Podcasts about American Heart Association

In this episode, Scott Becker discusses new findings from the American Heart Association suggesting that drinking up to five cups of coffee a day may support heart health and reduce stroke risk.

Dave Rubin of "The Rubin Report" gives a first look at the stories you need to know to start your day, including President Donald Trump rejecting New York City Mayor Zohran Mamdani's threat to arrest Israeli Prime Minister Benjamin Netanyahu over the International Criminal Court's warrant, declaring America will protect its closest ally; a suspect in custody after an incendiary device attack outside a federal immigration building in Manhattan, where authorities say anti-ICE materials, a manifesto, and pellet guns were recovered; and a new American Heart Association study finding that drinking up to five cups of black coffee a day is safe for most adults and may reduce the risk of heart disease, stroke, type 2 diabetes, and other cardiovascular conditions; and much more.

P.M. Edition for July 20. The Magnificent Seven have dominated the stock market for years. But now, as markets reporter Hannah Erin Lang discusses, there are signs that everyday investors are buying fewer shares of the megacap tech companies as they look to find the next big AI stock. Plus, a judge puts a temporary restraining order on the $81 billion merger of Paramount and Warner Bros. Discovery. And how much coffee should you drink for a healthy heart? A new scientific statement from the American Heart Association has the answer… and it may be more than you think. Alex Ossola hosts. Sign up for the WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices

Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/20-07-2026Nesta segunda-feira, o boletim analisa descobertas em biologia molecular de plataformas genéticas, a intersecção de fatores em cardio-oncologia e o planejamento estratégico de saúde frente a riscos ambientais. Abordamos o estudo publicado na Nature Biotechnology revelando que a resposta gerada por tecnologias de RNAm segue múltiplos caminhos no organismo, evidenciando o papel ativo das células musculares na apresentação de antígenos ao sistema de defesa. Detalhamos o alerta da American Heart Association direcionado a mulheres idosas, apontando que a fibrilação atrial e neoplasias mamárias compartilham fatores basais comuns como processos inflamatórios crônicos e distúrbios metabólicos. Por fim, trazemos no Radar a apresentação do plano AdaptaSUS no Congresso do Conasems, uma iniciativa do Ministério da Saúde para estruturar a resiliência de serviços públicos e o alerta precoce diante de oscilações ambientais extremas. Afya News. Informação médica confiável e atualizada no seu tempo.

Hurricane Season & Heart Health with American Heart Association & Dr. Antonio Lewis, cardiologist with Cleveland ClinicSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

From organizing as a teenage Republican to managing campaigns out of his college dorm room, serving in elected office, and building a career in government relations, Zach Almond has always known politics was where he belonged. Today, he's living that dream as Executive Director of the North Carolina Republican Party. Zach joins us to discuss his journey, what he's learned along the way, and why he's more optimistic about the 2026 midterm elections than many political prognosticators. Plus, Skye and Brian break down North Carolina's #2 business ranking, the latest fundraising numbers, budget schedule rumors, new polling, #TOTW, and much more. The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

Resources for the Community:___________________________________________________________________Linktree Our Favorite ThingsNeed help appealing your GLP-1 dials? www.FindHonestCare.com/KimFind Your US Representatives https://www.usa.gov/elected-officials ______________________________________________________________________"Both Our Advice and our Guest Expert insights don't replace your own care team. Always talk to a doctor who can review your personal records and labs to make the safest choices for you."How GLP-1s Broke Diet CultureFor decades, we believed weight gain and weight loss were mostly about willpower, calories, and exercise. Today, we're learning there's much more happening beneath the surface. The biology that drives hunger, metabolism, weight gain, and long-term health is far more complex than we once understood.In this episode, Dr. Chiadi Ndumele, preventive cardiologist at Johns Hopkins Medicine and a leader with the American Heart Association, explains why GLP-1 medications work, how weight, metabolism, and chronic disease are connected, and why the first-ever Cardiovascular-Kidney-Metabolic (CKM) Clinical Practice Guideline represents a major shift in how we understand and treat weight-related disease. You'll also hear a powerful patient story that shows why this new understanding is giving hope to millions.In this episode:Why GLP-1 medications work when diets often don't.What really drives weight gain, weight loss, and long-term weight management.How metabolism, hormones, genetics, and overall health work together.Why understanding your body can help you advocate for the quality care you deserve.GuestDr. Chiadi NdumelePreventive Cardiologist, Johns Hopkins MedicineChair, 2026 American Heart Association/American College of Cardiology Cardiovascular-Kidney-Metabolic (CKM) Clinical Practice GuidelineResourcesAmerican Heart Association: New Cardiovascular-Kidney-Metabolic (CKM) Clinical Practice Guidelinehttps://www.heart.org/en/news/2026/06/09/new-ckm-guideline-urges-early-weight-talks-to-prevent-health-risksProfessional Heart Daily: 2026 Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndromehttps://professional.heart.org/en/science-news/2026-guideline-for-the-prevention-detection-evaluation-and-management-of-ckm-syndromeAmerican Heart Association News Release: First-Ever Clinical Practice Guideline for Cardiovascular-Kidney-Metabolic Syndromehttps://newsroom.heart.org/news/first-ever-guideline-on-cardiovascular-kidney-metabolic-syndrome-issued______________________________________________________________________Join this channel to get access to perks:   / @theplussidez______________________________________________________________________#Mounjaro #MounjaroJourney #Ozempic #Semaglutide #tirzepatide  #GLP1 #Obesity #zepbound #wegovy #ObesityCare #PatientAdvocate #GLP1Community #RealGLP1StoriesSend us Fan Mail!Use Honest Care to Appeal GLP-1 Denials. Go to HonestCare.com/Kim  Honest Care can Appeal GLP-1 Denials. Go to FindHonestCare.com/Kim Support the showKim Carlos, Executive Producer TikTokInstagram Kat Carter,  Producer TikTokInstagram 

Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/14-07-2026Nesta terça-feira, o boletim analisa debates regulatórios sobre o manejo farmacológico em saúde mental, benefícios vasculares de análogos hormonais e a reorganização de fluxos de trabalho. Abordamos a mobilização federal nos Estados Unidos para estruturar diretrizes clínicas voltadas à desprescrição segura e gradual de moduladores de serotonina, distinguindo reações de descontinuação do retorno de quadros clínicos prévios. Detalhamos o estudo observacional destacado pela American Heart Association sugerindo que os agonistas de GLP-1 podem reduzir significativamente o risco de desfechos vasculares graves e internações em pacientes com distúrbios metabólicos e arteriais periféricos. Por fim, trazemos no Radar o relatório do McKinsey Health Institute sobre o papel da inteligência artificial em reduzir a carga administrativa e a documentação burocrática, devolvendo o tempo do médico para o cuidado direto. Afya News. Informação médica confiável e atualizada no seu tempo.

Dr. St-Onge is the founding Director of the Center of Excellence for Sleep & Circadian Research at Columbia University Irving Medical Center. The overall focus of her research program is the study of the impact of lifestyle, specifically sleep and diet, on cardiometabolic health. Dr. St-Onge has been NIH-funded since 2008, conducting innovative, cutting-edge clinical research combining her expertise on sleep, nutrition, and energy balance regulation to address questions related to the role of circadian rhythms, including sleep duration and timing as well as meal timing and eating patterns, on cardiometabolic risk. Dr. St-Onge was Center Director for the American Heart Association funded Go Red for Women Strategically Focused Research Center, aimed at determining the causality of the relation between sleep and cardiovascular disease and the specific role that sleep plays in the health of women throughout the life cycle. She is a pioneer in this field, having chaired the first scientific statements endorsed by the AHA on sleep and cardiometabolic health as well as meal timing and frequency and cardiovascular disease risk prevention. More recently, she chaired a follow-up scientific statement highlighting the role of multidimensional sleep health for cardiometabolic health. She is a Fulbright Scholar, and the recipient of an NHLBI Outstanding Investigator Award from the National Institutes of Health. Dr. St-Onge has authored over 200 peer-reviewed publications and is author of Eat Better, Sleep Better: 75 recipes and a 28-day meal plan that unlock the food-sleep connection.Support the show

Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/13-07-2026Nesta segunda-feira, o boletim analisa o desenvolvimento acelerado de soluções biológicas, os impactos das oscilações climáticas no sistema circulatório e o panorama epidemiológico sazonal. Abordamos a autorização no Reino Unido para o início dos ensaios clínicos de um imunizante desenvolvido pela Universidade de Oxford em apenas oito semanas contra uma variante emergente rara na África. Detalhamos o alerta da American Heart Association sobre como a exposição ao estresse térmico extremo sobrecarrega o organismo, exigindo monitoramento preventivo rigoroso em pacientes com insuficiência cardíaca e hipertensão. Por fim, trazemos no Radar o posicionamento da OPAS sobre a simultaneidade de múltiplos patógenos respiratórios sazonais no hemisfério sul e a urgência de impulsionar as coberturas vacinais. Afya News. Informação médica confiável e atualizada no seu tempo.

CardioNerds co-chairs Dr. Dinu Balanescu and Dr. Billy Joe Mullinax, along with FIT lead Dr. Shiavax Rao, discuss the evolving landscape of randomized controlled trials in pulmonary embolism with Dr. Jay Giri, interventional cardiologist, Associate Professor of Medicine, and Director of the Cardiovascular Catheterization Laboratories at the Hospital of the University of Pennsylvania. This episode examines the historical evidence behind systemic thrombolysis, the emergence of catheter-directed therapies and mechanical thrombectomy, and the landmark RCTs – STORM-PE, PEERLESS, HI-PEITHO, and PEERLESS II – that are reshaping intermediate-risk PE management. The discussion highlights challenges in PE trial design, the critical importance of clinical deterioration as an endpoint, and why this era represents an unprecedented wave of evidence generation in PE. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls: Systemic thrombolysis in intermediate-risk PE reduces hemodynamic decompensation but at the cost of ~1.5–2% intracranial hemorrhage risk – a near-zero net benefit that has driven the search for safer catheter-based alternatives. “Focus on clinical deterioration, not mortality” – Due to crossover design in contemporary PE RCTs, control-arm patients who decompensate are rescued with advanced therapies, biasing mortality toward the null. Clinical deterioration is the most informative endpoint to watch in HI-PEITHO, PRAGUE-26, and PEERLESS II. HI-PEITHO is the first large RCT to demonstrate that catheter-directed fibrinolysis plus anticoagulation significantly reduces the composite of PE-related death, cardiorespiratory decompensation, or PE recurrence versus anticoagulation alone (RR 0.39; 95% CI 0.20–0.77; P=0.005), with no intracranial hemorrhage in either arm. The four major upcoming/recently reported PE RCTs (HI-PEITHO, PRAGUE-26, PEERLESS II, PE-TRACT) enroll progressively different risk populations – from the most enriched (HI-PEITHO) to the most permissive (PE-TRACT, which includes intermediate-low risk patients) – enabling a nuanced understanding of which patients benefit most from intervention. PE device clearance follows a fundamentally different FDA pathway than structural heart devices (single-arm safety/efficacy studies vs. mandated RCTs), yet market forces and clinical need have ultimately driven industry and government to sponsor large-scale RCTs – a lesson in how evidence development can evolve organically alongside regulatory frameworks. Notes: Notes drafted by Dr. Shiavax Rao. Question #1: What is the current evidence behind advanced PE therapies? Systemic thrombolysis: Sixteen RCTs over 40 years (1972–2014) enrolling nearly 2,000 patients have studied systemic thrombolysis in intermediate-risk PE. The landmark PEITHO trial (n=1,006) showed that tenecteplase reduced the composite of death or hemodynamic collapse (2.6% vs. 5.6%; P=0.015), driven primarily by reduced hemodynamic decompensation (1.6% vs. 5.0%; P=0.002). However, this came at the cost of increased major bleeding (6.3% vs. 1.5%; P

This week we're joined by Kendra Cunningham and Kayla Messana, sisters and co-hosts of the podcast Flatlined and Fine, and their stories are almost impossible to believe. Kayla was 31, healthy, three kids, husband just back from deployment, when she woke him up with agonal breathing in the middle of the night. He dragged her to the floor, did CPR for 10 minutes, and she was shocked twice by an AED before going on to have cardiac arrest approximately eight more times in the next 24 hours. Four years later, she's been shocked by her ICD three additional times and still has no clear diagnosis. Then, a few years after Kayla's event, Kendra had her own cardiac arrest while awake and feeding her newborn twins, told her husband she was about to faint, and was gone within seconds, saved by a man whose only CPR training was a few American Heart Association videos he'd watched before their first child was born. Kristin and I swap notes with them on everything: what it's like to wake up in an ICU with no memory of what happened, how you explain cardiac arrest to kids who are five, six, and eight years old, the psychological weight of an idiopathic diagnosis that gives you no answers and no closure, and the very real experience of being a 31-year-old in a cardiology waiting room surrounded by people forty years older than you. We also get into the insurance disaster of a $15,000 whole exome sequencing test that Blue Cross Anthem denied, why Kendra couldn't pick up her newborn twins for months after her ICD surgery, and why I was cleared to perform eye surgery but not allowed to drive for six months. I also get publicly shamed for not having plugged in my ICD data transmitter in two years. It's earned. Takeaways: Cardiac arrest in young, healthy adults often has no identifiable cause. CPR saves lives even when the person doing it is terrified and untrained. The co-survivor experience is its own separate, underserved story. Young cardiac arrest survivors often get inadequate guidance from the healthcare system. Being shocked by an ICD is traumatic and disruptive in ways that don't get talked about enough. — Want more Kendra Cunningham and Kayla Messana? @flatlined.and.fine on Instagram Flatlined and Fine on Spotify: https://open.spotify.com/show/2nRXIK5OvgAv2CXKvCwrQu?si=eHV4s_CZTQyLAXLvf7A14A&nd=1&dlsi=359ec698e7c64c90 To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information. Head to http://www.cozyearth.com and use my code KNOCKKNOCK for an exclusive 20% off. Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

North Carolina lawmakers finally reached a budget agreement, a bipartisan one at that, and Skye and Brian break down what made it into the spending plan and what's next in the legislative session. Also, Rep. Phil Shepard (R-Onslow) reflects on his 15 years in the legislature, the evolution of North Carolina politics in his region, and the lessons he's learned.  The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

Episode 2821 - Vinnie Tortorich and Chris Shaffer discuss marketing ploys by Big Food, poorly done food studies, and that exercise is king. https://vinnietortorich.com/2026/07/exercise-is-king-episode-2821 PLEASE SUPPORT OUR SPONSORS Pure Vitamin Club Pure Coffee Club NSNG® Foods VILLA CAPPELLI EAT HAPPY KITCHEN YOU CAN WATCH THIS EPISODE ON YOUTUBE - @FitnessConfidential Podcast Vinnie's workout videos are available to purchase! Choose from a 2-day, 4-day, or 6-day workout–or buy all three at a discount! TO PURCHASE VINNIE'S WORKOUT VIDEOS, CLICK THIS LINK: https://vinnietortorich.com/workout Exercise is King Vinnie tells a story of "who is influencing whom?" (3:00) We can all do better, encourage each other, and be an example. The American Journal of Public Health recently published an article that highlights the connections between the marketing approaches of Big Food and Big Tobacco. (13:00) Lunchables are marketed as having a good amount of protein; however, the breakdown shows otherwise. (19:00) Big Food's entire goal is to get you addicted to their products. (28:00) You can find a book focusing on this topic in Vinnie's Book Club on his Amazon page. The book is "Salt, Sugar, Fat" by Michael Moss: https://www.amazon.com/dp/B07DF5QS3H?linkCode=ssc&tag=vinnitorto-20&creativeASIN=B07DF5QS3H&asc_item-id=amzn1.ideas.DLRU885XQ4BV&ref_=cm_sw_r_cp_ud_aipsfshop_aipsfvinnietortorich_109ME21EYG8380MBNX34_asin It appears that the American Heart Association finally agrees with what Vinnie has been saying for years: exercise is a poor way to lose weight. (43:00) Exercise is king for health and longevity! However, you need to eat real food, too. Another epidemiological study on meat consumption; however, it compares processed meats (like salami, pepperoni) to white meat, such as chicken (not processed). The comparison is off, so the outcome is off. (50:00) For a recent study on drinking tea, the article included all kinds of caveats, but the article about meat did not. Update on the PVC Magnesium product. (1:05:30) Anna's products are now linked to PureVitamin Club's website. Look under the "Food and Snacks" section to purchase them there, too. https://purevitaminclub.com/collections/food-and-snacks Vinnie hopes to add other products as well, all of which will be health-related. The NSNG® VIP GROUP IS NOW CLOSED AGAIN AS OF SUNDAY, MARCH 15TH Anna's next cookbook, Eat Happy Cocktail Hour, is filled with cocktails, mocktails, and appetizers and is available for pre-order right now. If you pre-order, you'll get bonus goodies! You can preorder from a wide variety of booksellers at https://eathappycocktailhour.com/ Save your receipt from wherever you preorder, you'll need it for your bonuses! Physical Release Date is October 2026 You can book a consultation with Vinnie to get guidance on your goals. https://vinnietortorich.com/phone-consultation-2/ More News Serena has added some of her clothing suggestions and beauty product suggestions to Vinnie's Amazon Recommended Products link. Self Care, Beauty, and Grooming Products that Actually Work! https://www.amazon.com/shop/vinnietortorich/list/3GPVU29UHHPMY?ref_=aipsflist Don't forget to check out Serena Scott Thomas on Days of Our Lives on the Peacock channel. "Dirty Keto" is available on Amazon! You can purchase or rent it here.https://amzn.to/4d9agj1 Please make sure to watch, rate, and review it! Eat Happy Italian, Anna's second cookbook, is available! You can go to https://eathappyitalian.com You can order it from Vinnie's Book Club. https://amzn.to/3ucIXm Anna's recipes are in her cookbooks, on her website, and on Substack —they will spice up your day! https://annavocino.substack.com/ PURCHASE DIRTY KETO (2024) The documentary launched in August 2024! Order it TODAY! This is Vinnie's fourth documentary in just over five years. Visit my new Documentaries HQ to find my films everywhere: https://vinnietortorich.com/documentaries Then, please share my fact-based, health-focused documentary series with your friends and family. Additionally, the more views it receives, the better it ranks, so please watch it again with a new friend! REVIEWS: Please submit your REVIEW after you watch my films. Your positive REVIEW does matter! PURCHASE BEYOND IMPOSSIBLE (2022) Visit my new Documentaries HQ to find my films everywhere: https://vinnietortorich.com/documentaries FAT: A DOCUMENTARY 2 (2021) Visit my new Documentaries HQ to find my films everywhere: https://vinnietortorich.com/documentaries FAT: A DOCUMENTARY (2019) Visit my new Documentaries HQ to find my films everywhere: https://vinnietortorich.com/documentaries

Rapid advances in acute ischemic stroke care have expanded treatment windows and improved patient outcomes through thrombolysis, mechanical thrombectomy, and optimized antithrombotic strategies. This episode highlights evolving approaches to patient selection, the growing role of tenecteplase, and the importance of team-based systems of care in delivering timely, effective treatment. In this episode, Casey S. Albin, MD, FAAN, speaks with Christopher R. Leon Guerrero, MD, author of the article "Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Leon Guerrero is an associate professor of neurology and the adult neurology residency program director at Atrium Health Carolinas Medical Center in Charlotte, North Carolina, where he also serves as outpatient stroke director. Additional Resources Read the article: Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr Albin: In stroke care, every minute kills nearly two million neurons. But today, we're going to unpack all the details about the latest treatments that can give those neurons back.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello and welcome. This is Dr. Casey Albin. Today, I'm interviewing Dr. Christopher Leon-Guerrero about his article on Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I always like to start by just having you introduce yourself so our listeners know a little bit about you.  Dr Leon-Guerrero: Thanks for the introduction, Dr. Albin. Really glad to be here today. My name is Chris Leon-Guerrero. I'm a vascular neurologist at Atrium Health in Charlotte, North Carolina, at Carolinas Medical Center. I'm an associate professor in the Department of Neurology. I serve as our Neurology Residency Program Director, and I also wear the hat of an outpatient stroke director in our clinics.  Dr Albin: So, you are wearing a lot of hats and balancing a lot of things, and it's a really exciting time to be talking about this. For our listeners, we are recording this right after the launch of the American Heart Association, American Stroke Association just released their new guidelines on acute ischemic care. So, no better time to kind of dive into some of this. And really, when I think about acute ischemic stroke care, it's dramatically transformed in the last two to three decades. I mean, from lengthening time windows for IV thrombolysis to expanded thrombectomy eligibility, this is really, I think, some of the most exciting stuff in neurology. And your article did a fantastic job of distilling those rapid advancements and clarifying some of the evidence behind some of these new evolving treatment selections and imaging modalities, and it's exciting. So, let's just start with thrombolysis. Where are we now with IV thrombolytics and the time windows there?  Dr Leon-Guerrero: So, a lot has changed in the last decade, since that initial trial with NINDS, nearly thirty years ago. We're still giving intravenous thrombolysis in the traditional time window up to 4.5 hours, and really emphasizing we should be selecting patients for treatment early and quickly as possible. In most of those cases, a non-con head CT is sufficient to rule out bleeding and initiate treatment as quickly as possible. Where things have gotten really exciting is using advanced neuroimaging to help select patients beyond that traditional 4.5 hour window, and we're able to treat patients even up to twenty-four hours from symptom onset.  Dr Albin: Which is really exciting. It has really totally shifted the paradigm here. You know, I think most listeners are going to be pretty familiar with three to four and a half hours. Like, that's sort of our standard. What can you tell us about some of the advanced imaging we're using for that later selection period?  Dr Leon-Guerrero: It's around the principle of you want to be able to, uh, rescue significant salvageable tissue without a lot of core. So, this large profusion deficit and small core is really how you're trying to select out these patients. And two types of modalities are used. One is going to be MRI, and a lot of those imaging protocols, you know, are outlined in the WAKE UP trial and basically are looking for patients with DWI hyperintense lesions and FLAIR negative lesions to suggest that patients in an early time window that's treatable for thrombolysis. And then in the other category, we'll be using profusion imaging, whether that's CT profusion or MR profusion, to look for patients with large salvageable tissue.  Dr Albin: Yeah. And I think that this has been one of the things that, to me, has been really impactful is I think when WAKE UP came out, it was exciting. It was fun to sort of think about, "Hey, we're going to be able to use MRI." But MRI can be very challenging to get acutely, especially in community centers where they don't have the capabilities to get someone from the emergency department into an MRI rapidly enough to make thrombolysis decisions. So, to see some of that expand to CT profusion has been really exciting. How are you going about sort of counseling patients or thinking about their risk when you're using some of those, like, advanced imaging techniques?  Dr Leon-Guerrero: Yeah. I think it's similar to the conversations we've had with patients even within the traditional 4.5 hour window. The risk for intravenous thrombolysis is hemorrhage, and counseling patients on the, you know, the risk and benefits of hemorrhage and the potential clinical benefit of receiving thrombolytics is important. And then providing patients with that information to make an informed decision, so that they can make the best decision for their own care.  Dr Albin: Totally. And it's, again, time sensitive, but trying to give families enough information and enough time to sort of process those, especially when it's a little bit beyond the standard that we're so used to consenting for. The other big area that's really changed is that tenecteplase has become the star of the show. It's really gained momentum, so what should clinicians understand about this?  Dr Leon-Guerrero: Yeah. There's been an explosion of data over the last decade on tenecteplase supporting its use for clinical practice. You know, there was recent updates even from the neurology journal with a large meta-analysis with all of the data showing good clinical outcomes and perhaps even lower risk of bleeding. And so, I think you're seeing a lot of centers across the country switching from alteplase to tenecteplase. There's some practical advantages. So tenecteplase is a one-time bolus dose. And then biologically, it seems to have better fibrin specificity, longer half-life, which may ultimately make it a more attractive drug and may make it even more effective. But I think the practical aspects of tenecteplase are not to be understated. I think there's a lot of advantages for speed and efficiency and for centers to make that switch.  Dr Albin: Yeah. I remember when our health system made the pivot from alteplase to tenecteplase. Like any changes, that obviously created some adjustments with the new workflow. But, the fact that this could be given just as a one-time dose and not with the "we got to calculate the bolus, and now we got to get the infusion on board," like really simplified workflow. So, I think that's been pragmatically one of the nicest things we've done in stroke care. Really exciting.  Dr Leon-Guerrero: Yeah. And, you know, it's a doable thing. I think you have to be, very deliberate about it at whatever center you're at to make sure that all stakeholders are aware of that change. I think that's helpful to get everybody involved and have a lot of planning to avoid wrong dosing errors or inadvertently dosing as alteplase versus tenecteplase. But it's certainly doable, and I think in the long term, centers that have switched have been pretty satisfied with tenecteplase.  Dr Albin: And you know, initially when this came out, there really was sort of a debate about, is it gonna be 0.25? Was it gonna be 0.4? Where have we landed with that debate?  Dr Leon-Guerrero: So, I think we found the correct dose is 0.25 milligrams per kilogram is the recommended dose with a max out of 25 milligrams. There's some within the American Heart Association guidelines that were just published. They mentioned even tier dosing based on 10 kilograms, so intervals. So, that may be an easier way for centers to do it. But that cap out dose of 25 milligrams at 0.25 milligrams per kilogram, I think, is the sweet spot.  Dr Albin: Yeah. That's great, and I think that that has helped, you know, say, "This is what we're doing. There's not a debate that's happening anymore." And that really just got codified in the new ASA guidelines, so really exciting there. So, there is a lot of guidance for these patients, but I think one of the things that your article really tackled is the fact that there are some special populations, where we really still don't have a lot of guidance. And so, I think just to kind of distill those for the listeners, thinking about our pregnant patients, thinking about children, how are we approaching thrombolysis decisions in these special populations?  Dr Leon-Guerrero: These are always tough cases. For example, for pregnant women, they've often been excluded in the thrombolytic trials. But there's still evidence. You know, there's some inference based on the evidence we do have, and there's a lot of registry and case reports suggesting potential safe treatment for pregnant women. And I think when you're approaching those cases, again, it's gonna be patient-centered and really should be multidisciplinary. These are the types of cases you really need to lean on your maternal fetal medicine colleagues, your high-risk OBGYNs, your obstetricians to help with that decision-making. And I think, a multidisciplinary approach is the way to go for these cases. It's the same thing with the pediatric population. We had some data. There was one trial, randomized control trial, called TIPS trial that looked at using intravenous alteplase for acute ischemic stroke in patients under the age of 18. It had difficulty with enrollment. But I think most experts would argue that patients with pediatric stroke should be considered for intravenous thrombolysis if appropriate. Again, same thing. You want to make it a multidisciplinary approach, really getting your pediatric neurologists, your pediatricians involved early to make the best decision for the patient.  Dr Albin: Yeah. That's just really an important takeaway, just thinking about this as a multidisciplinary decision, because there are going to be other stakeholders to the patient's care who may have some different information than what we as neurologists are bringing to the approach. And obviously, our perspective really matters. But trying to work in everyone's unique vantage point of the patient really helps to make the most effective decision. When we talk about acute ischemic stroke care, I really don't think that you could do justice to the topic without pivoting to mechanical thrombectomy, which, you know, as we think about how the medical field as a whole, not just neurology, how the medical field has evolved. I mean, there's probably no bigger impact than mechanical thrombectomy has made in terms of reducing not just morbidity, but mortality from stroke. I mean both. So, thrombectomy has been around for a while, but just walk our listeners through what's the core that we for sure know that these are the patients that this works for?  Dr Leon-Guerrero: The types of patients we should be selecting for intervention are patients with large vessel occlusions. And those initial trials that were published in 2015 really demonstrated that this is a quite an effective treatment for patients with large vessel occlusion ischemic strokes in the anterior circulation. When that smattering of publications occurred in 2015, the general consensus, we should be treating all patients up to six hours from symptom onset if they do have a large vessel occlusion. And then, Dr. Albin, as you know, the, the windows continue to expand. So, we were using advanced neuroimaging with MR selection and perfusion selection based on DAWN and DEFUSE 3 trial protocols to select patients all the way out to the 24 window, and it's even expanded beyond that over the last few years.  Dr Albin: I think that when we think about trials that really, totally, changed the game, when we think about DAWN and DEFUSE 3, and we switched from that time-based window to more of that, like we talked about for thrombolysis, that tissue-based clock and, like, looking at what is salvageable and where can we make an impact on salvageable tissue, truly moved the needle in terms of just bringing this therapy for people who, you know, it's hard to get in within six hours. When we moved the needle to 24, it made a huge difference. But people were still coming in with a lot of ischemic damage already done, and they would have traditionally been excluded from being enrolled in thrombectomy trials. But that's changing too. So where are we there?  Dr Leon-Guerrero: Yeah. I think there were lessons learned from DEFUSE and DAWN that we were probably over-selecting. Perhaps too stringent. You know, we had number needed to treat in the range of two to three for good outcome based on those trials. And so, I think those were lessons learned to move forward, and we, and, and people started looking at large core infarctions. And in the last few years, we've seen a multitude of randomized control trials examining large core infarctions. These are patients with ASPECT scores all the way down to zeros. A lot of the trials relied on three to six as their score, but there was at least one large core study that looked at ASPECT scores down to zero to two, and all of these studies showing benefit.  Dr Albin: Yeah. And we've really moved into if there's some tissue to spare there, probably getting clot out really makes a big difference in impact. You know, it was really surprising to me as a neurointensivist looking at these trials, that the trials had such low rates of hemorrhage, and pretty low rates of dramatic cerebral edema after thrombectomy. I don't know that we've seen all of that in sort of real world applications, but again, we are still seeing some of these patients come in, that really would've been devastated having some amount of functional recovery regained, which is incredible. In terms of another patient population that I think gives a lot of people pause or stickiness, is those basilar artery occlusions, right? Another large vessel, but one that we've had a little bit harder of a time enrolling in trials and having well-selected trials. Where are we now on whether or not basilar artery occlusion should go to mechanical thrombectomy?  Dr Leon-Guerrero: So, a lot of excitement in this area, too. There's at least two studies that were published in the last five years that were showing benefit in doing thrombectomy for patients with basilar artery occlusion up to 24 hours, and these were patients with moderate to severe deficits with NIH Stroke Scale scores greater than 10. And then making sure that they don't have large core, so using a newer scoring algorithm on the CAT scan called PC ASPECT, so basically a posterior circulation ASPECT score, to kind of make sure that patients don't have large core infarctions that are being considered for thrombectomy. All of those things collectively in those two recent studies, the ATTENTION trial and the BAOCHI trial, I think is what ended up making those studies positive, is that we were selecting the right types of patients, uh, without large core, early core, and patients with moderate to severe deficits that made the difference from previous trials.  Dr Albin: Yeah. I think that that's so important. Those trials to me, and like how long it took to get those enrolled, really emphasized to me that there really was a selection bias. Like, we believed this worked, which made it hard to then do a trial. But I'm so glad to hear that we have the data now to support moving forward in a more rigorous way.  Dr Leon-Guerrero: You're absolutely right. I think that was some of the challenges with the initial trials. In fact, the authors had commented on that. There's a lot of difficulties with lack of clinical equipoise, or experts wanting to take these patients anyways out of clinical trial and treat them, and so that's always been an issue. And then, you know, we all remember basilar artery occlusion cases. They can be severe, devastating cases in our career, but the reality is they're not that common. So, if you look at large vessel occlusions, they only account for about 10%, and if you look at all stroke patients presenting to most centers, they represent about 1% of cases. So really hard clinical trials to do just because there's thankfully not a lot of patients walking around with basilar artery occlusions, but certainly makes for challenges when you're trying to conduct randomized controlled trials on this subset of patients.  Dr Albin: Absolutely. But we did it, and I think that, like, really if, if the listeners take nothing else, it's that the field of vascular neurology is really moving forward with evidence-based, doing very rigorously controlled clinical trials, which is, I think, is what makes this field so exciting. Finally, closing out, cause we could talk all day, but we don't have all day. You know, it seems to me that more and more we are just using dual antiplatelet therapy all the time. And maybe that is, uh, a little bit of a hyperbole, cause I don't think it's all the time, but let's walk through— when is there good evidence for dual antiplatelet therapy?  Dr Leon-Guerrero: Yeah. So, there's strong evidence for early initiation of dual antiplatelet therapy or DAPT in patients with minor stroke or high-risk TIAs, and it's been studied using both clopidogrel as an add-on to aspirin and ticagrelor. Both seem like they're viable options in patients. I think one of the key things is the duration of therapy. So, in these cases with minor stroke and high-risk TIAs, we really should be confining the treatment of early DAPT for 21 days. The risk profile changes, so the risk of recurrent stroke starts to decline with time, and that risk of hemorrhage complications increases with time. And so that sweet spot of 21 days, or even some centers will do 30 days for just practical purposes, you know, really is what we should be doing in most of those cases. Other instances where DAPT can be considered, is in patients with intracranial atherosclerosis that's symptomatic, extrapolating from the SAMMPRIS trial that in the, in the medical management arm alone, used dual antiplatelet therapy with aspirin and clopidogrel for up to 90 days. So, you'll see that as well in clinical practice. Some people will opt for a 90-day duration for those patients with symptomatic intracranial atherosclerosis and stroke.  Dr Albin: Just so I emphasize, this is not set it and forget it. You can stay on DAPT forever. It is you're going to have a definitive time course, 21 days, 90 days. We have directed instructions where we're doing more benefit than harm because of that risk of hemorrhage.  Dr Leon-Guerrero: That's correct. In most cases, we really should be confining the duration of DAPT either to 21 days or 90 days. This is a challenging clinical practice. Centers really have been making an emphasis on stroke follow-up, so making sure these patients get appropriate and timely stroke follow-up to address these issues and to make sure that DAPT is discontinued if appropriate.  Dr Albin: Yeah. I love that, and I want to pull on that a little bit because you as someone who is helping direct a stroke center– A lot of this really does rely on systems of care. When we think about early lysis decisions or mechanical thrombectomy, it's how do we get the patient to one of those capable centers as quickly as possible? And then on the back end, when you're discharging a patient, how do you make sure that they are getting follow-up, making sure that they're getting their Holter monitor if they need it? You know, all the stuff that goes into kind of figuring out, why did the stroke happen? What are some of the things that you, in your role, are really excited about, that will move the needle over the next five or 10 years?  Dr Leon-Guerrero: Yeah. I think a lot of centers are doing it just like we're doing it. It really has to be a team-based approach, and you really want to reach the patient where they are in terms of the continuum of care. And so making sure if it's the in the field that you've reached out to your EMS and first responders to make sure they understand triage protocols to get patients where they need to be, to get the acute treatments that they need for the type of stroke that they're presenting with, to the actual centers that you work at, making sure your whole team, nurses, emergency physicians, APPs that are involved in care are all aware of the stroke protocols and how we're selecting these patients, making sure that your imaging protocols are up to date, and so that it's seamless when patients come in, that we're not adding on perfusion if we should have gotten that up front– We already know, have made decisions before that patient gets there. And then thinking about the patient after that hospital stay, I think, is critical. We really want to reduce their risk of recurrence, making sure that we're leveraging transitions of care, getting those patients seen in our stroke clinics for follow-up, and then make sure we're passing that baton to the long term. All of their long-term comorbidities that may be increasing their risk of stroke are managed and reduced as best as possible.  Dr Albin: From the Continuum journal to the continuum of stroke care.  Dr Leon-Guerrero: That's right.  Dr Albin: I mean, we have it all. I think that that really is so important. I'll just close with what's one thing that is your favorite part about being a vascular neurologist?  Dr Leon-Guerrero: I think it's what attracted to me to this field. As a medical student at that time, all we had was intravenous thrombolysis, and there was so much promise. There was so much promise that there was going to be widespread advancements in acute stroke, and here we are. There's been a tremendous amount of advancements and improvements for patients. I'm really excited to see what unfolds in the next few years, and I'm really excited that we've been able to increase the number of patients we're able to treat with acute ischemic stroke. I hope that we continue to expand the time window, the inclusion criteria, all of those things that we can treat more stroke patients effectively.  Dr Albin: It is really a very exciting time to be a vascular neurologist. Again, today, I've been interviewing Dr. Christopher Leon-Guerrero about his article on Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you again, Dr. Leon Guerrero and our listeners for joining today.  Dr Leon-Guerrero: Thanks for having me.  Dr Monteith: This is Dr. Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Ep 279 Why is Rick Rubin Selling Athletic Nicotine? Kitty wants to know. Why is nicotine suddenly being marketed as a wellness product? In this episode, Kitty O'Compost turns her satirical eye toward the rise of “athletic nicotine,” a new generation of premium nicotine pouches aimed at runners, creatives, executives, and health-conscious high performers. Using Rick Rubin's podcast sponsorship as a starting point, Kitty explores how a highly addictive substance is being wrapped in the language of mindfulness, optimization, and intentional living. With humor, skepticism, and a trip through the False Consensus Detector, Kitty examines the growing effort to separate nicotine from its tobacco past and position it alongside coffee, supplements, and other performance tools. Along the way, she asks whether beautiful branding can obscure biological reality and whether a wellness halo can transform public perception without changing the underlying molecule. Avis closes the episode with a personal reflection on his admiration for Rick Rubin's work and his repeated requests that Rubin reconsider promoting athletic nicotine to his audience. Listen for the peace. Referenced Materials & Studies: Corporate Strategy: Magazine, "How This Founder Changed Minds Instead of Pushing Sales" by Christopher Cason (April 2026). Link to Inc. Article Cardiovascular Risks:The American Heart Association (AHA) Policy Statement, "Impact of Smokeless Oral Nicotine Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment" (Published in Circulation). This study tracks the adverse effects of oral pouches on cardiovascular biomarkers and the specific dangers of synthetic nicotine. https://pubmed.ncbi.nlm.nih.gov/39624904/ Excerpt: “Abstract. Smokeless oral nicotine products are addictive, and their use has potential adverse effects on some but not all biomarkers of cardiovascular risk. The use of some types of these products, for instance, is associated with an increased mortality risk in those with ischemic heart or cerebrovascular disease. Similarly, smokeless tobacco has the potential to increase the risk of oral cancer, but the risks depend on the chemical composition of the product. The market of smokeless oral nicotine products has transformed since the last American Heart Association smokeless tobacco policy statement. Several varieties of tobacco-free oral nicotine products-including oral nicotine pouches; nontherapeutic nicotine gums, lozenges, and tablets; and nicotine gummies-have rapidly proliferated. The sales of oral nicotine pouches, in particular, have increased substantially; however, no data are available on their cardiovascular or health risks. In addition, synthetic (compared with tobacco-derived) nicotine has been used in some brands of oral nicotine products, but its cardiovascular and health effects have been inadequately studied. Robust public policy levers are identified to support ending addiction to all commercial tobacco products. Critical components and policy initiatives include clinicians emphasizing the prevention of tobacco product initiation and supporting cessation with established pharmacological and behavioral tobacco dependence treatment therapies as primary goals for achieving an end to commercial tobacco and nicotine addiction.” Public Health Data:The Centers for Disease Control and Prevention (CDC) Fact Sheet on Oral Nicotine Pouches, highlighting rapid dependency loops, systemic toxicity, and the acceleration of youth addiction through modern marketing. Excerpts: “There are no safe tobacco products, including nicotine pouches. This is especially true for youth, young adults, and women who are pregnant.” “More research is needed to better understand the short- and long-term health effects of using nicotine pouches.” Join the Community / Get the Books:AvisKalfsbeek.com  

Welcome to the Plant-Based Canada Podcast! In today's episode, we're joined by Dr. Vasanti Malik to discuss sustainable, healthy diets and environmental impacts. Dr. Vasanti Malik is an Associate Professor in the Department of Nutritional Sciences at the University of Toronto and holds a Tier 2 Canada Research Chair in Nutrition and Chronic Disease Prevention. She also serves as an adjunct faculty member at the Harvard T.H. Chan School of Public Health. Dr. Malik earned her MSc in Nutritional Sciences from the University of Toronto and a dual doctorate in Nutrition and Epidemiology from Harvard, where she also completed postdoctoral training.Her research focuses on dietary and lifestyle determinants of obesity and cardiometabolic diseases across diverse populations and life stages, with additional expertise in environmental sustainability and food systems. Using epidemiological studies, clinical trials, and evidence synthesis, she has published more than 150 peer-reviewed papers that have informed dietary guidelines and health policy internationally. Dr. Malik has contributed to expert advisory initiatives with organizations including World Health Organization and American Heart Association, and collaborates on global nutrition and chronic disease prevention research in Canada, the United States, and internationally.WebsiteDr. Vasanti Malik: https://nutrisci.med.utoronto.ca/faculty/vasanti-malikResources:TOsustain: https://utsc.utoronto.ca/foodandfarm/tosustainTMU Urban Farm: https://www.torontomu.ca/sciencerendezvous/activity-booths/urbanfarm/Lancet Planetary Health Abstract: https://pubmed.ncbi.nlm.nih.gov/38632913/ Diabetes & Community Gardens: https://healthypopulationsnetwork.utoronto.ca/news/catalyst-grants-fund-projects-aimed-reducing-type-2-diabetes-risk-peel-region Plant-Based Canada's Socials:Instagram  (@plantbasedcanadaorg)Facebook (Plant-Based Canada, https://m.facebook.com/plantbasedcanadaorg/)Website  (https://www.plantbasedcanada.org/)X / Twitter @PBC_orgBonus PromotionCheck out University of Guelph's online Plant-Based Nutrition Certificate. Each 4-week course will guide you through essential plant-based topics including nutritional benefits, disease prevention, and environmental impacts. You can also customize your learning with unique courses such as Plant-Based Diets for Athletes and Implementing a Plant-Based Diet at Home. As the first university-level plant-based certificate in Canada, you'll explore current research, learn from leading industry experts, and join a community of like-minded people. Use our exclusive discount code PBC2026 to save 10% on all Plant-Based Nutrition Certificate courses. uoguel.ph/pbn.Thank you for tuning in! Make sure to subscribe to the Plant-Based Canada Podcast so you get notified when new episodes are published. This episode was hosted by Stephanie Nishi RD, PhD.Support the show

This week, how workplace wellness can boost our energy and focus, the best ways to store and cook with olive oil, and how a quick brain type test may reveal how our mind works when it comes to weight loss. Plus, where to learn life-saving CPR skills and simple mood boosters to lift our spirits naturally.  Hear practical habit-building tips (cue, craving, response, reward) and everyday swaps to improve health, plus buying and storage advice for extra virgin olive oil — why darker bottles, cool cupboards, and mindful cooking matter. Learn about CPR and AED training, the American Heart Association's Nation of Lifesavers effort, and pick up simple workplace-wellness and instant mood-boosting strategies to fight fatigue and burnout.

This week on Do Politics Better, Brian Lewis and Skye David sit down with North Carolina Department of Natural and Cultural Resources Secretary Pam Cashwell to discuss her remarkable career in public service and her department's leadership role in commemorating America's 250th anniversary. Secretary Cashwell made history as the first Native American to serve in a North Carolina Governor's Cabinet. Throughout her career, she has been guided by a commitment to public service, holding leadership positions in civil rights enforcement, litigation, public safety, and state government. She reflects on the experiences that shaped her, the mentors who influenced her path, and why she believes public service remains one of the most meaningful ways to make a difference in people's lives. The conversation also explores North Carolina's plans for America 250, the nationwide commemoration of the 250th anniversary of the signing of the Declaration of Independence. As the state agency charged with preserving North Carolina's history, culture, and natural heritage, the Department of Natural and Cultural Resources is leading efforts to ensure communities across the state have opportunities to celebrate, learn, and reflect on the nation's founding and the many stories that have shaped North Carolina over the past two and a half centuries. Plus, Brian and Skye unpack another busy week in North Carolina politics. They provide the latest updates on state budget negotiations, veto override efforts at the General Assembly, and legislation that is moving—or waiting in the queue—as lawmakers race toward key deadlines. They also discuss the Carolina Hurricanes' visit to the legislature, reflect on the life and legacy of a former state senator following his passing, and cover a variety of other political developments from around the state. The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/23-06-2026Nesta terça-feira, analisamos a importância do vínculo na pediatria, um alerta cardiovascular sobre os cigarros eletrônicos e o papel da ancestralidade na oncologia de precisão. Discutimos um estudo nacional que comprova como a falta de um médico de atenção primária de referência aumenta a dependência das crianças pelo pronto-socorro como principal porta de entrada no sistema de saúde. Detalhamos a pesquisa apresentada na American Heart Association revelando que aditivos sintéticos com efeito "ice" em vapes provocam arritmias e estresse celular cardíaco. Por fim, no Radar, abordamos um estudo brasileiro com mais de mil pacientes com câncer de pulmão que mapeou a influência das mutações no gene TP53. Afya News. Informação médica confiável e atualizada no seu tempo.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-490 Overview: In the US, maternal morbidity and mortality rates are among the highest in the western world, and stroke is one of the leading causes—responsible for 1 of 12 maternal deaths. This rate is estimated to be much higher in high-risk pregnancies. Join us as we discuss a recent study examining rates of maternal stroke in which 1 in 4 women with stroke experienced a missed diagnostic opportunity and hear what these findings mean for your practice. Episode resource links: Haghighi N, Bourscheid RM, Shang C, et al. Identifying missed diagnostic opportunities in maternal stroke. Stroke. 2026;57(2). doi:10.1161/STROKEAHA.125.052995 Chen Y, Shiels MS, Uribe-Leitz T, et al. 2025. Pregnancy-Related Deaths in the US, 2018-2022. JAMA Network Open.  Lappen JR, Pettker CM, Louis JM. 2021. American Journal of Obstetrics and Gynecology. Society for Maternal-Fetal Medicine Consult Series #54: Assessing the Risk of Maternal morbidity and Mortality. American Journal of Obstetrics and Gynecology. Miller EC, Bello NA, Chen PR, et al 2026. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement from the American Heart Association. Stroke.  Bushnell C, Kernan WN, Sharrief AZ, et al. 2024. Guideline for the Primary Prevention of Stroke: A Guideline from the American Heart Association/¬American Stroke Association. Stroke.  Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-490 Overview: In the US, maternal morbidity and mortality rates are among the highest in the western world, and stroke is one of the leading causes—responsible for 1 of 12 maternal deaths. This rate is estimated to be much higher in high-risk pregnancies. Join us as we discuss a recent study examining rates of maternal stroke in which 1 in 4 women with stroke experienced a missed diagnostic opportunity and hear what these findings mean for your practice. Episode resource links: Haghighi N, Bourscheid RM, Shang C, et al. Identifying missed diagnostic opportunities in maternal stroke. Stroke. 2026;57(2). doi:10.1161/STROKEAHA.125.052995 Chen Y, Shiels MS, Uribe-Leitz T, et al. 2025. Pregnancy-Related Deaths in the US, 2018-2022. JAMA Network Open.  Lappen JR, Pettker CM, Louis JM. 2021. American Journal of Obstetrics and Gynecology. Society for Maternal-Fetal Medicine Consult Series #54: Assessing the Risk of Maternal morbidity and Mortality. American Journal of Obstetrics and Gynecology. Miller EC, Bello NA, Chen PR, et al 2026. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement from the American Heart Association. Stroke.  Bushnell C, Kernan WN, Sharrief AZ, et al. 2024. Guideline for the Primary Prevention of Stroke: A Guideline from the American Heart Association/¬American Stroke Association. Stroke.  Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Sometimes V-fib doesn't respond to the shock at all. Sometimes it converts and comes right back. Those are two completely different problems.In this episode, Sarah breaks down the science behind why defibrillation fails, how to recognize the difference between refractory and recurrent V-fib, and respond when shocks aren't working. You'll learn how to start approaching the electrical storm at the bedside — that means understanding transthoracic impedance, optimizing your pad placement, and knowing when to reach for double sequential defibrillation.Topics discussed in this episode:Refractory vs. recurrent V-fibThe physiology of ventricular fibrillation and re-entry tachycardiasMisconceptions about defibrillationTransthoracic impedance and how to reduce itAnterior-lateral vs. anterior-posterior pad placementDouble sequential defibrillation: evidence and objectionsKey findings from the DOSE VF trialAmerican Heart Association. (2025). 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.Cheskes, S., Dorian, P., Feldman, M., McLeod, S., Scales, D. C., Pinto, R., Turner, L., Morrison, L. J., Drennan, I. R., & Verbeek, P. R. (2020). Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 150, 178–184. https://doi.org/10.1016/j.resuscitation.2020.02.010D. Hasegawa, A. Sharma, Y. I. Lee, & R. Sato. (2023). A systematic review and meta-analysis of esmolol for refractory ventricular fibrillation and pulseless ventricular tachycardia. Chest, 164(4 Suppl.), A1568. https://doi.org/10.1016/j.chest.2023.07.1077International Liaison Committee on Resuscitation. (2025). 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).Mentioned in this episode:CONNECT

NC Family Policy Council Lobbyist Jere Royall sits down for a fascinating conversation about politics, family, and the power of relationships in #ncpol. Jere is the son of the late Sen. Ken Royall, one of the most influential figures in modern North Carolina political history when he became both the Senate Majority Leader and Appropriations Chairman decades ago. Gov. Jim Hunt described the Durham legislator as "a master of the legislative process" who helped shape state policy from education and economic development to mental health reform and hospitals. Despite growing up in a household led by a Democratic political giant, Jere charted a different path. He became a lobbyist and advocate for many of the social and family policy causes most closely associated with North Carolina conservatives and the Republican Party.  Jere reflects on lessons learned from his father, the values that shaped his own political worldview, and how respect, trust, and personal relationships still matter in a highly polarized political environment. Plus, Skye and Brian break down the latest political news, including budget news, political news, an election bill, a rumor, the Canes win, and more.  The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

My guest is the extraordinary Dr. Richard Allen Williams, a world renowned cardiologist. He founded the Association of Black Cardiologist 50 years, when there was only 2 Black Caridiologists in the United States. He founded the Minority Health Institute when it was not popular to talk of the health disparities between the races. He is an international on hypertension, healthcare disparities, diabetes, obesity,heart failures and sudden cardiac death. He was honored by the American Heart Association with their LifeSaver Award. Additionally... he is a renowned jazz trumpeter, who has worked or learned from some of the jazz icons of all time. It is a MARVELOUS episode!!!  Produced, directed, edited and host by Stephen E Davis.  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Many people worry about memory loss and cognitive decline as they age. In this episode of Health Matters, host Courtney Allison speaks with Dr. Matthew Fink, neurologist-in-chief at NewYork-Presbyterian and Weill Cornell Medicine, about how lifestyle choices—especially diet—can help protect the brain. Dr. Fink explains the MIND diet, a combination of the Mediterranean and DASH diets, which emphasizes whole foods like leafy greens, berries, fish, nuts, and olive oil while limiting salt, sugar, and ultra-processed foods. He breaks down how key nutrients such as B vitamins and antioxidants support brain metabolism, reduce inflammation, and may slow the aging process. The conversation also highlights the brain's high energy demands and why proper nutrition is essential for cognitive function. Dr. Fink shares research showing that healthy lifestyle interventions can significantly lower the risk of dementia and discusses the broader benefits of the MIND diet for heart health and stroke prevention. Finally, Dr. Fink outlines additional habits that support brain health, including regular physical activity, quality sleep, and social connection, emphasizing that even small, gradual changes can lead to meaningful long-term benefits.   Chapters 00:00 – Why Brain Health Is in Your Control How lifestyle choices can reduce dementia risk and why prevention starts early 03:00 – What Is the MIND Diet? Key components of the Mediterranean and DASH diets and how they support the brain 06:00 – Brain-Boosting Nutrients and Foods to Avoid The role of B vitamins, antioxidants, and which foods increase risk 10:30 – Beyond Diet: Exercise, Sleep, and Daily Habits How movement, rest, and social connection contribute to cognitive health     Key Topics Covered MIND diet overview Mediterranean diet and DASH diet Brain metabolism and energy use B vitamins and brain health Antioxidants and inflammation Foods that support cognitive function Foods to limit (salt, sugar, processed foods) Dementia and Alzheimer's prevention Stroke and heart disease connection Exercise and brain function Sleep and cognitive health Lifestyle changes for healthy aging   Takeaway Message You have more control over your brain health than you might think. By focusing on whole, nutrient-rich foods, limiting processed options, staying active, and getting enough sleep, you can significantly reduce your risk of cognitive decline and support a healthier brain as you age.   Doctor Bios Matthew E. Fink, MDis currently the Louis and Gertrude Feil Professor and chair of the Department of Neurology at Weill Cornell Medicine, and neurologist-in-chief at NewYork Presbyterian/Weill Cornell Medical Center.  In addition, he is chief of the Division of Stroke and Critical Care Neurology at NewYork-Presbyterian/Weill Cornell Medical Center, and vice chair of the medical board. Dr. Fink attended college at the University of Pennsylvania, medical school at the University of Pittsburgh, and served as resident and chief resident in internal medicine at the Boston City Hospital. He came to New York and trained in neurology at the Neurological Institute of NewYork-Presbyterian/Columbia University Irving Medical Center, and served as chief resident under Dr. Lewis P. Rowland. Subsequently, he joined the faculty of Columbia University and became the founding director of the Neurology-Neurosurgery Intensive Care Unit at NewYork-Presbyterian and was appointed associate professor of clinical neurology and neurosurgery while at Columbia. Dr. Fink was a founding member and chair of the critical care section of the American Academy of Neurology, and the research section for neurocritical care of the World Federation of Neurology. He is board-certified in internal medicine, neurology, critical care medicine, vascular neurology, and neurocritical care.  He has been elected as a Fellow of the American Neurological Association, the American Academy of Neurology, and the Stroke Council of the American Heart Association. Throughout his career, Dr. Fink has been involved in the education and training of students, residents and fellows in the field of stroke and critical care neurology, as well as an active participant in clinical research within this field. He is a leader in this new specialty, has lectured widely, and has published many research and clinical articles in the field of stroke and critical care. In addition, he currently serves as editor of the monthly publication, NEUROLOGY ALERT, and is a past-president of the New York State Neurological Society.

Are eggs bad for you because they may raise cholesterol?It's one of the most common nutrition questions in cardiology, and one of the most misunderstood. The reality is that raising cholesterol and harming your health aren't always the same thing, and when it comes to eggs, the data tells a much more nuanced and reassuring story than most people have been led to believe.In this conversation, Dr. Bret Scher walks through the science of eggs, cholesterol, and cardiovascular risk, cutting through decades of nutritional confusion to help you understand what it actually means for your individual dietary choices.You'll learn:Why the original "eggs cause heart disease" logic doesn't hold up under scientific scrutinyWhat happens to LDL and HDL when most people eat whole eggsWho the "egg hyper responders" are and what genetics has to do with itWhy hazard ratios in observational egg studies are often clinically unhelpfulWhat the American Heart Association now says about eggs and cardiovascular riskWhy eggs are one of the most nutrient dense whole foods availableHow to think about egg quality, quantity, and individual responseThe takeaway: eggs can be part of a healthy whole foods dietary pattern for most people. Context, metabolic health, and the totality of your diet often matter far more than any single food.

Primary stroke prevention is a critical opportunity for neurologists, with most stroke risk driven by modifiable factors such as hypertension and lifestyle behaviors. This episode highlights practical tools and strategies, including Life's Essential 8 and contemporary risk calculators, while also exploring evolving approaches to shared decision making and secondary prevention. In this episode, Katie Grouse, MD, FAAN, speaks with Mitchell S. Elkind, MD, MS, FAAN, author of the article "Stroke Prevention" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Elkind is the Chief Science Officer for Brain Health and Stroke at the American Heart Association in Dallas, Texas, and a professor of neurology and epidemiology at Columbia University in New York, New York. Additional Resources Read the article: Stroke Prevention Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @MitchElkind Full episode transcript available here Dr Grouse: Neurologists have generally been more involved in secondary stroke prevention, but primary stroke prevention is increasingly recognized as an important topic of discussion for neurologists. Today, I have the opportunity to interview Dr. Mitchell Elkind, who wrote the article on stroke prevention in the newest Continuum issue on cerebrovascular disease.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, and please introduce yourself to the audience.  Dr Elkind: Thank you so much, Katie. So, my name is Mitch Elkind, and I'm the Chief Science Officer for Brain Health and Stroke at the American Heart Association and a stroke neurologist by background.  Dr Grouse: Well, I just want to start by saying that I really enjoyed reading this article. I think this is just a really wonderful article I recommend strongly. Such a high yield, an important topic for a lot of us who see patients who are interested in learning about their stroke risks or need help with, uh, stroke prevention after having a stroke. So, I wanted to start. What's changed in the last couple of years? You know, what are some big highlights that you really want to stress that are different from maybe the last time we reviewed this topic?  Dr Elkind: Sure. Well, there's been a lot of development in the field of secondary stroke prevention, for one thing. But even beyond that, I think we increasingly appreciate how important it is to control what we call the social drivers of health on the earlier side, primordial or primary prevention. And that has been a big advance, I'd say. And I would also say, I think it's really important for neurologists to understand some of those questions about primordial and primary prevention. You know, we tend to get involved with patients after they've had a stroke or maybe a TIA, some kind of event. But sometimes we find people who are following for, you know, non-stroke related conditions who have risk factors also. And we can really play an important role in identifying those risk factors and helping to prevent a first stroke or vascular event as well. So, I think it's real important for us to be doctors even before we're neurologists. So, you know, Katie, about ninety percent of stroke risk is modifiable, so we can do a great job as neurologists in preventing stroke. And one of the most important things that we can do is to identify and treat high blood pressure. And recently, actually, the American Heart Association, American College of Cardiology guidelines on the management of hypertension have said that treatment of high blood pressure not only prevents stroke, but it can also help to prevent cognitive decline and dementia. And this is the first time that we've had a class of recommendation one and level of evidence A, the highest level of recommendation we give for the use of blood pressure treatment to prevent dementia. And that's largely based on the results of some large trials that have come out recently showing that you can prevent dementia with blood pressure control. So that's a really exciting link, I think, between cardiovascular risk factor control and subsequent brain health. It just illustrates the role that neurologists can play in, so many conditions outside of stroke as well.  Dr Grouse: That's a really great point, and I want to get a little more into the idea of primordial stroke prevention. Can you tell us a little bit more about what that might be?  Dr Elkind: So primordial prevention refers to addressing how we can prevent risk factors from occurring in the first place, and how can we improve the environments in which people live. You know, we know that only about twenty percent of health outcomes is dependent on what happens between the patient and their doctor in the office. About eighty percent of it is due to what happens in the environments in which we live, work, pray, and play. And so that's what we mean when we refer to the social drivers of health. What is the neighborhood like where somebody lives? Do they have access to healthy food? Do they have places where they can go to exercise? Is there air pollution in the area that may affect their health? You know, one really interesting fact that's become apparent in the last few years is that air pollution is a major risk factor for stroke. Something like a sixth of all strokes can be attributed to the quality of air. And so, what are the things we can do at the broader public policy, community level to reduce the risk of risk factors like high blood pressure and diabetes even before somebody has an event that brings them to the attention of the doctor? So that's what we're thinking about with regard to primordial prevention. It's the earliest stage in prevention.  Dr Grouse: And that's really fascinating. You know, I think an area that we haven't, as neurologists, really put a lot of our time thinking about, but clearly a very important thing. I really appreciated reading your article about how you incorporated the fact that, you know, a lot of these risk factors overlap very, very closely with all the risk factors for various types of cardiovascular events. And I would imagine that the work you've done as the Chief Clinical Science Officer for the American Heart Association has informed a lot of the way you've thought about-Trying to bring all these risks together and think a little bit more holistically about the whole thing. Could you tell us a little bit more about that and the work that you've done on the American Heart Association's Life's Essential 8 score?  Dr Elkind: Sure. I can't take credit for it. It's really work that was done by others at the Heart Association, particularly a cardiologist and epidemiologist named Don Lloyd-Jones. But many other volunteers participated. Life's Essential 8 is our approach to primary stroke prevention and cardiovascular prevention more broadly. We say Life's Essential 8 because it includes four health behaviors and four health factors that people can observe to reduce their risk of cardiovascular disease. The four factors are kind of things like know your numbers, your blood pressure, your blood sugar, your body mass index, right, which is a combination of weight and height, and your cholesterol level. So, know those numbers and keep them within the recommended ranges, and talk to your doctor if they're not. And then four lifestyle behaviors. So, one of them is to eat a healthy diet, and typically that means the Mediterranean diet. It means getting regular exercise, and we recommend 150 minutes a week of moderate to vigorous physical activity. Of course, it means abstinence from smoking or other tobacco products. And the last one, the eighth one, which I was so excited about when we added this, is sleep, recommending at least seven hours of sleep a night. So, I was really excited about this because we used to talk about Life's Simple 7, and then the last iteration of our recommendations included this recommendation for adequate sleep because of the mounting evidence of the importance of sleep to cardiovascular health. But sleep is really a brain function, right? And so, it was really the first, in a way, specific brain function that was added to our recommendations. So that's Life's Essential 8. People can read about it online at heart.org and recommend it to your patients as a simple way for people to understand the best approach to reducing their risk of cardiovascular disease, including stroke.  Dr Grouse: I checked it out myself after reading the article. It's very accessible to patients. It's a great education tool. And they can, you know, see their own score and use that in their own way to, to think about what their risks are and how they can help mitigate and then rescore themselves down the line. There's also, though, on the kind of more the clinician side, the PREVENT calculator as well. Could you tell us a little bit more about how we could use that in approaching this patient population?  Dr Elkind: Yeah. So, I think of Life's Essential 8 as being a patient-focused tool that people can use. PREVENT is really more for clinicians. Anybody can look it up online and enter your data into it. There's a risk calculator online. But the basic idea behind PREVENT and other similar risk calculators is that it's a way to estimate somebody's risk of having a cardiovascular event like stroke or a heart attack or even heart failure by entering information about your health. And we used to think, we used to use something called the ASCVD, atherosclerotic cardiovascular disease risk calculator, or the Framingham score. Framingham Heart Score, for example, was another one. PREVENT is the latest version, and it has several advantages over those earlier types of risk predictors. For one thing, it predicts risk at younger ages as well. It goes down to age 30. It predicts risk over a longer duration of time, so over 30, 10 or 30 years. It eliminates the use of race as an item to put into the calculator and substitutes for that socioeconomic status, so it's not a race base, but a measure of social disadvantage. And it also includes kidney elements, kidney measures. It includes renal function, for example, that weren't included in prior measures, and it can also be used to predict heart failure, which was not part of the original calculators. Another major advantage of the PREVENT study is that it was based on real-world data from about three million patients, many, many more than the 50,000 or so that the earlier risk calculators were based on. So, it has a much more robust data set and therefore allows a bit more precision in the ability to predict future risk of events. And typically, primary care doctors would enter their patient's data, calculate a risk, and then based on the results of the risk calculator, they can make recommendations about what type of medications a person should take or what other strategies they could use to reduce their risk. And so that's the role that PREVENT plays, is really being focused more for the clinician than the patient.  Dr Grouse: Really great tool for us to be aware of. You earlier alluded to the fact that neurologists are in the situation where we sometimes are helping patients with this primary prevention. But you also make a case for why it's in the patient's best interest for us to be involved in, in these conversations when we can, when we have the opportunity. Can you tell us more about that?  Dr Elkind: Shared decision-making is really important because we know that people aren't going to lead the healthiest possible lives if they're not invested in their care. And so, a doctor telling somebody what to do if the patient doesn't want to do it is gonna have limited benefit.So we emphasize the importance of shared decision-making as much as possible. And I think that where this comes up a lot is actually in the situation of, for example, atrial fibrillation, where patients will often be put on a blood thinner. And many people are fearful of blood thinners. They worry about the risk of bleeding. Maybe they know a relative who's had a bleeding complication from a blood thinner, and so they may be disinclined to try it. And so, it's really important to have these discussions about the risks and the benefits of medication and engage the patient in thinking about this. And there are even tools and visual aids that people can look to to help explain some of these complicated concepts to patients. So, these are the kinds of things that reflect implementation science as a way to improve adherence. We know what works in a clinical trial setting often, but the challenge is translating that into the real world and getting our patients to use the medications that we believe scientifically have been shown to be of benefit. I've actually been surprised sometimes at conversations I've had with people, in some cases, healthcare professionals who resist going on blood thinners because of their fear of the complications. And I feel like the evidence is there. Why don't they believe me? And that's why it's really important to have the conversation. Even our peers and colleagues can sometimes question the evidence, and it's important for us to be aware of that.  Dr Grouse: Absolutely. I think that sounds very reasonable to me, and hopefully these tools will help us with making some of these decisions with our patients. Now, turning our attention a little bit to secondary prevention. So, you know, someone's already had a stroke or a TIA, sort of thinking about what we can do to optimize their risk factors for further strokes. You know, I think there has been some changes that have happened, I think, in the last few years that might be affecting some of the decisions we're making and some of the advice we're giving our patients. I wanted to talk a little bit about GLP-1 receptor agonist medications. Is the data there to support use of this either in secondary prevention or even in primary prevention in the case of stroke?  Dr Elkind: There is evidence that supports the use of GLP-1s for stroke prevention. We need more data, though. We need trials that focus only on patients with stroke, for example, there have been studies in patients with cardiovascular disease broadly that include stroke patients. But if you look at the subcategory just of stroke patients alone, the data in that subgroup alone don't always show a benefit. And so, we need more data that's focused on stroke patients alone. So, I think the data are continuing to emerge, but we need more still.  Dr Grouse: Is there any development in the thought about whether we should be putting patients on antiplatelet therapies for incidental, incidentally identified strokes? For instance, if you got an MRI for migraine or for other reasons and you found one, no history of any stroke-like symptoms. Should we be putting these patients on aspirin or any other types of therapies?  Dr Elkind: That's a really great question. And again, it's an area where there's some controversy and really, there's really no definitive data that would support using antiplatelet therapy in people with incidentally discovered infarcts or what we call, you know, whispering strokes or silent strokes. Many stroke neurologists will use antiplatelet agents. This is one of those areas where it's so important to identify the risk factors. As we were saying before, patients who have other neurological disorders like migraine or epilepsy may turn out to have cardiovascular risk factors like diabetes and high blood pressure. That's why it's so important for neurologists to be able to treat those patients or refer them to specialists who can. Patients who have incidentally discovered lesions similarly are a group where we should be looking for risk factors. So, I don't think of it only in terms of do we put them on an antiplatelet or not, but really more holistically, can we identify their other risk factors and address those? Should the patient's information be entered into a risk calculator like PREVENT, for example, so that we can come up with a more global or holistic measure of their cardiovascular risk and address that as appropriate? Because if they are at risk for stroke, they're also at risk for cardiac events, including heart attack, heart failure, sudden cardiac arrest, and so forth. So, I think of it as a, as a great kind of teachable moment or an opportunity to catch somebody and bring them into the healthcare system more broadly and address those other potential risk factors.  Dr Grouse: Speaking of, of risk factors that we often like to think about and work up when possible, in cases where it seems certainly possible the patient had an embolic stroke, but perhaps we've done a few weeks or four weeks of cardiac monitoring, have not found any evidence of atrial fibrillation. What's new and what's the current recommendations for doing further monitoring when there's high suspicion for cardioembolic stroke?  Dr Elkind: This is a really active area of investigation, and guidelines suggest that we should do some cardiac monitoring for atrial fibrillation after an unexplained stroke, but it's not clear how much we should do. Studies generally show that the longer you follow somebody on a cardiac monitor after stroke, the more likely you are to detect atrial fibrillation. It could be as high as thirty percent after a few years. And that's great. And if you detect atrial fibrillation, people usually end up being recommended for a blood thinner. But how extensively we should monitor remains unknown. And I think a lot of the investigation recently has been around the question of, are there other ways to get that information rather than waiting six months or a year for the person to develop atrial fibrillation?It's a little bit funny logically to think a person has a stroke today, a year later you discover atrial fibrillation on the monitor, and you say, "Oh, now I know what caused your stroke a year ago." Right? The temporality, the causality perhaps is off in that case. And so, wouldn't it be better if we could tell what somebody's risk of having another cardioembolic stroke is, or the likelihood that they have atrial fibrillation is at the time that you first see them for the stroke, you know, in the hospital, for example. And so, there's some really new technologies that have evolved like AI or artificial intelligence interpretation of EKGs that can give a really good indication of which people are gonna go on to develop atrial fibrillation. And so, I think we need some more trials in that area to demonstrate that we can detect the risk of AFib and treat that even before it appears on one of those delayed monitors. That's an area that I think is very exciting right now. There's also a further question with regard to how to treat these patients, which is that sometimes atrial fibrillation is a consequence of the stroke itself. So, we can think about what people call known AF, meaning atrial fibrillation that's known about before the stroke even occurs, versus AF that's detected after a stroke, or AF-DAS, people will say. Those may have very different implications for the risk of recurrence and what the person's cardiovascular status is. So, I think what we've learned over the last few years is that atrial fibrillation, it used to be like the slam dunk for a stroke neurologist. It was the easy thing. You know, you had a stroke, you have AFib, you should be on a blood thinner. Now we know that there's lots of different kinds of AFib. There's AFib before stroke, there's AFib after stroke, there's burden of atrial fibrillation. So, some people may have 30 seconds of AFib, some people may have several hours, some people may be in it continuously. It comes and goes, and that can make it challenging to manage. So, we have a lot more work to do to understand this problem better.  Dr Grouse: That also gets me into some other interesting areas that I think there's still some question, you know, how aggressive should you be? How often is it a case of is this correlated or is this causative? For instance, when a patent foramen ovale is, is discovered in patients with cryptogenic stroke. Are there any tools or new developments to help us understand whether these PFOs should be closed in these cases?  Dr Elkind: PFO and stroke is a great story that's been going on for decades. And again, we've made tremendous progress in the last several years. So, it's true that about 20% or so of people have a PFO, and because of that, it can be really hard to say with any certainty whether an individual patient sitting in front of you, that the PFO was the cause of their stroke. Rarely we can have a really high degree of certainty. You know, if somebody has, uh, a DVT, for example, and shortly after that maybe they have pulmonary embolism and then a stroke, and we can say, "Oh, clearly this was a paradoxical embolism," went to the lungs and then some crossed over and went to the brain. That happens really infrequently. Most of the time you're faced with a patient who has a PFO and a stroke, and they may have some other risk factors. There are some tools that we can use to help figure out the likelihood that a PFO is related to a stroke. One of those is called the ROPE score or the risk of paradoxical embolism score that was developed by David Thaler and, uh, David Kent from Tufts and a group of other investigators as well. That score allows one to say what the likelihood is that the PFO was causative of the stroke, and it's based on a person's risk factors such that the younger you are, the more likely it is the PFO caused the stroke. And the absence of risk factors make it more likely that the PFO caused the stroke. So, the higher your ROPE score indicating the fewer other reasons you have a stroke, the more likely the PFO is to be causative. So that can be helpful in identifying patients who may have had a stroke due to their PFO. There are other features that are identified in something called the PASCAL score, which is a way of assessing the degree of shunting and whether or not there's an atrial septal aneurysm that can be used as additional factors that lead to the likelihood that a PFO was causative rather than just incidental. So, by putting this kind of information together, we can kind of do precision neurology or precision prevention by identifying which patients with a PFO are really the ones we need to worry about and do procedures like closure.  Dr Grouse: I look forward to hearing more and learning more as more advances are made in these areas. Dr Elkind: Thank you.   Dr Grouse: And thank you so much for joining us today to talk about your article.   Dr Elkind: Oh, I appreciate it. Thank you for giving me the opportunity. I really enjoyed it.  Dr Grouse: Again, today I've been interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this episode, preventive cardiologist Dr. Ann Marie Navar, a member of the committee that helped shape the American Heart Association's new recommendations for earlier cholesterol management, explains why many experts believe cardiovascular prevention should begin decades before most people ever experience symptoms. Dr. Navar explains why lowering LDL cholesterol earlier in life can have lasting benefits decades later, how ApoB and lipoprotein(a) are reshaping the way experts think about heart disease risk, and why some of the most popular fears surrounding statins aren't supported by the evidence. The conversation also explores the growing divide between evidence-based medicine and the wellness industry and the challenges of separating compelling biological theories from treatments that have actually been proven to improve health outcomes. She's a wealth of knowledge and a wonderful guest. Hope you enjoy.

Mark Ezzell, Director of the North Carolina Governor's Highway Safety Program, was in his early 20s when his father, Sen. Jim Ezzell, died on Capital Boulevard in Raleigh on the eve of session starting in 1991.   That loss not only changed Mark's life forever, it also created an opening in the North Carolina Senate for a young House member named Roy Cooper. But this story is about more than politics, it's also about perseverance and grace.   Senator Ezzell, who lived with cerebral palsy, and his wife made the intentional decision to adopt a child with a disability. At age eight, Mark was adopted from foster care and welcomed into a family that saw his potential, not his limitations. Born with spina bifida, Mark has spent his life navigating challenges from a wheelchair while building a successful career in public service, including his work today of preventing highway fatalities.   Plus, Skye and Brian unpack another busy week: state budget negotiations continue, a moratorium on certain property tax increases heads to Governor Stein's desk, political news, a state senator has his eyes on a mayor's office, and graduation ceremonies are getting out of hand.   The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

#thismorning | #Move More for Your #Health, Not Just for the #Scale | Damon L. Swift, Ph.D, American Heart Association & University of Virginia | #Tunein: broadcastretirementnetwork.com #Aging, #Finance, #Lifestyle, #Privacy, #Retirement, #wellness

Click to Text Thoughts on Today's EpisodeWhen a friend described drooping eyes, slurred words, and fuzzy thinking at brunch — and then brushed it off as anxiety — I knew something wasn't right. That conversation sparked this important Common Sense episode on recognizing the warning signs of stroke, TIA, and heart attacks, and why acting fast can make all the difference. I hope this episode gives you a little more confidence and a little less hesitation if you ever need it. Share it with someone you love. It might matter more than you know.In This Episode:Why women are more likely to dismiss their symptoms — and the cost of waitingThe FAST acronym for stroke and TIA: F — Face droopingA — Arm weaknessS — Speech difficultyT — Time to call 911What a TIA (transient ischemic attack) is and why feeling better doesn't mean you're in the clearAdditional stroke warning signs beyond FASTHow heart attacks present differently in women — including jaw pain, back pain, nausea, fatigue, and shortness of breath with no chest pain at allWhy you should call 911 instead of driving yourselfA personal reflection on loss and the what-ifs we carryEpisodes Discussed:500th Episode: ​5 Uncomfortable Lessons from 500 Episodes​For more information on heart attacks and stroke visit:American Heart Association — heart.org — covers both heart attack and stroke, very thorough, well-organized for general audiencesAmerican Stroke Association — stroke.org — technically a division of AHA but has its own dedicated stroke content including FAST informationMy latest recommended ways to nourish and move your body, mind and spirit: Nourished Notes Bi-Weekly Newsletter30+ Non-Gym Ways to Improve Your Health (free download)Connect with Amy: GracedHealth.com Instagram: @GracedHealthYouTube: @AmyConnell

Host Jeremy C. Park interviews Missy Acosta, Senior Vice President, Brand Experience with Delta Dental of Tennessee, who highlights Tennessee's largest dental benefits carrier and their differentiation as a not-for-profit 501(c)4 with a mission of "Ensuring Healthy Smiles" and a focus on philanthropy and community investment. Missy talks about Delta Dental of Tennessee's charitable arm, The Smile180 Foundation, which was founded in 2014 with three philanthropic pillars: to increase access to dental care for underserved communities, support children's hospitals, and fund oral health education across Tennessee and beyond. Missy shares a number of examples how their support of charitable dental clinics, including Church Health and Christ Community Health Services in Memphis and Neighborhood Health and Interfaith Dental in Nashville are increasing access to dental care for underserved communities. She discusses why oral health is a top priority for children's hospitals, including St. Jude Children's Research Hospital and Monroe Carell Jr. Children's Hospital at Vanderbilt, and explains why their support of oral health education covers everything from kids television programming to promote healthy habits to supporting colleges of dentistry in Tennessee to help equip the next generation of dentists and oral hygienists to be successful and to help address dental deserts across the state. Missy talks about how these efforts tie in with the Healthy Smiles Initiative, along with some of their other philanthropic efforts, including providing mouth guards to youth playing sports through various organizations and affiliations. Missy then highlights their fifth annual Kids Dental Day, scheduled for Friday, July 10 at First Horizon Park, home of the Nashville Sounds. More than 500 youth from various nonprofits in Middle Tennessee will be attending the fun, festival-like event where they will receive free dental screenings, cleanings, new socks and shoes through a partnership with Soles4Souls, new books through Book 'Em, snacks, and more. Over 100 volunteers will be coming out to support the kids and a number of organizations will be providing interactive games and experiences, like PBS Kids, American Red Cross, Adventure Science Center, American Heart Association, Schenk Photography, and the Colgate Bright Smiles Bright Futures Program. The dental organizations participating include Neighborhood Health, Meharry School of Dentistry, South College, LINKS INC., and Hope Smiles. Partners for the event include Nashville Sounds, cityCURRENT, Signature Transportation, United Way, Kroger, OneGen, Henry Schein, and Dunkin. Missy talks about why this annual event is so important in the community and how this can serve as inspiration for other companies to give back and get more involved in making a difference. Missy closes by inviting youth-serving organizations and volunteers who wish to serve to connect with KidsDentalDay.com to learn more and to plan ahead for next year. Visit www.KidsDentalDay.com to learn more about Kids Dental Day and visit https://deltadentaltn.com to learn more about Delta Dental of Tennessee.

In part two of this series, Dr. Andy Southerland and Dr. Dan Ackerman discuss a few rapid‑fire concepts from the 2026 guidelines, focusing on what is new and how emerging data may shape patient care.  Show transcript:  Dr. Andy Southerland: Hello, everyone. This is Andy Southerland from the University of Virginia. And for today's Neurology Minute, I'm speaking with my friend and colleague, Dan Ackerman, Chief of Neurology and Director of Stroke at St. Luke's University Health System. We've been speaking in the main neurology podcast on tips for updated clinical practice related to the 2026 American Heart Association guidelines for the early management of patients with acute ischemic stroke. I'm going to hit Dan with a few rapid fire concepts that were touched on the guidelines that I think are new or provide some new insights, new based on the data and to how we treat patients. So Dan, you ready for it? Rapid fire, acute stroke treatment decision making? Dr. Dan Ackerman: Absolutely. Hit me. Dr. Andy Southerland: All right, Dan. I'm a resident going to my first stroke alert on July one this year and I've got a patient coming in, they're having disabling stroke symptoms and they're, in every other way, eligible to receive thrombolysis, but they have a history of paroxysmal atrial fibrillation. They are on apixaban and they took a dose of that apixaban. They forgot to take one yesterday, but they took one the day before, had the evening before. And so 36 hours ago, they took a dose of their apixaban. So based on previous dogma, I think prior guidelines might've said if it's within that 48 hour window, that's a relative contraindication of thrombolysis. What, say, you based on the new guidelines and then how do they inform us about making that decision? Dr. Dan Ackerman: I would actually say the new guidelines are a little bit more aligned with what you just said. You mentioned it as a relative contraindication to thrombolysis. I think before these guidelines came out, a lot of people would've said, "No, that is a strict contraindication to thrombolysis." And a lot of folks would run a stroke code or a stroke lid a little slower knowing that, hey, this person is on, whether it's apixaban, rivaroxaban, edoxaban, dabigatran, et cetera, any of these direct oral anticoagulants and say, "Well, no, we know that person's not a candidate for thrombolytics." Well, no, the newer guidelines would suggest that that is a relative contraindication, not a strict contraindication. And when we look back at studies on this, it has not been suggested that there is a big contribution in terms of exactly how long ago that last dose was. Was it two hours ago, 12 hours ago, 20 hours ago? And there has not been shown to be a clear benefit of testing for factor Xa activity levels, bleeding time and the like. So the guidelines do suggest that, hey, we need more data on this. It's not to, say, that this is 100% perfectly fine. Remember, that's a relative contraindication, so it's still a risk benefit discussion, but studies have not shown an increased risk for hemorrhagic complications in patients who have had recent DOAC exposure who receive IV thrombolysis otherwise according to the guidelines. So I would tend to offer it in that situation and make sure that we document what drugs someone's on, how long ago was their last dose, all of this kind of information in addition to what we might normally otherwise get down. Dr. Andy Southerland: Does that change, Dan, if they took the DOAC in the last 24 hours or even 12 hours? They took it last night, and they're presenting in the morning with their stroke-like symptoms? Dr. Dan Ackerman: The guideline just suggests less than 48 hours, and the data, to my knowledge, doesn't really delineate, at this point, any particular timeframe where we would say, no, there's a cutoff there at two hours or eight hours or 12 hours. So at this point, I would not use that as a way to decide not to offer thrombolysis based on that timeframe. Dr. Andy Southerland: Fair enough. I think that's very reasonable. And I think, again, it's always a good conversation to have either with your attending, if you're that resident on July 1, but particularly with the patient and their family on the risk-benefit of what we know based on the data. Well, that's all the time we have for this Neurology Minute. We hope this discussion will continue to help everyone out there in the hyperacute management of patients with acute ischemic stroke, making those difficult treatment decisions. Good luck.  

In part one of this series, Dr. Andy Southerland and Dr. Dan Ackerman discuss what stands out in the latest thrombolysis guidelines, how these decisions are applied in stroke center practice, and how to educate residents and fellows on incorporating new evidence into treatment choices. Show transcript: Dr. Andy Southerland: Hi. This is Andy Southerland from the University of Virginia, and for today's Neurology Minute, I'm speaking with my friend and colleague, Dan Ackerman, Chief of Neurology and Director of Stroke at St. Luke's University Health System. I've been speaking with Dan on the main neurology podcast regarding updates to acute stroke treatment related to the 2026 American Heart Association guidelines that came out in late January of this year on the early management of patients with acute ischemic stroke. For our episode today, we might focus our discussion around thrombolytic therapy thrombolysis, which is at the core of what we do as acute stroke neurologists when it comes to treatment decision-making. So maybe as a first prompt, Dan, when you look at these guidelines, what stands out to you as you're thinking about how you practice, how you all are practicing at your stroke center, and then specifically how we educate our residents, our fellows on what they need to know, particularly the newness of it when it comes to making thrombolysis treatment decisions? Dr. Dan Ackerman: With all the discussions we've had in the past, there have been a lot of specifics about certain studies and how they might affect practice, but this guideline really opened up a lot and gave us an opportunity to do things in a way that makes really good clinical sense and really brings a lot of practices that have now become common at some centers into the fore so that we can get that information out to everyone and make sure everyone has that same really high level of stroke care everywhere they go. I think the first thing that stands out to me is what did not change. And want to reinforce that, particularly for people who are just getting into this, stroke alert is a screening tool, not a severity score. It's not like an MI alert where you do an EKG and you see the tombstone wave and you say, "Oh, there's an MI and we're taking them to treatment." This is a screening tool, so it is meant to be highly sensitive at the cost of being specific. At our shop for a long time now, we have initiated stroke alert for anyone who presents either within 24 hours of acute onset of neurologic symptoms or has an unknown onset of acute neurologic symptoms and they are still symptomatic to some degree at the time of their presentation, and that's it. We don't make any other statements about how severe something is or what kinds of symptoms someone necessarily has to have. We purposely keep it as broad as possible, again, because we're trying to screen. And the other thing that has not changed, time is still brain. So with all of these different nuances on how we can treat patients and who might be candidates for intervention, it is still a matter of understanding these guidelines, applying our best evidence, but doing it as quickly as possible to make sure that we are rescuing as much of that ischemic penumbra as we possibly can. Now, aside from that, in terms of what stands out that is different, I think one of the early things for me are the recommendations for extended time window for IV thrombolysis. So when you look at the original studies, we understand that when you get out beyond four and a half hours, if you just take all-comers, the risk is going to start to outweigh the benefit. But that doesn't mean there's zero benefit or that no one would receive benefit, but it's a question of, well, how do we cherry-pick those patients who may still receive benefit? And there are a few real specifics in the guideline that help us figure that out. One is for patients who have an unknown time of onset, but they're within four and a half hours of symptom discovery. And for those patients, they would suggest that doing a stat MRI and comparing a DWI lesion with the corresponding area flare to determine if you see DWI hyper-intensity and the flare image is nice and normal, that would suggest that stroke is young enough that it may still be appropriate to treat that patient. But we would also say for folks who have salvageable ischemic penumbra, so again, brain at risk that is not core yet, who either awoke with stroke symptoms within nine hours from the midpoint of sleep or, and this is the kicker, are within four and a half to nine hours from last known well. So in other words, they may have been symptomatic already for more than four and a half hours. If those patients have an appropriate ischemic penumbra, it may be reasonable to treat them with IV thrombolysis to improve functional outcomes. Dr. Andy Southerland: Well, that's all for this Neurology Minute. We hope this vibrant conversation will help all those who are out looking to make the best treatment decisions for their patients, both based on established evidence and most recent evidence in our new guidelines.  

Doctor Mau Informa ®️ #drmauinforma Cuando discutimos la diabetes tipo 2 y la prediabetes, nuestro enfoque se centra casi exclusivamente en restringir los carbohidratos y perder peso. Sin embargo, los datos de los ensayos clínicos más recientes revelan un punto ciego enorme en nuestros paradigmas de atención: el músculo esquelético es nuestro órgano de eliminación de glucosa más grande, e ignorarlo acelera el envejecimiento metabólico. En este episodio, desglosamos las pautas clínicas y los datos de ensayos más recientes que demuestran por qué el entrenamiento de hipertrofia mecánica funciona como una poderosa intervención no farmacológica para el control del azúcar en sangre, incluso para personas con un peso normal. En este episodio aprenderás: → Por qué la diabetes tipo 2 actúa como un factor de riesgo independiente para la sarcopenia acelerada y el declive de la función muscular. → Los datos moleculares que demuestran que el entrenamiento de resistencia mejora la HbA1c en aproximadamente un 0.57% y la glucosa en ayunas en ~7 mg/dL. → Por qué el entrenamiento de hipertrofia es significativamente superior al entrenamiento de resistencia a la fatiga para la inflamación sistémica y la retención de masa magra. → Los sorprendentes resultados del ensayo Kobayashi: por qué el entrenamiento de fuerza venció al cardio en la diabetes tipo 2 de peso normal. → Los parámetros de programación exactos de la Asociación Americana de Diabetes y el ACSM necesarios para optimizar la eliminación metabólica en la práctica.

Former NC Lieutenant Governor Dan Forest sits down for a candid conversation about the twists and turns that have shaped his life, career, and outlook on the future.   The Republican reflects on growing up in a political family, how his parents' divorce affected him and influenced his views on faith, family, and perseverance. He also opens up about one of the most difficult chapters of his public life: his 2020 gubernatorial loss, what he learned from the experience, and how it changed his perspective on politics and leadership. Today, Forest has embarked on a new chapter that he says he genuinely loves. As a lobbyist and leader of a coalition focused on blockchain technology and AI, he is helping businesses and policymakers navigate some of the most transformative innovations of our time. He discusses the opportunities and challenges presented by AI, the future of cryptocurrency, and why he believes emerging technologies will reshape government, business, and everyday life. Plus, Skye and Brian break down the latest developments at the General Assembly, including a budget update, several key bills on the move, and a notable veto override. They also take a look at the stories shaping the week across North Carolina before turning their attention to the state's collective obsession: the Carolina Hurricanes.  The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

You've probably heard of a sweet tooth, the term for people who love sugary foods and desserts. But you might be less familiar with a salt tooth. In other words a  preference for salty foods, such as crisps, olives, cheese and other salty things.  According to a study presented at the American Heart Association's Scientific Sessions meeting in 2016, there is a genetic basis for your salt cravings. Some people carry a variation of a gene that may give them more of a taste for salt. This gene also affects how people perceive bitterness, which may explain why people with a salt tooth tend to avoid foods such as broccoli and dark leafy greens. What causes a salt tooth, and is it bad for your health ? How can you satisfy your salt tooth without harming your health ? In under 3 minutes, we answer your questions ! To listen to the last episodes, you can click here : ⁠⁠What is brain tapping, the viral technique for improving sleep quality?⁠⁠ ⁠⁠What is the half and half drinking method?⁠⁠ ⁠⁠How can heatwaves impact our mental health?⁠⁠ A podcast written and realised by Amber Minogue. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Casandra MacLeod discusses central retinal artery occlusions, recent trials, and those anticipated in the future.  Show citation:  Préterre C, Gaultier A, Obadia M, et al. Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial. Lancet Neurol. 2025;24(11):909-919. doi:10.1016/S1474-4422(25)00308-4  Poli S, Grohmann C, Wenzel DA, et al. Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial. Int J Stroke. 2024;19(7):823-829. doi:10.1177/17474930241248516  Ryan SJ, Jørstad ØK, Skjelland M, et al. A Randomized Trial of Tenecteplase in Acute Central Retinal Artery Occlusion. N Engl J Med. 2026;394(5):442-450. doi:10.1056/NEJMoa2508515 Show transcript:  Dr. Casandra MacLeod Hello, this is Casandra MacLeod, a neurology resident at Cleveland Clinic with today's Neurology Minute. Today we will be discussing central retinal artery occlusions, or CRAOs, and the recent trials that have come out and even those further on the horizon. The 2026 American Heart Association and American Stroke Association guidelines for the early management of patients with acute ischemic stroke were recently published and in them highlight the uncertainty around the treatment of acute CRAOs with intravenous thrombolysis, even when the patient presents within four and a half hours and is otherwise eligible. These guidelines come after two recent trials, which we will further discuss. The thrombolysis in patients with acute central retinal artery occlusion, or the THEIA trial, was published in the November issue of Lancet Neurology. This multicenter trial out of France randomized 70 patients with acute CRAOs presented within four and a half hours of time from last known well to either receive IV alteplase and oral placebo or IV placebo and oral aspirin. While safety measures showed no symptomatic hemorrhage event, although they did have one asymptomatic intracerebral hemorrhage occur, the primary outcomes, which included visual acuity improvement at one month, showed some evidence for a trend of improved acuity in the IV thrombolytic group at 66% compared to 48 in the aspirin group, it did not reach significant. And now more recently, the Tenecteplase in central retinal artery occlusion study, or TenCRAOs, was published in the January 2026 issue of The New England Journal of Medicine. TenCRAOs was a six European country multicenter trial that randomized 78 patients with CRAOs all presenting within four and a half hours of time from last known well to either receive IV Tenecteplase or aspirin, both with placebo-matching as in THEIA. The primary outcomes of TenCRAOs also included visual acuity at one month, but unfortunately this trial also did not show [inaudible 00:02:07]. They showed 20% in the IV TNK group compared to 24% in aspirin. And additionally, there was one fatal intracerebral hemorrhage in the TNK group that should be considered. Overall, the AHA and ASA guidelines state the usefulness of treatment with intravenous thrombolysis is uncertain. And this is based largely on these studies as neither trial showed improved visual recovery. Although both of these trials are underpowered, leading many to believe that the jury is still out on the use of IV thrombolytics in CRAOs. But importantly, stay on the lookout for one last trial. The early reperfusion therapy with intravenous alteplase for recovery of vision and acute central retinal artery occlusion, or the Revision trial, is actively recruiting. Revision is similar in design as THEIA, but with a goal of up to 422 total patients for a goal of a well-powered study to guide decision making. 

Bob Harringson and former FDA commissioner Rob Califf discuss medical misinformation, its impact on public and individual health, and how to fight against it. This podcast is intended for healthcare professionals only. To read a transcript or to comment, visit https://www.medscape.com/author/bob-harrington  Is a Long-Simmering Crisis Boiling Over? U.S. Primary Care Today https://doi.org/10.1056/NEJMms2510425 The Global Wellness Economy Hits a Record $6.8 Trillion and Is Forecast to Reach $9.8 Trillion by 2029 https://globalwellnessinstitute.org/press-room/press-releases/the-global-wellness-economy-hits-a-record-6-8-trillion-and-is-forecast-to-reach-9-8-trillion-by-2029/  Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association https://doi.org/10.1161/CIR.0000000000001078  Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17018-9/abstract  Here's What We Know https://weillcornell.org/heres-what-we-know  Fifth Circuit sides with ivermectin-prescribing doctors in their quarrel with the FDA https://www.courthousenews.com/fifth-circuit-sides-with-ivermectin-prescribing-doctors-in-their-quarrel-with-the-fda/  SNAP Tracker: People Are Losing Food Assistance as the Republican Megabill Is Implemented https://www.cbpp.org/research/food-assistance/snap-tracker-people-are-losing-food-assistance-as-the-republican-megabill  Chronic Conditions and Food Insecurity in US Children https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839376  As Unregulated Peptides Flood the Market, Clinicians Encouraged to Counsel Patients https://www.medscape.com/viewarticle/unregulated-peptides-flood-market-clinicians-encouraged-2026a1000e63 Coethia https://coethia.com/  You may also like: Hear John Mandrola, MD's summary and perspective on the top cardiology news each week, on This Week in Cardiology https://www.medscape.com/twic  Questions or feedback, please contact news@medscape.net

Welcome back, everyone. Today we're diving into one of the most hotly debated topics in obstetrics- should we be treating preeclampsia without severe features with antihypertensive medications during expectant management? Now, if you've been following the literature- and our show, you know that the landmark CHAP trial changed the game for chronic hypertension in pregnancy. It showed us that targeting a blood pressure below 140 over 90 reduces serious maternal complications, without harming the baby. That was a big deal. But here's the thing, CHAP studied chronic hypertension. Then there was the CHIP trial- that also found that tight control of gestational hypertension and nonproteinuric chronic hypertension was also beneficial. These did not address preeclampsia without severe features, and yet, the ripple effects of that trial have sparked a global conversation about whether we should be extending those same treatment principles to women with preeclampsia who don't yet have severe features. And this is where it gets really interesting, because the guidelines don't agree. In the United States, ACOG and the Society for Maternal-Fetal Medicine still say: hold off on antihypertensives unless blood pressures hit the severe range at 160/110. But step outside the US, and you'll find the World Health Organization, the International Society for the Study of Hypertension in Pregnancy, FIGO, NICE, and Hypertension Canada all recommending treatment at 140 over 90, regardless of whether the diagnosis is chronic hypertension, gestational hypertension, or preeclampsia. So who's right? And more importantly what does this mean for the patient sitting in front of you right now, at 34 weeks, with a blood pressure of 150 over 95, some proteinuria, but no severe features? Today, we're going to break this down. We'll review the controversy, walk through the divergent guidelines, and most importantly talk about the real, practical implications that favor treating these patients during expectant management. Because when you're watching someone with preeclampsia, waiting for the right time to deliver, there's a strong argument that controlling their blood pressure isn't just reasonable…may be protective. So grab your coffee, settle in, and let's get into it.1. Society for Maternal-Fetal Medicine Statement: Antihypertensive Therapy For mild chronic Hypertension in Pregnancy-The Chronic Hypertension And Pregnancy Trial. American Journal of Obstetrics and Gynecology. 2022. Society for Maternal-Fetal Medicine; Publications Committee. 2. Preeclampsia. The New England Journal of Medicine. 2022. Magee LA, Nicolaides KH, von Dadelszen P.3. Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.The Cochrane Database of Systematic Reviews. 2018. Abalos E, Duley L, Steyn DW, C.4. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association. Stroke. 2026. Miller EC, Bello NA, Chen PR, et al.5.Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022. Garovic VD, Dechend R, Easterling T, et al.

Dr. Arreaza: Hello, everyone, my name is Dr. Hector Arreaza, I am a family physician and an associate program director in the Clinica Sierra Vista – Rio Bravo Family Medicine Residency Program.  Today we're discussing one of the most powerful predictors of health that many people rarely think about: geography. Where someone lives can influence everything from access to physicians and emergency care to chronic disease outcomes and life expectancy. Joining us today is Peyton, who will be taking a deeper look into the matter. Peyton, thank you for being here — can you start by introducing yourself, please? Peyton: Hello, thank you for having me. My name is Peyton, I am a 4th year medical student with Western Atlantic University, and I am from a very small town in South Dakota.  Dr. Arreaza: Peyton, you are on your last few days in your FM rotation, when are you graduation?  Peyton, you prepared this topic and it is great. When people hear the phrase “your ZIP code can determine your health,” what does that actually mean? Peyton: It basically means that where someone lives can significantly influence their health outcomes and even life expectancy. A person's ZIP code can affect access to physicians, hospitals, transportation, emergency services, and preventative care. Arreaza: Talking about prevention. The American Heart Association agrees with you because Zip code is not part of the cardiovascular risk calculator called PREVENT. I invite everyone to take a look at this new calculator. I think a lot of people assume healthcare is equal as long as hospitals or clinics exist nearby, right? Peyton: Yes, patients may still struggle with overcrowded healthcare systems, which can lead to long wait times. In fact, a national physician appointment survey found that average wait times for new patient primary care appointments in major cities can exceed three weeks, with some cities reporting significantly longer delays depending on specialty access and provider availability. Dr. Arreaza: And when patients experience those kinds of delays, they may frequently switch between providers, which becomes much harder to establish consistent long-term care. Peyton: One of the biggest issues many patients face is continuity of care — having consistent follow-up with the same provider over time. Dr. Arreaza: And that continuity really matters in medicine, especially family medicine, it is one of our keywords: continuity of care. Peyton: Exactly. Preventative care and chronic disease management work best when patients have long-term relationships with healthcare providers. But in many underserved communities, patients may wait months for appointments, frequently change providers, or rely on emergency rooms instead of primary care clinics. Dr. Arreaza: And urgent care too. When care becomes fragmented, conditions like hypertension, diabetes, and chronic illnesses can become much harder to manage. Peyton: Exactly. Delayed screenings, missed follow-up appointments, and lack of preventative care often lead to patients presenting later with more advanced disease that could have been treated earlier. Dr. Arreaza: And urban communities may face some of the same challenges, but rural communities are at a different level of barriers to health care. Peyton: Absolutely. Rural communities often experience significant physician shortages. According to the Health Resources and Services Administration, over 100 million Americans live in primary care shortage areas, and nearly 65% of those shortage areas are located in rural regions. Peyton: I think one of the biggest solutions starts with strengthening primary care and investing more heavily in underserved communities, especially rural areas. Dr. Arreaza: And that includes increasing the number of physicians going into family medicine and primary care specialties.  Peyton: Here is an interesting fact: According to the Graham Center, Northeastern states receive high graduate medical education (GME) funding but produce relatively fewer primary care physicians. Northwestern states receive low GME funding but perform relatively better, producing slightly above the U.S. average (70.8 vs 69.8 primary care physicians per 100,000 people). However, even this remains far below Canada's average of 119 primary care physicians per 100,000 people.  Right now, the United States is facing a growing physician shortage. According to the Association of American Medical Colleges, the country could face a shortage of up to 86,000 physicians by 2036, with primary care being one of the most affected areas. Arreaza: Another group that may help address the physician shortage is International Medical Graduates. We'll cover this in more detail in a future episode, but it's worth mentioning briefly here. We have highly trained physicians, including neurosurgeons, driving Uber. There is nothing wrong with that work, but their medical skills could be used to help more people. I'll leave our listeners with that thought: IMGs can help. So, Peyton, are you interested in rural medicine? Peyton: I am very interested in Rural medicine, in fact my next few rotations will be back in South Dakota on the Pine Ridge Indian Reservation. Actually, the Pine Ridge Reservation is the poorest Indian Reservation in the country.  Peyton: The measure of any healthcare system is not how well it serves those closest to its centers of power, but how far its reach extends to those who need it most. If we are serious about health equity, the road forward must run through every small town, every county clinic, and every community that has been told to wait its turn. Their turn is now. References Association of American Medical Colleges (AAMC). The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. https://www.aamc.org/workforce American Academy of Family Physicians (AAFP). Rural Practice and Physician Recruitment.https://www.aafp.org Centers for Disease Control and Prevention (CDC). Rural Americans at Higher Risk of Death from Five Leading Causes.https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html Cecil G. Sheps Center for Health Services Research. Rural Hospital Closures.https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001–2014. JAMA. 2016;315(16):1750–1766. https://jamanetwork.com/journals/jama/fullarticle/2513561 Health Resources & Services Administration (HRSA). Health Professional Shortage Areas (HPSAs).https://data.hrsa.gov/topics/health-workforce/shortage-areas Rural Health Information Hub. Healthcare Access in Rural Communities.https://www.ruralhealthinfo.org/topics/healthcare-access Rural Health Information Hub. Transportation to Support Rural Healthcare.https://www.ruralhealthinfo.org/topics/transportation Rural Health Information Hub. Rural Residency Planning and Development. https://www.ruralhealthinfo.org/topics/rural-residency-programs Centers for Disease Control and Prevention (CDC). Health and Access to Care in Rural America.https://www.cdc.gov/ruralhealth/index.html Measure of America. A Portrait of Los Angeles County 2026. Social Science Research Council.https://ssrc-static.s3.amazonaws.com/moa/APortraitofLosAngelesCounty2026.pdf Merritt Hawkins. Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/ Fenster, T. L., MD, Park, J., PhD, Huffstetler, A. N., MD, & Topmiller, M., PhD (2026). Graduate Medical Education Funding Does Not Flow to Primary Care Physician Production. American family physician, 113(4), 321–322. https://pubmed.ncbi.nlm.nih.gov/42101593/ Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!

865. The USDA unveiled the 2025–2030 Dietary Guidelines for Americans, and the "Inverted Pyramid" has been sparking a lot of discussion. After a decade of MyPlate, why is the government returning to a pyramid visual—and why is it upside down?In this episode, Monica breaks down the major shifts in the new US guidance, including:The protein pivot: Why protein is taking center stage and what it means for your health.The plant-based omission: Why beans and legumes were left out of the new visuals despite the scientific evidence.The global gap: How the new US pyramid compares to the UK's Eatwell Guide and Canada's food plate.AHA vs. USDA: Why the American Heart Association is issuing its own "course correction" on salt and saturated fat.This episode will help you navigate these changes without losing sight of common-sense nutrition.Nutrition Diva is a Quick and Dirty Tips podcast, hosted by Monica Reinegal.New to Nutrition Diva? Check out our special Spotify playlist for a collection of the best episodes curated by our team and Monica herself! We've also curated some great playlists on specific episode topics including Staying Strong as We Age, Diabetes, Weight Loss That Lasts and Gut Health! Also, find a playlist of our bone health series, Stronger Bones at Every Age. Have a question for Nutrition Diva? Email: nutrition@quickanddirtytips.comFind Monica at wellnessworkshere.comDiscover more from Nutrition Diva:Facebook LinkedInNewsletterTranscripts available at QuickandDirtyTips.com. Hosted on Acast. See acast.com/privacy for more information.

CardioNerds Dr. Joseph Kassab, Dr. Mariana Garcia-Arango, and Dr. Christopher Mason explore the technological revolution of Coronary CT Angiography (CCTA) with expert faculty Dr. Michael Gallagher. The discussion details how CCTA has evolved into a frontline diagnostic and preventive tool, moving beyond simple anatomy to incorporate physiology via CT-FFR and biology through AI-driven plaque quantification. The episode reviews landmark evidence like the SCOT-HEART and PROMISE trials, the nuances of CAD-RADS 2.0 reporting, and the emerging role of AI in monitoring treatment response and personalizing cardiovascular care. Critically, they also discuss some of the assumptions and limitations of these techniques. Stay tuned for a matching review article to be submitted to US Cardiology Review, the official Journal of CardioNerds. This episode was supported by an independent medical education grant from HeartFlow. All CardioNerds education is planned, produced, and reviewed solely by CardioNerds.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here. CardioNerds Multimodality Cardiovascular Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll Pearls Shift in Paradigm: CCTA is no longer just an anatomic test; with some key limitations, it can provide anatomy, physiology (CT-FFR), and plaque biology (AI-CPA) in a single non-invasive scan. The “Power of Zero” vs. Plaque: While a normal CCTA has a >95% negative predictive value, future MIs often arise from non-obstructive plaque that traditional stress tests might miss. CAD-RADS 2.0 Utility: The addition of plaque burden modifiers (P1–P4) is a “game changer,” allowing clinicians to identify high-risk patients who need aggressive lipid-lowering despite having only mild stenosis. CT-FFR as a Virtual Stress Test: CT-FFR uses computational fluid dynamics to simulate blood flow, potentially reducing unnecessary invasive catheterizations by approximately 61% without sacrificing safety. Seeing the Invisible: AI-based quantitative plaque analysis (QCPA) can identify “subvisual” plaque and low-attenuation (lipid-rich) components that are the primary drivers of acute coronary syndromes. Show Notes How has the role of CCTA changed compared to traditional functional testing? Historically, stress testing answered “is there ischemia today?”, which often reflects late-stage disease. CCTA identifies disease across the entire spectrum, asking “is there atherosclerosis and how much plaque is present?”. Landmark evidence: SCOT-HEART showed a 41% relative risk reduction in MI at 5 years attributed to intensified preventive therapies, and PROMISE showed CCTA was better at selecting patients who truly needed invasive angiography. Diagnostic CCTA imaging depends on the protocol, contrast timing, heart rate, heart rhythm, breathholding, scanner quality, and several patient factors (obesity, prior stents, heavy calcification, complex bypass anatomy, and motion artifact all may limit imaging). “CCTA is exceptional for the right patient, with the right scanner, and the right team.” What are the key modifiers introduced in CAD-RADS 2.0, and why do they matter? CAD-RADS 2.0 moved beyond stenosis severity to include plaque burden (P0 to P4), high-risk plaque (HRP) features, and the presence of ischemia based on CT-FFR. It serves as a clinical decision support tool: a patient with mild (25-49%) stenosis but “extensive” (P4) plaque burden is considered high risk and warrants aggressive risk factor modification. How is CT-FFR calculated, and when is it most useful in clinical practice? CT-FFR uses resting CCTA data and computational fluid dynamics to create a 3D model of coronary flow during simulated maximal hyperemia. It is often used for intermediate lesions (40–90% stenosis) to predict if they are  ischemia-producing, guiding the decision whether to proceed with invasive angiography.  The assumptions necessary for this computational modeling may not apply well to patients with microvascular dysfunction, significant myocardial scar or prior infarction, or ventricular hypertrophy. Still, data indicate that CT-FFR performs similarly to PET in predicting hemodynamically significant lesions.  CT-FFR performs well at the extremes (either clearly normal or clearly abnormal). Accuracy dips, however, in the intermediate range (~0.75-0.80), where decision-making is most critical. In this grey zone, additional factors can help guide the approach, including the amount of myocardium supplied, translesional gradient, and plaque features.   CT-FFR has not been validated in distal segments, stented segments, heavily calcified coronary arteries, or in patients with severe aortic stenosis. Caution with CT-FFR should be utilized in very calcified coronary segments.  What is AI-based quantitative plaque analysis (QCPA), and what metrics are ready for clinical use? This is potentially a paradigm shift, moving away from stenosis-centric thinking to a more disease burden and plaque biology focus. QCPA uses deep learning algorithms to automatically segment the vessel wall and quantify plaque volume in mm³. Ready for “prime time” metrics include: Total Plaque Volume (TPV), non-calcified plaque volume, and Low-Attenuation Plaque (LAP) burden. Can serial CCTA be used to monitor the effectiveness of medical therapies like statins? While not yet a routine guideline-driven practice, trials like PARADIGM and EVAPORATE show that therapies can stabilize plaque; notably, CCTA is better for monitoring than CAC scores, which can be misleading as statins often increase plaque calcification as part of the stabilization process. There are no randomized trials that serial CCTAs improve outcomes. Cost and radiation exposure will be notable limitations. Serial scan timing, scan acquisition and interpretation standardization would be key. Dr. Gallagher notes that we are moving toward a world in which plaque burden may become a “treatment biomarker,” similar to tumor burden in oncology.  References 1. Coronary Computed Tomography Angiography From Clinical Uses to Emerging Technologies: JACC State-of-the-Art Review. Abdelrahman KM, Chen MY, Dey AK, et al. Journal of the American College of Cardiology. 2020;76(10):1226-1243. doi:10.1016/j.jacc.2020.06.076. 2. Non-Invasive Imaging in Coronary Syndromes: Recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration With the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Edvardsen T, Asch FM, Davidson B, et al. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2022;35(4):329-354. doi:10.1016/j.echo.2021.12.012. 3. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Gulati M, Levy PD, Mukherjee D, et al. Journal of the American College of Cardiology. 2021;78(22):e187-e285. doi:10.1016/j.jacc.2021.07.053. 4. Contemporary, Non-Invasive Imaging Diagnosis of Chronic Coronary Artery Disease. van der Bijl P, Gulati M, Saraste A, et al. Lancet (London, England). 2025;406(10519):2577-2587. doi:10.1016/S0140-6736(25)01586-7. 5. State of the Art: Evaluation and Medical Management of Nonobstructive Coronary Artery Disease in Patients With Chest Pain: A Scientific Statement From the American Heart Association. Slipczuk L, Blankstein R, Bucciarelli-Ducci C, et al. Circulation. 2025;152(23):e443-e466. doi:10.1161/CIR.0000000000001394. 6. Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study. Li C, Hu Y, Jiang J, et al. JACC. Cardiovascular Interventions. 2024;17(17):1980-1992. doi:10.1016/j.jcin.2024.06.027. 7. Clinical Outcomes Based on Coronary Computed Tomography-Derived Fractional Flow Reserve and Plaque Characterization. Sato Y, Motoyama S, Miyajima K, et al. JACC. Cardiovascular Imaging. 2024;17(3):284-297. doi:10.1016/j.jcmg.2023.07.013. 8. Clinical Use of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve: Expert Consensus by an International Working Group. Tang CX, Leipsic JA, Nørgaard BL, et al. European Radiology. 2026;:10.1007/s00330-025-12313-6. doi:10.1007/s00330-025-12313-6. 9. Diagnostic accuracy of computed tomography–derived fractional flow reserve: a systematic review. Cook CM, Petraco R, Shun-Shin MJ, et al. JAMA Cardiol. 2017;2(7):803-810. Doi:10.1001/jamacardio.2017.1314 10. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). Nørgaard BL, Leipsic J, Gaur S, et al. J Am Coll Cardiol. 2014;63(12):1145-1155. Doi:10.1016/j.jacc.2013.11.043 11. Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis. Driessen RS, Danad I, Stuijfzand WJ, et al. J Am Coll Cardiol. 2019;73(2):161-173. Doi:10.1016/j.jacc.2018.10.056. 12. 1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: the PLATFORM study. Douglas PS, De Bruyne B, Pontone G, et al. J Am Coll Cardiol. 2016;68(5):435-445. Doi:10.1016/j.jacc.2016.05.057. 13. Comparison of an initial risk-based testing strategy vs usual testing in stable symptomatic patients with suspected coronary artery disease: the PRECISE randomized clinical trial. Douglas PS, Nanna MG, Kelsey MD, et al; PRECISE Investigators. JAMA Cardiol. 2023;8(10):904-914. Doi:10.1001/jamacardio.2023.2595. 14. Diagnostic and clinical value of FFRCT in stable chest pain patients with extensive coronary calcification: the FACC study. Mickley H, Veien KT, Gerke O, et al. JACC Cardiovasc Imaging. 2022;15(6):1046-1058. doi:10.1016/j.jcmg.2021.12.010. 15. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Williams MC, Kwiecinski J, Doris M, et al. Circulation. 2020;141(18):1452-1462. doi:10.1161/CIRCULATIONAHA.119.044720. 16. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. Nurmohamed NS, Bom MJ, Jukema RA, et al. JACC. Cardiovascular Imaging. 2024;17(3):269-280. doi:10.1016/j.jcmg.2023.05.020. 17. Interaction of AI-Enabled Quantitative Coronary Plaque Volumes on Coronary CT Angiography, FFRCT, and Clinical Outcomes: A Retrospective Analysis of the ADVANCE Registry. Dundas J, Leipsic J, Fairbairn T, et al. Circulation. Cardiovascular Imaging. 2024;17(3):e016143. doi:10.1161/CIRCIMAGING.123.016143. 18. Prognostic Value of AI-Based Quantitative Coronary CTA vs Human Reader-Based Visual Assessment: Results From the CONFIRM2 Registry. van Rosendael A, Nakanishi R, Bax JJ, et al. JACC. Cardiovascular Imaging. 2026;19(3):345-359. doi:10.1016/j.jcmg.2025.09.021.13. Pericoronary Adipose Tissue as a Marker of Cardiovascular Risk: JACC Review Topic of the Week. Tan N, Dey D, Marwick TH, Nerlekar N. Journal of the American College of Cardiology. 2023;81(9):913-923. doi:10.1016/j.jacc.2022.12.021. 19. Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients With Elevated Triglycerides on Statin Therapy: Final Results of the EVAPORATE Trial. Budoff MJ, Bhatt DL, Kinninger A, et al. European Heart Journal. 2020;41(40):3925-3932. doi:10.1093/eurheartj/ehaa652. 20. Coronary CT Angiography Evaluation With Artificial Intelligence for Individualized Medical Treatment of Atherosclerosis: A Consensus Statement From the QCI Study Group. Schulze K, Stantien AM, Williams MC, et al. Nature Reviews. Cardiology. 2026;23(2):100-115. doi:10.1038/s41569-025-01191-6.

In this episode of HeartDoc VIP, Dr. Joel Kahn breaks down the newly released — but not yet fully published — results from the highly anticipated Triumph-1 study on retatrutide, an investigational weight loss medication that's already generating major buzz in the cardiometabolic world. The reported weight loss results at 80 and 104 weeks are remarkable, with side effects appearing consistent with other medications in this class, including semaglutide and tirzepatide. Dr. Kahn discusses what's known so far, what questions still remain, and why the full peer-reviewed publication is so important before drawing final conclusions on risks and benefits. FDA approval may not be far away. Other topics in this packed episode include the troubling rise in fatal heart attacks among younger adults, a modified Mediterranean diet linked to lower diabetes risk, the connection between food preservatives and heart disease, atrial fibrillation in athletes, nitric oxide's role in brain health, fatty liver disease and cardiovascular risk, and how the American Heart Association's Life's Essential 8 score may predict diabetes risk in women. Thanks to Igennus for sponsoring this episode. Visit their site and use promo code DRKAHN to save on high-quality supplements.

In this Retail Technology Spotlight episode, Chris Walton sits down with Kevin Billings, Vice President of Business Development at Sifter Solutions, to unpack how GLP-1 medications, SNAP legislation, and nutrition focused merchandising are reshaping the future of grocery retail. From state-by-state SNAP restrictions to hyper personalized shopping experiences powered by nutrition data, Kevin explains why retailers can no longer afford to treat food intelligence as a niche capability. Drawing from decades of experience across the American Heart Association, Label Insight, NIQ, and Sifter, Kevin shares how retailers can use product level nutritional data to drive compliance, improve shopper experiences, and prepare for a future where health outcomes increasingly influence merchandising strategy. The conversation also explores how grocers can connect pharmacy, loyalty, and merchandising programs to serve shoppers using GLP-1 medications while differentiating themselves against competitors like Amazon and Walmart. From electronic shelf tags and personalized promotions to Arkansas' statewide SNAP technology rollout, this episode offers a practical look at how retailers can prepare for the next era of food as medicine and nutrition driven retail innovation. Key Topics Covered: • 00:11:36 – How SNAP restriction waivers are changing grocery retail state by state • 00:15:57 – Why retailers need product level nutrition data for compliance and merchandising • 00:18:22 – Inside Arkansas' first statewide SNAP shopper technology initiative • 00:24:25 – Why grocers should already be merchandising for GLP-1 shoppers • 00:31:53 – Kevin's vision for the future of hyper personalized grocery shopping See our past 8 years of wonderful Spotlight Series podcast guests, featuring roughly 200 movers and shakers in retail, by clicking here: https://omnitalk.blog/category/spotlight-series-podcast/ #retailtech #groceryretail #GLP1 #foodasmedicine #SNAP #retailinnovation #nutrition #AI #retailoperations #merchandising #loyalty #pharmacy #grocerytech #OmniTalk #retailpodcast *Sponsored Content*

In the first episode of this series on Obesity, our host is joined by Dr. Mikhail Kosiborod to discuss the evolving science and cardiometabolic diseases associated with obesity. This special episode is sponsored with support from AstraZeneca. Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Mikhail Kosiborod, MD, Senior Vice President Late-Stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D at AstraZeneca. Selected references: Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation October 2023

Rep. Allen Chesser is a combat veteran who served more than two decades ago, but he says war is still claiming lives today. With veteran suicide continuing to devastate military families, Rep. Chesser joins Skye and Brian for a candid Memorial Day conversation about service, sacrifice, mental health, and why he believes lawmakers must do more to support veterans long after they return home. The Nash County Republican also discusses his own mental fitness, personal discipline, and how he balances public service and family life. Plus, Skye and Brian break down the latest revenue forecast numbers, where budget negotiations currently stand, a growing list of proposed constitutional amendments at the legislature, and the politics of hugging. The Do Politics Better podcast is sponsored by New Frame, the NC Travel Industry Association, the American Heart Association, the NC Pork Council, the NC Realtors, Heal the System NC, and the NC Healthcare Association.

What if every time you reached for a packaged snack… you were quietly increasing your risk of a heart attack? In this urgent and deeply personal solo episode, Darin breaks down groundbreaking new research showing that each serving of ultra-processed food may increase cardiovascular risk by over 5%, not over time, but every single time you eat it. This isn't about calories. It's about chemistry, biology, and a system engineered for convenience at the expense of your health. From the shocking data to the underlying mechanisms: gut destruction, visceral fat accumulation, brain hijacking, and toxic exposure, this episode exposes the real cost of ultra-processed food and gives you the tools to reclaim control of your health and your life. What You'll Learn The shocking stat: 5% increased heart risk per serving of ultra-processed food Why ultra-processed foods act like compounding debt on your health The difference between calories vs chemical toxicity in food How emulsifiers and additives destroy your gut microbiome Why ultra-processed foods increase visceral fat around your organs How these foods are engineered to override your brain's satiety signals The hidden toxins from processing and packaging (PFAS, bisphenols, AGEs) Why this crisis disproportionately impacts certain communities The truth: you can't "out-exercise" ultra-processed food damage Practical ways to transition back to real, whole foods Chapters 00:00:04 – Opening: SuperLife mission and setting the stage 00:00:33 – Sponsor: Alkemis Paint and hidden indoor toxicity 00:01:24 – Why conventional paints off-gas harmful chemicals for years 00:02:27 – Cradle-to-Cradle certification and non-toxic living 00:03:24 – Entering the episode: the 5% heart risk question 00:03:34 – The shocking claim: every serving increases heart risk 00:04:16 – Ultra-processed food as "compounding debt" 00:05:08 – Leaning into discomfort as a path to growth 00:06:33 – The convenience trap: food delivered instantly 00:07:15 – The real cost: trading time for lifespan 00:08:07 – 2026 study overview (MESA dataset, 6,800 participants) 00:09:01 – 5.1% increased cardiovascular risk per serving explained 00:09:29 – 66.8% higher risk in high-consumption groups 00:10:08 – Risk is independent of calories, weight, and fitness 00:10:56 – "This is not a calorie story—it's a chemistry story" 00:11:10 – Racial disparities and food system inequality 00:12:08 – Additional studies confirm elevated heart risk 00:13:04 – Global meta-analysis: over 1 million participants 00:13:26 – The conclusion: the science is no longer debatable 00:14:18 – Sponsor: Shakeology and nutrient density 00:15:36 – What is ultra-processed food? (NOVA classification) 00:16:18 – Examples: chips, cereals, protein bars, fast food 00:16:57 – "These foods are engineered—not real food" 00:17:00 – Mechanism #1: gut microbiome disruption 00:18:03 – Emulsifiers and inflammation explained 00:18:49 – Gut inflammation triggers systemic disease 00:19:18 – Mechanism #2: visceral fat accumulation 00:19:56 – Why visceral fat is more dangerous than visible fat 00:20:18 – Mechanism #3: brain hijacking and satiety override 00:20:47 – Engineered foods and addictive eating patterns 00:21:04 – Mechanism #4: toxins from processing and packaging 00:21:30 – PFAS, bisphenols, and chemical contamination 00:21:37 – The solution: whole food first 00:22:02 – Breaking habits and reclaiming control 00:22:20 – Simple swaps: fruit, nuts, whole ingredients 00:23:00 – "If you can't trace it back to a real food, put it down" 00:23:32 – Making whole food convenient 00:24:06 – Batch cooking and preparation strategies 00:24:16 – Personal story: losing a friend to diet-related illness 00:24:40 – The emotional reality: this is life or death 00:25:00 – Community support and accountability 00:25:25 – Call to action: share this message 00:25:41 – Closing: courage, awareness, and living a SuperLife 00:26:23 – Outro Thank You to Our Sponsors: Shakeology: Get 15% off with code DARINO1BODI at Shakeology.com. Alkemis Paint: Go to https://alkemispaint.com/ and use code DARIN10 for 10% off your order. Join the SuperLife Patreon: This is where Darin now shares the deeper work: - weekly voice notes - ingredient trackers - wellness challenges - extended conversations - community accountability - sovereignty practices Join now for only $7.49/month at https://patreon.com/darinolien Connect with Darin Olien: Website: darinolien.com Instagram: @darinolien Book: Fatal Conveniences Platform & Products: superlife.com New Show: Roadmap to Happiness Key Takeaway "Every time you reach for ultra-processed food, you're not just making a small decision—you're compounding a biological cost that your body has to pay later. But the moment you become aware, you reclaim your power. Because the same way those choices can slowly take your health away… different choices, repeated daily, can give it all back." Bibliography/Sources Primary Study — News Hook Haidar, A., Rikhi, R., Watson, K. E., Wood, A. C., & Shapiro, M. D. (2026). Association between ultraprocessed food consumption and cardiovascular disease risk: MESA. JACC: Advances. https://doi.org/10.1016/j.jacadv.2025.102516 Supporting Studies — 2026 Willett, Y., Yang, C., Dunn, J., et al. (2026). Consumption of ultra-processed foods and increased risks of cardiovascular disease in U.S. adults. The American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2026.01.012 Systematic Reviews & Meta-Analyses Dose-response meta-analysis: UPF consumption and cardiovascular events risk — 20 studies, 1.1M participants. (2024). eClinicalMedicine. https://doi.org/10.1016/j.eclinm.2024.102480 Ultra-processed foods and cardiovascular disease: Analysis of three large US prospective cohorts and a systematic review and meta-analysis. (2024). The Lancet Regional Health – Americas. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(24)00186-8/fulltext Mechanisms — Gut, Inflammation & Additives Ultra-processed foods and cardiovascular diseases: Potential mechanisms of action. (2021). Advances in Nutrition. https://pmc.ncbi.nlm.nih.gov/articles/PMC8483964/ Ultra-processed foods and food additives in gut health and disease. (2024). Nature Reviews. https://pubmed.ncbi.nlm.nih.gov/38388570/ Ultra-processed foods and incident cardiovascular disease in the Framingham Offspring Study. (2021). Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2021.01.047 Ultraprocessed foods and their association with cardiometabolic health: A science advisory from the American Heart Association. (2023). Circulation. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001365 Visceral Fat Konieczna, J., et al. (n.d.). Contribution of ultra-processed foods in visceral fat deposition: Prospective analysis nested in the PREDIMED-Plus trial. Clinical Nutrition. https://www.explorationpub.com/Journals/edd/Article/100523 NOVA Classification Monteiro, C. A., Cannon, G., Levy, R. B., et al. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://pubmed.ncbi.nlm.nih.gov/30744710/ Policy & Public Health Context American College of Cardiology. (2025). ACC 2025 concise clinical guidance: Front-of-package labeling endorsement. Journal of the American College of Cardiology. U.S. Departments of Agriculture and Health and Human Services. (n.d.). Dietary guidelines for Americans, 2025–2030. https://www.dietaryguidelines.gov General Coverage — News Hook Food Safety Magazine. (2026, April). Study links diets high in ultra-processed foods to increased heart attack, stroke risk. https://www.food-safety.com/articles/11290-study-links-diets-high-in-ultra-processed-foods-to-increased-heart-attack-stroke-risk ScienceDaily. (2026, March). Ultra-processed foods linked to 67% higher risk of heart attack and stroke. https://www.sciencedaily.com/releases/2026/03/260319074604.htm

A U.S. fighter jet went down in Iran and there's been a shakeup of Army leadership. The retirement of a privacy officer at the Department of Justice shines a light on the Trump Administration's interest in voter information.And, the American Heart Association releases its guidance on the pattern of eating that promotes good health and helps fend off disease.Please help us out by completing a short survey telling us what you like and how we could improve our podcast. You can find it right now at www.npr.org/springsurveyWant more analysis of the most important news of the day, plus a little fun? Subscribe to the Up First newsletter.To manage podcast ad preferences, review the links below:See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy