked
childhood obesity to obesity
among pregnant women.
Explore that territory a tad,
and give some correctives
and easy ways to address that,
or ways of addressing that.
- It's really a fascinating study.
As we think about cardiovascular disease,
we're looking along the life course.
What this study did, from the
Framingham Heart Study population,
they took about 879 individuals
starting in the 1970s,
and looked back at their parents,
basically, at their mother.
Was their mother overweight
or obese during pregnancy?
What they found, in
fact, was if the mother
was overweight or obese,
then the offspring,
the children, as they grew
up over their lifetime,
had a significantly
increased risk of having
heart attack and
cardiovascular disease death.
We don't usually think about that,
we think about the child
themselves and how they grew up,
or, as they get older, the risk factors.
Now, we're realizing a
risk factor is actually
whether your mother
was overweight or obese
when you were in utero.
So that's really looking,
even extending the life course
in thinking about the risk
of cardiovascular disease.
- Is that obesity a
function of eating habits?
Of handed down eating
habits from mother to child?
What is the in utero effect?
- I'll comment, and then see if
my colleagues want to add to that.
There's two or three different ways
or interpretations of this.
One could be shared
environment, that if the mother
eats in an unhealthy pattern,
or there's obesity in the mother,
that that environmental sharing,
or habit, if you will, will be shared.
There's a little bit
of biologic data that,
if the mother is obese, that
something happens in utero
to the child's development.
It can affect certain
organs or hormone levels,
and may have effects later on in life.
So it's not just a habit.
There may actually be
some biology that changes
for the baby as they're developing.
- My field's in genetics, and
we certainly recognize that
there are epigenetic factors
that get upregulated,
they're called Methylation.
These factors get
methylated, and it causes
gene expression long term
across the life span.
It could be that you're getting
these early biologic changes in utero.
The good thing about epigenetic changes
is that they are reversible,
so there is good news about
adopting a healthy lifestyle,
even if you had an obese mother.
- The process of reversing,
what kind of work
is being done clinically,
doctor to mother,
to sort of get that message across?
- We're very early in the
epigenetics field in that domain.
I can say that there was
evidence from earlier studies,
some done in Europe,
not mother to child, but just in adults,
that the Mediterranean diet, for instance,
could reverse some of the
methylation that had occurred
in some key regulating enzymes.
- What about stress and
its role in heart disease,
in blood pressure,
perhaps hormonal effects
that tie into weight and overweight?
- That's a tough one.
Stress is a very hard
thing to measure, and yet,
everyone, just universally,
knows they are stressed.
We do know that when you induce
stress in clinical studies,
in a study that was presented here
at the American Heart Association,
they do stress by having
someone read a speech
in front of a group of
people they didn't know
about a stressful situation.
For some people, that
may be very stressful,
and indeed, it was associated with
greater Myocardial ischemia, or reduced,
or fusion blood flow in cardiac imaging,
Amit can talk about.
But what's interesting is
we do know that stress,
when we can measure it under
these standardized ways,
is definitely associated with increased
blood pressure, as you mentioned,
and there can be long-term
detrimental effects,
your ability to cope and
how that affects your diet
and in other parts of your life.
- I think that's important,
that there's two facets,
one is the physiologic
effects, the stress itself,
how that may affect the blood vessels,
whereas all other hormonal aspects,
increasing adrenaline levels.
The good side is how it
affects your behaviors,
and I'm sure (mumbles)
you can talk about that.
How that changes the way people behave
and healthful behaviors.
- I think stress can
also cause overeating,
even undereating, but also
lack of physical activity,
lethargy, being very sedentary.
- So this new research also had explored
the gender divide, or the
differences in gender,
and part of what was presented this week
indicated that women with
stable coronary heart disease
were more likely than men
to have reduced blood flow
because of heightened emotional stress.
Would y'all talk about that some?
- I'll start again, and I will say
it's a really fascinating study,
partly by the way they did it.
This investigator had
previously shown, years ago,
that when young women have a heart attack,
they have a much higher
risk of dying from it then.
Young women are certainly a unique group,
they don't get heart disease as often,
and so better understanding
why they're developing it,
and why they're at worse risk of dying.
What they did was they took
these women and men, there
were about 530 people,
and they essentially gave them
two types of a stress test.
One was a walking stress
test, the usual way,
and the other was, as mentioned,
they had to give a public speech about
some uncomfortable thing in their life.
We call that physiologic stress.
Then they actually measured
blood flow in the heart
with a nuclear tracer that they injected,
a standard stress test that
we do to open up blood flow.
Essentially, what they found
in both these women and men
that had heart disease,
the exercise stress test
was the same amount of reduced blood flow.
But in women, with the physiologic stress,
the public speaking, they
had a much greater reduction
of blood flow than men.
That was exacerbated in young women,
so if they were under 55,
there was three-fold reduction
in the blood flow to the heart.
I think that really speaks
to how men and women
are different, particularly young women.
And how the physiology of
stress make that (mumbles).
- A word of caution about that study,
and not a caution about
that study, but it was
in women with coronary disease,
so they were already diseased.
Whether or not this would
reflect women who are healthy
and have normal cardiac
physiology, we don't know.
- What were the triggers?
What things tended, the
things that they were
talking about, set them off?
The sort of common, every
day things, perhaps?
- I don't know that we know
the details of the test,
but I will say that if you think about it,
what was reported, they
basically asked them themselves
to think about something that's stressful.
Stress is sometimes internal,
it's what is stressful to you.
They had to recall something
that they thought was stressful
and then talk about it publicly.
To think about the scheme of stress,
that probably is not as
extreme as some other things,
and nevertheless, it still
caused reduction of blood flow.
That just goes to tell you
that even day-to-day stressors,
may have an impact on our
physiology of blood flow.
- There was also news this week linking
chronic asthma to heart attack,
which is perhaps an association that
the average person would never make.
Is there something that
the millions of people
in this country who have asthma
ought to be concerned about?
And tell us about that.
- Certainly, Katti.
There were two different studies of asthma
presented here at the
American Heart Association.
One used a data from a
very well-known study
called the Multi-Ethnic
Atherosclerosis Study,
that's a mouthful, that's a
long-term cardiovascular study.
In that study, they
looked at three groups.
Those who had what they
called active asthma, that is,
if they were symptomatic and they were
taking medications for their asthma,
and they compared them to the group
that reported asthma but
was not being treated,
and then finally the group with no asthma.
What they found, that if
you had active asthma,
that is, asthma that required medication,
that you were about 70% more likely
to have a heart attack over a
ten year period of follow-up.
What that says is that
there may be something
about the process of having active asthma
that is either correlated with
(mumbles) or heart attack.
It may be mediated through
a common process called inflammation,
or it could be some other mechanism.
The second study was
done in the Mayo Clinic,
and there they compared
active asthma cases again,
those that were treated, as cases compared
to asthmatics that did
not require treatment.
They too noted about a 60% increase
in cardiovascular risks
from active asthma.
So this says that those who have asthma
may want to talk to their
doctor or healthcare provider
about whether or not they have
cardiovascular risk factors
that require attention.
- In the simplest lay
terms, would you explain
inflammation, its role in asthma,
and perhaps what might be some
anti-inflammatory remedies,
whether through food
or medicine or whatnot?
- Inflammation, if you
think about cutting yourself
and getting an infection, we
have inflammatory processes
that get upregulated internally.
Another very common cause of inflammation
that leads to inflammation
throughout our body,
is having periodontal disease.
We've had a long recognition
that periodontal disease
is linked to cardiovascular disease,
probably through this information.
So you get any kind of
infection in your system,
if you get atherosclerosis,
you get an upregulation
of this inflammatory parameters.
They're called CRP, C-reactive proteins
is one measure, there are
other biochemical measures.
So essentially, its an upregulation
of our body's defense mechanisms,
probably initially to
help fight the infection,
and then they get
persistently upregulated.
- What we know is that
healthy lifestyle practices
can decrease inflammation,
the inflammatory response,
and quicken resolution.
A healthy diet, physical
activity, getting enough sleep,
avoiding stress, and keeping
all those risk factors
in check can really
help quell inflammation.
- I'm sorry, go on please.
- As an asthma study, we
also don't know as well
in terms of, remember these
people are mainly a bit older,
about asthma control over a lifetime,
and whether that can suppress
some of the inflammation
over your lifetime.
So part of that is certainly lifestyle,
incredibly important in what we don't know
about asthma treatment and management.
- For those of us who did
not have the good pleasure
of being there with you this week,
what is the level of
energy there, the optimism,
the challenges, what's the climate?
And if you all three would address that,
where do we go from here?
Sort of our last weigh-in of this chat.
- I loved this meeting because
there's so much enthusiasm.
It's just a very vibrant
meeting with a lot
of very, very high level
science and top-level interest
in learning everything that people can,
so that when they go back home,
they can translate this into practices.
It's very exciting.
- I would agree, this is
probably the best few days
out of the year in many ways
from a scientific perspective,
and probably one of the big challenges is
taking this excitement and
information and digesting it.
You need several weeks
to digest and make sense
out of all the things
that we learned here.
But very exciting.
- I would say the level of excitement's
really off the scale, Katti.
The American Heart Association
brings science to life.
That's really what this meeting is about.
We bring the best new
evidence for not only how
to treat patients with heart
failure, with arrhythmias,
with heart attacks, with strokes,
but also, we bring
messages to the consumers
about how they can prevent
cardiovascular disease and stroke
for themselves and their family.
- Thank you so much for your time
and your science and your answers.
I'm sure they'll all be put to good use.
And thank you to those
of you who chimed in
on this live chat, and have
a good afternoon, everyone.
