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Cardiovascular Medicine

Cardiovascular Medicine, Chronic Disease, Stanford News

Born with high cholesterol

high cholesterol illustrationOn a Friday morning last October, I drove to the East Bay to meet with a fellow who I had been told had quite a story to tell. I met Scott Radabaugh in a coffee shop in San Ramon – a tall, dark-haired man with a weightlifter’s physique and an eagerness to unburden himself of the many troubles he’d suffered as a result of his genetic predisposition to high cholesterol. This was no garden-variety high cholesterol, but the kind of numbers that put people at serious risk of heart attack at a relatively young age.

We talked for more than 2 ½ hours as Radabaugh, 46, detailed his surgeries – his quadruple bypass and the surgery to clear a clogged vessel in his neck – as well as his ongoing anxiety about when the next heart event might strike.

“I’m on hyper alert,” he told me for a story that appears in Stanford Medicine magazine’s new issue. “Once I have chest pains, it may be time…What’s scary is that I don’t go anywhere without nitroglycerin or aspirin [to help defuse a blood clot or heart attack]. I think about my own mortality many times a day.”

Radabaugh had learned just three years ago that he had inherited a gene for high cholesterol, a condition known as familial hypercholesterolemia (FH). People with FH are born with high cholesterol – yes, babies can suffer from high cholesterol. And the harmful substance begins building up in the arteries from that time forward.

Unfortunately, Radabaugh had passed the gene on to his three children, and he felt some guilt in that. All of the children, as well as Radabaugh himself, are taking medication to help prevent heart problems and are careful in their eating habits. The disease, I learned, is relatively common in the U.S. population, though few people are aware it. As an advocate with the FH Foundation, a nonprofit patient organization, Radabaugh is hoping to change that – and to help others avoid some of the heartache he’s experienced himself.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions and Hope for patients with familial hypercholesterolemia
Illustration, which originally appeared in Stanford Medicine magazine, by Lincoln Agnew

Cardiovascular Medicine, Podcasts

Dick Cheney on his heart transplant: “It’s the gift of life itself”

Dick Cheney on his heart transplant: "It's the gift of life itself"

Cheney2Dick Cheney has lived with chronic heart disease for virtually all of his adult life. At 37, as a young man running for the U.S. Congress in Wyoming, he had his first heart attack. His last – a fifth – occurred in 2010 and by then having taken advantage of everything medicine and technology had to offer, Cheney knew he was at the end of the road. And, remarkably, as the former vice president told me in this 1:2:1 podcast, he didn’t fear death:

I concluded that sooner or later, I was going to run out of technology, run out of new innovations and developments in the area of heart medicine… I  thought about it, I guess, I was at peace. It was not painful. It wasn’t surprising or frightening. I had come to that point where I fully expected that I had lived a wonderful and remarkable life. I had a tremendous family. I had everything a man could ask for.

Facing end stage heart failure, in the summer of 2010 he received a left ventricular assist device commonly known as an LVAD. But he knew the device wouldn’t be enough. A transplant was the only option that would set aside decades of heart ailments and give him something he had thought was impossible: longevity. Twenty months later, at 71 years old, a late night phone call informed him a donor had been found. Life for Dick Cheney would begin anew.

Now, nearly two years after his transplant, Cheney and his cardiologist, Jonathan Reiner, MD, have written a book about his history of heart ailments, Heart: An American Medical Odyssey. As we were putting together the current issue of Stanford Medicine – a special on cardiology – it made sense to include an interview with Cheney, and so I pursued one.

Cheney launched the book last fall with a number of high-profile media interviews starting with Sanjay Gupta’s on CBS’ 60 Minutes. We spoke a few days before Thanksgiving when family matters were in the press. I decided not to repeat the buzz questions that had already consumed the press at the time – the Homeland scenario or whether his years of service in the White House afforded him special access to health care unavailable to everyone else. I pursued a different line.

This wasn’t the taciturn Cheney that I had feared as an interviewer. He was pensive, reflective and clearly extremely grateful that he was able to have this extension on life. His co-author Reiner told him that a heart transplant is a spiritual experience so I asked Cheney what’s been his? He told me:

It’s the gift of life itself… After you’ve been through all of the procedures and so forth and then anticipating death and finding your life has been extended that it’s miraculous… You have a sense that after you’ve been through all of  that, everything else is small. You don’t sweat the small stuff… A friend of mine asked me when I told him it was a spiritual experience: “Does that mean now, that you’re a Democrat?” I told him, “Well, not that spiritual.”

I closed the interview with a final question. What if he learned he had the heart of a liberal Democrat? Well, you’ll have to listen to the podcast or read the Q&A to find out his response.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions
Illustration, which originally appeared in Stanford Medicine magazine, by Tina Berning

Cardiovascular Medicine, Research, Stanford News, Technology, Transplants

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions

spring14_magazine-coverThe heart is a paradoxical organ. It declares its presence with that distinctive thump thump, yet its moment-to-moment condition is really hard to decipher. But as I learned while editing the just-published Stanford Medicine magazine special report “Mysteries of the heart,” new technologies and research are making it easier to assess heart health and diagnose disease. With heart disease the No. 1 cause of death worldwide, that’s good news.

The issue, published during American Heart Month, was supported in part by the Stanford Cardiovascular Institute. Among its contents:

  • A change of heart“: An interview with former vice president Dick Cheney on having “virtually everything done to me that you could do to a heart patient,” culminating with a transplant.
  • Fresh starts for hearts“: A feature on using stem cells to revolutionize cardiac care, and a family for which new treatments can’t come soon enough.
  • The ultramarathoner’s heart“: Visionary computer designer Mike Nuttall’s exploits as an ultramarathoner, despite having severe heart disease (online only).
  • Hiding in plain sight“: The story of a man born with high cholesterol — a surprisingly common but hidden and deadly condition.
  • Switching course“: A piece detailing the untangling of a heart surgery that saves babies, but threatens their lives in adulthood.
  • The heart gadgeteers“: A report on the new wave of heart- and fitness-monitoring devices, and why it’s hard to integrate them into the medical system.
  • Easy does it“: An article on an alternative to open-heart surgery to replace aortic valves.
  • Dear Dr. Shumway”: Catching up with a kid who in 1968 wrote to transplant pioneer Norman Shumway, MD, for advice — on his frog heart transplant.

The issue also includes articles on the use of big data in medicine, which will be the focus of the Big Data in Biomedicine conference May 21-23 at Stanford.

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a babyFactoring in the environment: A report from Stanford Medicine magazine and New issue of Stanford Medicine magazine asks, What do we know about blood?
Illustration by Jason Holley

Cardiovascular Medicine, Medicine and Society

Transforming the rhythms of the heart into music

Transforming the rhythms of the heart into music

Back in 2000, jazz drummer Milford Graves received a Guggenheim grant and developed technology to record music based on the natural rhythms of the human heart. Graves then began experimenting with using various diagnostic tools to listen to volunteers’ hearts and parsing the data with software. This process enabled him to zero in on the micro-rhythms within a single heartbeat. If the heart sounded abnormal, he would create a counter-rhythm to use in helping the heart return to a normal pattern.

Among those who worked with Grave was drummer Greg Fox. The recordings of Fox’s heart were used to produce his latest alum titled “Mitral Transmission.” The above sample track showcases Fox’s biometric instrument.

Via Medgadget
Previously: Real-time MRI music video

Cardiovascular Medicine, Chronic Disease, Genetics, Research, Stanford News

Damage to dead cell disposal system may increase heart disease

Damage to dead cell disposal system may increase heart disease

garbage cansThink of it like taking out the garbage.

That’s the way Stanford researcher Nicholas Leeper, MD, explained to me the findings of his recently published study.

Actually, it’s more helpful to think of the study’s discoveries on the genetics of heart disease as something of a garbage strike – at the molecular level.

Due to a genetic defect, the body’s ability to dispose of its daily tonnage of dead cells gets damaged, and as a result the body’s garbage - in the form of old cells and debris - starts to build up in the walls of its blood vessels. Normally, the body is extremely efficient at taking out the garbage. Two hundred billion cells die every day in our bodies and most get cleared out within a matter of seconds. But when this process breaks down and garbage in the form of necrotic cells starts building up in the walls of blood vessels, it’s not a good thing.

Leeper, a physician and assistant professor of vascular surgery, and colleagues Yoko Kojima, MD, Tom Quertermous, MD, and others set out to discover why genetic variation at the chromosome 9p21 location has been repeatedly identified as the most important commonly inherited DNA sequence for a wide range of cardiovascular diseases including stroke, heart attacks and aneurysms.

Conducting studies in mice with atherosclerosis, the researchers showed that loss of a candidate gene at this locus leads to impaired “efferocytosis” - from the Latin for “take to the grave” – the process by which dead or necrotic cells are removed. Literally, the burying of dead cells. Mice with this genetic variation showed an increase in buildup of these dead cells, further advancing their atherosclerosis as opposed to those that did not have the genetic variation.

In other words, a commonly inherited genetic variant, which is found in 20 percent of the population, contributes to the development of coronary artery disease (also known as coronary atherosclerosis) by stimulating the accumulation of necrotic debris within the evolving plaque. Coronary atherosclerosis is the process by which plaque builds up in the wall of heart vessels, eventually leading to chest pain and potentially lethal heart attacks. Leeper explained it to me further:

If you were born with genetic variation at the 9p21 locus, your risk of heart disease is elevated, though we haven’t understood why. This research gets at that hidden risk. You can be a non-smoker, be thin, have low blood pressure, and still be at risk for a heart attack if you were born with this variant. This work may help explain that inherited risk factor, and more importantly help develop a new therapy to prevent the heritable component of cardiovascular disease.

Photo by shooting brooklyn

Cardiovascular Medicine, Stanford News, Transplants, Videos

A physician shares his story of being diagnosed with amyloidosis

A physician shares his story of being diagnosed with amyloidosis

Long before Kevin Anderson, MD, was diagnosed with amyloidosis, a disorder in which abnormal proteins build up in tissues and organs, his physical health began deteriorating. The most noticeable change was his increased difficulty in walking up the stairs to the hospital room where he practiced. In the above video, Anderson shares his story of working with Ron Witteles, MD, co-director of the Stanford Amyloid Center, to receive a heart transplant and get his health back on track.

Via Stanford Hospital & Clinics Facebook page
Previously: Survey shows Americans need a refresher course on heart health, Ask Stanford Med: Answers to your questions about heart health and cardiovascular research and Ask Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart health

Cardiovascular Medicine, In the News, Public Health

Survey shows Americans need a refresher course on heart health

heart_shapeIs there a specific gene that helps determine your risk for heart disease? What are the signs and symptoms of a heart problem? Does fish oil help prevent heart disease?

If you find yourself baffled by these questions, you’re not alone. A recent survey conducted by the Cleveland Clinic found that many Americans are misinformed when it comes to heart health and, as a result, aren’t taking the steps necessary to guard off future heart problems. Health Day reports on the survey results:

Although 64 percent of Americans have heart disease or know someone who does, 70 percent of Americans are unaware of all the symptoms of the condition, the researchers found. Less than a third were able to identify unusual fatigue, sleep disturbances and jaw pain as a few of the possible signs of heart disease.

Meanwhile, Americans also have their vitamin facts wrong. Although there are no vitamins that can promote heart health, the survey found that 44 percent of Americans think vitamins can lower cholesterol and 61 percent wrongly believe that vitamins or supplements can help prevent heart disease.

Even fish oil supplements do little to prevent heart disease, the researchers said. Still, 55 percent of Americans believe taking the recommended daily dose of fish oil can ward off the condition. The researchers also cautioned that seafood could be just as high in cholesterol as red meat. The survey showed, however, that only 45 percent of Americans are aware of this.

Americans are also not up to speed on sources of sodium. When it comes to salt, about 32 percent of people wrongly believe that cheese is the biggest culprit, the survey found. Just 24 percent of Americans were aware that bread products typically have a higher salt content.

The survey also showed that almost 60 percent of Americans think there is a heart disease gene that helps determine their risk for the condition. Scientists have not yet identified any such gene.

In recognition of February being American Heart Health Month, Stanford Hospital & Clinics is issuing weekly challenges to help you take the first steps toward a lifetime of better heart health. Visit the hospital’s website and Facebook page or follow @StanfordHosp on Twitter to learn more about heart disease and ways to keep your heart healthy.

Previously: The exercise pill: A better prescription than drugs for patients with heart problems?, Heart attacks and chest pain: Understanding the signs in young women, Childhood obesity a risk for imminent heart problems, research shows, Ask Stanford Med: Answers to your questions about heart health and cardiovascular research and Ask Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart health
Photo by samantha celera

Cardiovascular Medicine, Emergency Medicine, Patient Care, Pediatrics, Research

New approach to resuscitation training saves more kids

New approach to resuscitation training saves more kids

Heart-2014Children whose hearts stop while they are in the hospital need fast, well-coordinated resuscitation to give them the best chance of surviving their cardiac arrest. But because pediatric cardiac arrests are (fortunately) rare, pediatric physicians, nurses and other caregivers have few opportunities to experience a real response to this life-threatening emergency. And rehearsing what to do in educational settings outside the hospital may not give responders the chance to practice for unexpected problems that can arise in real life.

To solve this problem, a team at Lucile Packard Children’s Hospital Stanford implemented a new training approach. Lynda Knight, RN, MSN, the hospital’s pediatric resuscitation program educator, wanted to make sure that every person responding to emergency “codes” broadcast through the hospital when a patient’s heart stops – from attending physicians to security guards – had regular opportunities to practice working together. Knight and Deborah Franzon, MD, led a group that staged mock “codes” to simulate cardiac arrests in many locations throughout the hospital.

After the new training was implemented, the hospital’s survival rate for cardiac arrest patients jumped from 40 percent (a figure similar to the national average for children’s hospitals) to 60 percent. The findings were published this week in Critical Care Medicine.

From our press release about the study:

One key goal of the training package was for one person to quickly assume the role of the code team leader, and for others to take on specific, pre-defined roles in the team’s response. The roles were based on American Heart Association guidelines about best practices for resuscitation.

“It’s sort of like an orchestra,” Franzon said. “Everyone has a really important part to play.” For instance, one physician or nurse stood at the code cart, distributing equipment. A social worker comforted the patient’s parents. Security guards directed unnecessary foot traffic away from the area. A nursing supervisor made sure all essential roles were filled quickly.

“With this training in place, responding to codes becomes muscle memory for the whole team,” Knight said. “That’s what’s going to save lives.”

Photo by dev null

Cardiovascular Medicine, Research, Stanford News, Stem Cells

Stanford cardiologist joins CIRM Google+ Hangout today

Stanford cardiologist joins CIRM Google+ Hangout today

Have lunch plans yet? Join a California Institute for Regenerative Medicine Google+ Hangout discussing the latest developments in stem cell therapies for heart disease. Stanford cardiologist Joseph Wu, MD, a CIRM grantee, joins CIRM science officer Cathy Priest, and stem cell clinical trial participant Fred Lesikar in conversation.

The hangout happens from noon ’til 1 PM Pacific time today. Use the hashtag #AskCIRM_Heart to ask questions on Twitter.

Previously: Shushing T cells promotes acceptance of stem cell therapies, say Stanford researchers“Clinical trial in a dish” may make common medicines safer, say Stanford scientistsSudden cardiac death has cellular cause, say Stanford researchers and Overcoming immune response to stem cells essential for therapies, say Stanford researchers

Cardiovascular Medicine, Ethics, Health Policy, Stanford News

Will new guidelines lead to massive statin use?

As recently written about on Scope, new guidelines on statin use, and an accompanying risk-assessment calculator, have generated much conversation in the medical community. In a new Viewpoint piece in the Journal of the American Medical Association, Stanford professor and health research and policy expert John Ioannidis, MD, DSc, discusses potential implications of the guidelines, which could lead to more widespread use of statins for primary prevention. “It is uncertain whether this would be one of the greatest achievements or one of the worst disasters of medical history,” he writes of potential worldwide “statinization.” Read on to get more of his thoughts.

Previously: Stanford expert weighs in on new guidelines for statin useThe exercise pill: A better prescription than drugs for patients with heart problems?“U.S. effect” leads to publication of biased research, says Stanford’s John Ioannidis and A call for mega-trials for blockbuster drugs

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