Podcasts about American Heart Association

Dr. Enid Chung Roemer, Associate Scientist and Deputy Director, Institute for Health and Productivity Studies at Johns Hopkins Bloomberg School of Public Health discusses why workplace wellness is so important - particularly now that so many workers have moved online – and offers great tips and resources for incorporating more wellness into your workspace.   Show Notes: Resources CDC Workplace Health Resource Center CDC: https://www.cdc.gov/workplacehealthpromotion/index.html To receive the Giant Nutrition Workplace Wellness Program Brochure, healthyliving@giantfood.com.   Organizational Health Assessment Tools CDC Scorecard: CDC Worksite Health ScoreCard  Wellness Council of America: https://www.welcoa.org/resources/ American Heart Association: https://www.heart.org/en/professional/workplace-health Health Enhancement Research Organization (HERO): https://hero-health.org/   Exemplary Workplace Health Promotion Programs: The Health Project (Winning Programs tab): http://thehealthproject.com/ Promoting Healthy Workplaces Project: https://www.jhsph.edu/research/centers-and-institutes/institute-for-health-and-productivity-studies/projects/current-projects/promoting-healthy-workplaces/

The following question refers to Section 8.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Western Michigan University medical student & CardioNerds Intern Shivani Reddy, answered first by University of Southern California cardiology fellow and CardioNerds FIT Trialist Dr. Michael Francke, and then by expert faculty Dr. Prateeti Khazanie. Dr. Khazanie is an associate professor and advanced heart failure and transplant Cardiologist at the University of Colorado. Dr. Khazanie is an author on the 2022 ACC/AHA/HFSA HF Guidelines, the 2021 HFSA Universal Definition of Heart Failure, and multiple scientific statements. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Clinical Trials Talks Question #22 You are taking care of a 34-year-old man with chronic systolic heart failure from NICM with LVEF 20% s/p CRT-D. The patient was admitted 1 week prior with acute decompensated heart failure. Despite intravenous diuretics the patient developed acute kidney injury, and ultimately placed on intravenous inotropes on which he now seems dependent. He has been following up with an advanced heart failure specialist as an outpatient and has been undergoing evaluation for heart transplantation, which was subsequently completed in the hospital.   His exam is notable for an elevated JVP, a III/VI holosystolic murmur, and warm extremities with bilateral 1+ edema. His most recent TTE shows LVEF 20%, moderate MR, moderate-severe TR and estimated RVSP 34 mmHg. His most recent laboratory data shows Na 131 mmol/L, Cr 1.2 mg/dL, and lactate 1.6 mmol/L. Pulmonary artery catheter shows RA 7 mmHg, PA 36/15 mmHg, PCWP 12 mmHg, CI 2.4 L/min/m2 and SVR 1150 dynes*sec/cm5.   The patient was presented at transplant selection committee and approved for listing for orthotopic heart transplant. What is the most appropriate next step in the management of this patient? A Refer patient for transcatheter edge-to-edge repair for MR B Continue IV inotropes as a bridge-to-transplant C Refer patient for tricuspid valve replacement D Initiate 1.5L fluid restriction Answer #22 Explanation The correct answer is B – continue IV inotropes as a bridge-to-transplant. Positive inotropic agents may improve hemodynamic status, but have not been shown to improve survival in patients with HF. These agents may help HF patients who are refractory to other therapies and are suffering consequences from end-organ-hypoperfusion. Our patient is admitted with worsening advanced heart failure requiring intravenous inotropic support. He has been appropriately evaluated and approved for heart transplant. He has demonstrated the requirement of continuous inotropic support to maintain perfusion. In patients such as this with advanced (stage D) HF refractory to GDMT and device therapy who are eligible for and awaiting MCS or cardiac transplantation, continuous intravenous inotropic support is reasonable as “bridge therapy” (Class 2a, LOE B-NR). Continuous IV inotropes also have a Class 2b indication (LOE B-NR) in select patients with stage D HF despite optimal GDMT and device therapy who are ineligible for either MCS or cardiac transplantation, as palliative therapy for symptom control and improvement in functio...

CPR and AED Awareness week is wrapping up, but in this episode, we talk about making sure to have the tools you need to save a life in your tool box!! Marta Countess, Chair of the Lehigh Valley & Berks Go Red for Women Luncheon and President of Countess Communications, joins the show to talk about American Heart Association's focus on CPR and AED awareness, as well as their big Go Red for Women Luncheon coming up later this month! Visit lehighvalleygored.heart.org info!! It's the TACKLING ADULTHOOD podcast! Brought to you by the nation's first cable company – Service Electric, celebrating 75 years - visit SECTV.com!! And by the Cumulus Podcast Network and Cumulus Media Allentown! Find the TACKLING ADULTHOOD podcast on our station's website - Google, Spotify, Apple Podcasts - or wherever you get your podcasts!!See omnystudio.com/listener for privacy information.

Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 4. Today, Dr. Koren and Dr. Joshi finished the series discussing current research on the role of eosinophils in asthma and the treatment options available for people with eosinophilic asthma. They also cover the importance of proper diagnosis and monitoring for effective management of asthma symptoms. Eosinophils are a type of white blood cell that can contribute to inflammation and airway hyperresponsiveness in people with asthma. This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.Listen to the whole series:Two Docs Talk: Allergies and Asthma Pt 1Two Docs Talk: Allergies and Asthma Pt 2Two Docs Talk: Allergies and Asthma Pt 3Common medications:The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair). The anti-IL4/IL13 product is dupilumab (Dupixent)The anti-IgE agent is omalizumab (Xolair)The anti-TSLP agent is Tezepelumab. (Teszpire) Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. Original Air Date: April 14, 2023Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

The American Heart Association says:  American adults consume an average of 17 teaspoons of added sugar every day, more than 2-3 times the recommended amount for men and women respectively. This adds up to around 60 pounds of added sugar consumed annually.  Sue Thomas is on a mission to change this alarming trend.  As “The Sugar Free Coach -  she works to empower people to break their addiction to sugar. “I believe everyone has the right to take back control of their wellbeing. Sugar is added to so many foods in 21st century life and many people do not realise they have an addiction to sugar which is compromising their quality of life. But more importantly sugar and its relationship with insulin is causing a health epidemic in the western world. Not just diabesity and heart disease, but menopause, autoimmunity, and mental wellbeing are just a few of the other conditions influenced by sugar and insulin imbalances. I am Sue Thomas, The Sugar Free Coach and nutritional therapist, passionate about educating people to understand how they can live a full and vibrant life.”  She joined me this week to tell me more.   For more information: https://www.suethomaswellbeing.co.uk/#:~:text=Hi%2C%20I'm%20Sue%2C,weight%20management%20easy%20and%20effortless. Instagram: @suethomas_thesugarfreecoach  

In this episode of GRUFFtalk, host Barbara Hannah Grufferman chats with Dr. Margaret Nachtigall, a board-certified reproductive endocrinologist and a founding member of the North American Menopause Society, about hormone therapy (HT).   Dr. Nachtigall gives a masterclass on HT, including the latest position statements from the North American Menopause Society, the American Heart Association, and the USPSTF. She also discusses the benefits and risks of HT, the ideal time to start and stop HT, and other key things every woman should consider before taking HT.  What you'll learn from this episode:  The benefits of HT  The risks of HT  The ideal time to start HT  The ideal time to stop HT  Revised HT Position Statements from the North American Menopause Society (NAMS) the American Heart Association (AHA) and the USPSTF (United States Preventive Services Task Force).  If you are considering HT, it is important to talk to your doctor about the risks and benefits, but the best place to start is by listening to this masterclass with Dr. Margaret Nachtigall.  Links to learn more:  Menopause and Heart Health: https://www.barbarahannahgrufferman.com/menopause-and-your-heart/  Five Things That Change After Menopause: https://podcasts.apple.com/us/podcast/grufftalk-how-to-age-better-with-barbara-hannah-grufferman/id1623436268?i=1000597359042  Your Brain on Menopause: https://podcasts.apple.com/us/podcast/grufftalk-how-to-age-better-with-barbara-hannah-grufferman/id1623436268?i=1000585467956    Connect with Barbara Hannah Grufferman:  Website: https://www.barbarahannahgrufferman.com  Instagram: @Barbara Hannah Grufferman  Facebook: @BarbaraHannahGruffermanAuthor  Learn more about your ad choices. Visit megaphone.fm/adchoices

Seed Oils, Omega 6, and InflammationJust about everyone in the low-carb community is talking about how bad seed oils are. They claim the medical community has it wrong. The conspiracy-minded folks claim doctors want to keep people sick. Thus dependent on medicine for pills and surgery. Hence, seed oils are the new evil part of the picture.The New Sugar ConspiracySeed oils, hydrogenated oils, and omega-6 fatty acids have replaced sugar as the new reason for ill health in America.Their logic goes like this:Seed oils are high in omega-6 fatty acids. They claim that high Omega 6 fatty acids are pro-inflammatory. Therefore, if you have more seed oils in your diet, you will have more inflammation. Inflammation is the root cause of heart disease.Their argument is logical, partially true, and the conclusion is incorrect. They are selling you snake oil (well, usually supplements).It is Peanut ButterThe keto crowd will say how "real" peanut butter is made with peanuts and salt. Claiming this peanut butter is "candy" or "full of garbage" and isn't fit to be eaten. But is it? Let's break this down.Added SugarFirst, the added sugar, which according to the label is 3 grams per serving (two tablespoons), so the whole thing is 190 calories, of which 12 of those calories come from sugar, the rest from fat.Here is the label from Sprouts Pure Peanut Butter. Nothing but ground peanuts. No salt, no oils, no sugar. There are 200 calories from two tablespoons.Of the 200 calories from all peanut butter, with no added sugar, you get the same number of calories from the peanut butter with sugar in it. How much sugar? Well, about 3 grams per serving of sugar. How much is that? Not much. To exceed the recommended dose of sugar from the American Heart Association, you would need to have more than 6% of your calories. In Skippy, it is 1.5% added sugar.Low Carb Sugar ConspiracySugar was the "evil" that low carbohydrate folks said caused obesity. If you read their literature from twenty-plus years ago, it blamed sugar for obesity. Not just sugar, but any carb that was sugar, they claimed, would become fat. They even had their alternative view of history of obesity in the country.They stated that the world was not obese until Ancel Keys blamed heart disease on fat. Then the US government promoted a low-fat diet. The result was obesity bloomed because they replaced fat with sugar. That evil food pyramid caused people to turn away from fat, substituting sugar. That sugar substitution led to obesity.It sounds so logical. If you ever go on a low-carb diet (Atkins, South Beach, Paleo, Keto, Carnivore), you stop eating junk food and eat steak. You feel satisfied eating lots of meat. Then you get tired of steak. You lose weight because you are in a calorie deficit, not because of ketosis. But that weight loss leads to confirmation of the theory that sugar made you fat.You go off the restrictive diet. Now you gain weight. You gain weight because you are eating more. But you blame the slice of bread. What you forget is now you are eating more steak because you have more flavors in your mouth. That slice of bread is 100 calories, but you think an 18-ounce Porterhouse (1260 calories) is a diet food? So you blame the bread or the lava cake. But not the extra calories.Where It Falls ApartBut something about your low-carb diet doesn't make sense. You notice that obesity has increased in the United States. But...

This guest grew up outside of New York City and was a child model, appearing in ads and commercials. After college, she traveled 3,000 miles to Arizona to join the sales team at the Phoenix Suns, then as Senior Director at the American Heart Association, and she is now the vice president and executive director of the Desert Financial Foundation. She is married and the proud parent to her boxer, Lola! Please welcome Carlissa Wright! ---------- Guiding Growth: Conversations with Community Leaders Join our hosts, Sarah Watts and Ben Kalkman, as we explore the human journey of leaders - their stories of humility, triumph, roadblocks, and lessons learned - as they reflect on how they became who they are today and share stories of inspiration and hope with listeners. We'll take away the title, just for a moment, and enjoy a connection with the soul. Be sure to subscribe to our show for more interviews with community leaders. This podcast is brought to you by the Gilbert Chamber of Commerce and Modern Moments. Learn more about our show at https://guidinggrowth.co. View our Privacy Policy at https://modernmoments.com/privacy

Here's another update on a cultural trend that should come as no surprise. A study of more than twenty-five hundred subjects ages thirteen to twenty four has found that those who vape nicotine only, THC only, or both nicotine and THC are more likely to report anxiety symptoms, symptoms of depression, and suicidal thoughts than those who don't vape nicotine or THC through electronic smoking devices. In addition, the symptoms of anxiety were more frequently reported among those who only vape THC, the major psychoactive component in cannabis. And, over half of those who vape nicotine, THC, or both report experiencing symptoms of depression as opposed to only twenty-five percent who do not vape. This research from the American Heart Association reminds us of the dangers of vaping any substance. Parents, teach your kids to steward their bodies to God's glory. And, if their anxiety is overwhelming, point them to a competent Christian counselor.

The following question refers to Section 7.6 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by premedical student and CardioNerds Intern Pacey Wetstein, answered first by Mayo Clinic Cardiology Fellow and CardioNerds Academy Chief Dr. Teodora Donisan, and then by expert faculty Dr. Nancy Sweitzer.Dr. Sweitzer is Professor of Medicine, Vice Chair of Clinical Research for the Department of Medicine, and Director of Clinical Research for the Division of Cardiology at Washington University School of Medicine. She is the editor-in-chief of Circulation: Heart Failure. Dr. Sweitzer is a faculty mentor for this Decipher the HF Guidelines series.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. /*! elementor - v3.13.3 - 28-05-2023 */ .elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}Clinical Trials Talks Question #21 Ms. Betty Blocker is a 60-year-old woman with a history of alcohol-related dilated cardiomyopathy who presents for follow up. She has been working hard to improve her health and is glad to report that she has just reached her 5-year sobriety milestone. Her current medications include metoprolol succinate 100mg daily, sacubitril-valsartan 97-103mg BID, spironolactone 25mg daily, and empagliflozin 10mg daily. She is asymptomatic at rest and up to moderate exercise, including chasing her grandchildren around the yard. A recent transthoracic echocardiogram shows recovered LVEF from previously 35% now to 60%. Ms. Blocker does not love taking so many medications and asks about discontinuing her metoprolol. Which of the following is the most appropriate response to Ms. Blocker's request? A Since the patient is asymptomatic, metoprolol can be stopped without risk B Stopping metoprolol increases this patient's risk of worsening cardiomyopathy regardless of current LVEF or symptoms C Because the LVEF is now >50%, the patient is now classified as having HFpEF and beta-blockade is no longer indicated; metoprolol can be safely discontinued D Metoprolol should be continued, but it is safe to discontinue either ARNi or spironolactone Answer #21 Explanation The correct answer is D – continue current therapy. The patient described above was initially diagnosed with HFrEF and experienced significant symptomatic improvement with GDMT, so she now has heart failure with improved ejection fraction (HFimpEF). In patients with HFimpEF after treatment, GDMT should be continued to prevent relapse of HF and LV dysfunction, even in patients who may become asymptomatic (Class 1, LOE B-R). Although symptoms, functional capacity, LVEF and reverse remodeling can improve with GDMT,

Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 3 The Evil Eosinophils.  In this episode, Dr. Michael Koren and Dr. Sunil Joshi explore allergy shots vs. allergy drops for managing allergic rhinitis. For people with allergic rhinitis, allergy shots and allergy drops are two options for managing symptoms. The doctors explain the difference between the two treatments and their effectiveness in reducing allergic rhinitis symptoms. They also discuss the pros and cons of each option and how to decide which one is best for you.This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.Listen to the whole series:Two Docs Talk: Allergies and Asthma Pt 1Two Docs Talk: Allergies and Asthma Pt 2Two Docs Talk: Allergies and Asthma Pt 4Common medications:The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair). The anti-IL4/IL13 product is dupilumab (Dupixent)The anti-IgE agent is omalizumab (Xolair)The anti-TSLP agent is Tezepelumab. (Teszpire) Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. Original Air Date: April 14, 2023Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

Coach Sal hits on the virtue signaling of the nutritional world- addressing the American Heart Association and their proposed diet. The two dip into the mailbag- ab work, pole dancing, cross fit, and salt in-take ... plus more covered. Don't miss which book he suggests to Dave ...

Recentemente, em abril de 2023, a American Heart Association publicou um relatório classificando as melhores e as piores dietas. O critério? Alinhamento às diretrizes da própria AHA. A melhor foi a DASH, e a pior foi… very low-carb. Mas você sabia que até agora as duas dietas nunca haviam sido testadas uma contra a outra? Até agora… Neste episódio discutimos os resultados de um experimento comparando essas estratégias. Estamos no Instagram: Dr. Souto - Sari Fontana  Área de membros do blog Ciência Low-Carb: Clique Aqui! Para ser avisado sobre cada novo episódio e receber os links das matérias mencionadas e as referências bibliográficas por e-mail, cadastre-se gratuitamente em https://drsouto.com.br/podcast Para aprender sobre rótulos e como fazer melhores escolhas, acesse https://sarifontana.substack.com/ e cadastre seu e-mail. Você passa a receber conteúdo gratuito, e se quiser apoiar este trabalho, receber conteúdo exclusivo e enviar rótulos para a Sari analisar, faça upgrade para os planos pagos. Conheça também o Podcurso Low-Carb da Teoria à Prática em https://drsouto.com.br/podcurso/

The following question refers to Sections 7.3.2, 7.3.8, and 7.6.2 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Palisades Medical Center medicine resident & CardioNerds Intern Dr. Maryam Barkhordarian, answered first by Hopkins Bayview medicine resident & CardioNerds Academy Fellow Dr. Ty Sweeny, and then by expert faculty Dr. Robert Mentz. Dr. Mentz is associate professor of medicine and section chief for Heart Failure at Duke University, a clinical researcher at the Duke Clinical Research Institute, and editor-in-chief of the Journal of Cardiac Failure. Dr. Mentz is a mentor for the CardioNerds Clinical Trials Network as lead principal investigator for PARAGLIDE-HF and is a series mentor for this very Decipher the Guidelines Series. For these reasons and many more, he was awarded the Master CardioNerd Award during ACC22. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #20 Ms. Betty Blocker is a 60-year-old woman with a history of alcohol-related dilated cardiomyopathy who presents for follow up. She has been working hard to improve her health and is glad to report that she has just reached her 5-year sobriety milestone. Her current medications include metoprolol succinate 100mg daily, sacubitril-valsartan 97-103mg BID, spironolactone 25mg daily, and empagliflozin 10mg daily. She is asymptomatic at rest and up to moderate exercise, including chasing her grandchildren around the yard. A recent transthoracic echocardiogram shows recovered LVEF from previously 35% now to 60%. Ms. Blocker does not love taking so many medications and asks about discontinuing her metoprolol. Which of the following is the most appropriate response to Ms. Blocker's request? A Since the patient is asymptomatic, metoprolol can be stopped without risk B Stopping metoprolol increases this patient's risk of worsening cardiomyopathy regardless of current LVEF or symptoms C Because the LVEF is now >50%, the patient is now classified as having HFpEF and beta-blockade is no longer indicated; metoprolol can be safely discontinued D Metoprolol should be continued, but it is safe to discontinue either ARNi or spironolactone Answer #20 Explanation The correct answer is B – stopping metoprolol would increase her risk of worsening cardiomyopathy. Heart failure tends to be a chronically sympathetic state. The use of beta-blockers (specifically bisoprolol, metoprolol succinate, and carvedilol) targets this excess adrenergic output and has been shown to reduce the risk of death in patients with HFrEF. Beyond their mortality benefit, beta-blockers can improve LVEF, lessen the symptoms of HF, and improve clinical status. Therefore, in patients with HFrEF, with current or previous symptoms, use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, sustained-release metoprolol succinate) is recommended to reduce mortality and hospitalizations (Class 1, LOE A). Beta-blockers in this setting provide a high economic value. Table 14 of the guidelines provides recommendations for target doses for GDMT medications. Specifically for beta blockers, those targets are 25-50mg twice daily for carvedilol (or 80mg once daily for the continuous release formulation), 200mg once daily for metoprolol succinate,

We had the pleasure of interviewing Destiny Malibu over Zoom video!Destiny Malibu is an all American, multi-cultural, bilingual singer, songwriter, musician and podcaster. Destiny is Instagram verified and is best known as a Pop Singer specializing in high-energy genre-blending music who is an American Idol Alum, performs at schools across the US and is currently performing multiple dates in Las Vegas. Destiny's sound is similar to artists like: Arianna Grande, Ellie Golding and Iggy Azalea. With over 200,000 followers and subscribers on Instagram, Youtube, Tiktok and others, her content has over 7 million total views. Destiny Malibu as seen on ABC, Fox News & Univision is an American Idol Alum and is currently performing multiple dates at Virgin Hotels Las Vegas where she also films her mental health focused podcast, the Destiny Malibu Podcast.Destiny Malibu has also collaborated with American Heart Association, John Paul Mitchell, Sirius XM, Professional Fighters League, among others and has performed internationally in Singapore, Dominican Republic, and in the USA at the Texas Rock Fest, Florida Music Festival, House of Blues Hollywood, the Viper Room and schools across America traveling on her 45 ft tour bus with line-ups that have included Earth, Wind & Fire, Plain White T's and others.Destiny Malibu released 3 Albums - Kissed by An Angel, Sweet Persuasion and Out of the Shadows and a single cover of “ Mary Did You Know” in 2022. Her album “Kissed by an Angel” has over one million streams. Destiny Malibu recently performed multiple standing room only concerts at Virgin Hotels Las Vegas and she will continue to film and release new episodes of her Destiny Malibu Podcast- a podcast aimed to speak to those dealing with mental health concerns like anxiety, depression and self-love. Destiny Malibu first appeared on Univision at the age of 5 singing with classmates and her mother, who was a popular Latin Artist. Destiny wrote her first song , “A million kisses” at the age 9 and at 17, she was signed as a songwriter to Burnett Music Group. Her love to share her music in person has led her to performing her own songs worldwide. Destiny is an American Idol alum and has since released 3 albums and 9 music videos. In 2023 she will be on the cover of Deluxe Version Magazine - Lake Las Vegas whose cover has been previously graced by artists like Olivia Newton John & Shania Twain. Destiny Malibu will also be releasing the title song of her podcast, "Say My Name", from her 4th and upcoming album in 2023.We want to hear from you! Please email Hello@BringinitBackwards.com. www.BringinitBackwards.com#podcast #interview #bringinbackpod #DestinyMalibu #SayMyName #NewMusic #ZoomListen & Subscribe to BiBhttps://www.bringinitbackwards.com/follow/ Follow our podcast on Instagram and Twitter! https://www.facebook.com/groups/bringinbackpodThis show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/4972373/advertisement

How Universities, Rather Than Being Overseers Of The Integrity Of Knowledge Became Producers Of Commercial Knowledge Dr. John Abramson, M.D• https://hcp.hms.harvard.edu/people/john-david-abramson • Book – Sickening Ian Harris, MD • https://med.unsw.edu.au/our-people/ian-harris • Book - Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence Dr. Robert Yoho • http://www.robertyohoauthor.com • Book - Butchered by “Heathcare” Dr. Robert Lustig • http://www.robertlustig.com • Book - Metabolical #BigPharma #AmericanHealthCare #HealthCarePolicy Dr. John Abramson, M.D. is an author and medical doctor and has served as a family physician for over 20 years. His recently release book Sickening  How Big Pharma Broke American Health Care and How We Can Repair It. Is about the inside story of how Big Pharma's relentless pursuit of ever-higher profits corrupts medical knowledge—misleading doctors, misdirecting American health care, and harming our health. John Abramson MD,  He was twice voted “best doctor” in his area by readers of the local newspapers and three times selected by his peers as one of a handful of best family practitioners in Massachusetts. He has been on the faculty at Harvard Medical School for over 15 years, where he has taught primary care and currently teaches health care policy. To Contact Dr John Abramson MD go to hcp.hms.harvard.edu/people/john-david-abramson Dr Ian Harris is a practicing orthopedic surgeon, university professor and an acclaimed author of several books including Hippocrasy: How doctors are betraying their oath. Professor Ian Harris is an orthopedic surgeon who works at Liverpool, St George, St George Private and Sutherland Hospitals in Sydney. His academic affiliation is with UNSW, South Western Sydney Clinical School at Liverpool Hospital, in Sydney. In addition to approximately 200 peer-reviewed publications, he also wroteSurgery, The Ultimate Placebo - an eye-opening evaluation of commonly performed surgical operations that have been tested and shown to be no more effective (and arguably worse) than placebo, or that have never even been tested. He suggests we treat new surgical procedures like new drugs, and only pay for those that are part of a trial to find out if they really work. To Contact Dr Harris go to Email: ianharris@unsw.edu.au Dr. Robert Yoho is an author and accomplished retired Los Angeles cosmetic surgeon. His Book, Butchered by “Heathcare”: What to Do About Doctors, Big Pharma, and Corrupt Government Ruining Your Health and Medical Care. Dr Robert Yoho grew up in Kent Ohio. He was an Eagle Scout and a Judo wrestler. Went to Oberlin College and Case Western Reserve Univ. Medical School. In 2019 Dr Yoho retired from his medical and surgical practice. He now is a full time writer and speaker. No longer responsible for patient care he is able to write full time without conflicts of interest. To Contact Dr Robert Yoho go to  robertyohoauthor.com  Dr. Robert Lustig is a The New York Times bestselling author and author of Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine and a Professor of Pediatric Endocrinology at the University of California, San Francisco. Dr. Robert Lustig, a pediatric neuroendocrinologist who has long been on the cutting edge of medicine and science, challenges our current healthcare paradigm which has gone off the rails under the influence of Big Food, Big Pharma, and Big Government. Dr. Lustig has authored 125 peer-reviewed articles and 73 reviews. He has mentored 20 pediatric endocrine fellows, and trained numerous other allied health professionals. He provides endocrinologic support to several protocols of the Children's Oncology Group.  He is the former Chairman of the Ad hoc Obesity Task Force of the Lawson Wilkins Pediatric Endocrine Society, a member of the Pediatric Obesity Practice Guidelines Subcommittee of The Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration, a member of the Bay Area Board of Directors of the American Heart Association, and a member of the Steering Committee of Health Foods, Healthy Kids of the Culinary Institute of America. He also consults for several childhood obesity advocacy groups. Dr. Lustig lives in San Francisco with his wife Julie and two daughters. Spare time (what little there is) is spent cooking, theater-going, and traveling. To Contact Dr Robert Lustig, M.D.  go to robertlustig.com Disclaimer:Medical and Health information changes constantly. Therefore, the information provided in this podcast should not be considered current, complete, or exhaustive. Reliance on any information provided in this podcast is solely at your own risk. The Real Truth About Health does not recommend or endorse any specific tests, products, procedures, or opinions referenced in the following podcasts, nor does it exercise any authority or editorial control over that material. The Real Truth About Health provides a forum for discussion of public health issues. The views and opinions of our panelists do not necessarily reflect those of The Real Truth About Health and are provided by those panelists in their individual capacities. The Real Truth About Health has not reviewed or evaluated those statements or claims. 

Welcome to MedEvidence: Two Docs Talk Allergies and Asthma Part 2, Prevention, Testing and Treatment.  In this episode, Dr. Michael Koren and Dr. Sunil Joshi explore the importance of prevention before treatment and the different testing and treatment options available for pollen allergies. They also cover clinical treatments, such as immunotherapy, and how they can help manage symptoms.This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.Listen to the whole series:Two Docs Talk: Allergies and Asthma Pt 1Two Docs Talk: Allergies and Asthma Pt 3Two Docs Talk: Allergies and Asthma Pt 4Common medications:The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair). The anti-IL4/IL13 product is dupilumab (Dupixent)The anti-IgE agent is omalizumab (Xolair)The anti-TSLP agent is Tezepelumab. (Teszpire) Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. Original Air Date: April 14, 2023Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

It's Not What's In The Food, It's What's Been Done To The Food Dr. Robert Lustig • http://www.robertlustig.com • Book - Metabolical #RobertLustig#BigFood #BigPharma #BigGovernment Dr. Robert Lustig is a The New York Times bestselling author and author of Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine and a Professor of Pediatric Endocrinology at the University of California, San Francisco.  Dr. Robert Lustig, a pediatric neuroendocrinologist who has long been on the cutting edge of medicine and science, challenges our current healthcare paradigm which has gone off the rails under the influence of Big Food, Big Pharma, and Big Government. You can't solve a problem if you don't know what the problem is. One of Lustig's singular gifts as a communicator is his ability to “connect the dots” for the general reader, in order to unpack the scientific data and concepts behind his arguments, as he tells the “real story of food” and “the story of real food.” Metabolical weaves the interconnected strands of nutrition, health/disease, medicine, environment, and society into a completely new fabric by proving on a scientific basis a series of iconoclastic revelations, among them: • Medicine for chronic disease treats symptoms, not the disease itself• You can diagnose your own biochemical profile • Chronic diseases are not "druggable," but they are "foodable" • Processed food isn't just toxic, it's addictive• The war between vegan and keto is a false war—the combatants are on the same side• Big Food, Big Pharma, and Big Government are on the other side Making the case that food is the only lever we have to effect biochemical change to improve our health, Lustig explains what to eat based on two novel criteria: protect the liver, and feed the gut. He insists that if we do not fix our food and change the way we eat, we will continue to court chronic disease, bankrupt healthcare, and threaten the planet. But there is hope: this book explains what's needed to fix all three. Dr. Lustig has become a leading public health authority on the impact sugar has on fueling the diabetes, obesity and metabolic syndrome epidemics, and on addressing changes in the food environment to reverse these chronic diseases. A native of Brooklyn, New York, graduated from Massachusetts Institute of Technology and received his M.D. from Cornell University Medical College. He completed his pediatric residency at St. Louis Children's Hospital, his clinical fellowship at UCSF, his post-doctoral fellow and research associate in neuroendocrinology at The Rockefeller University. He has been a faculty member at the University of Wisconsin-Madison, and the University of Tennessee, Memphis. In 2013, Dr. Lustig received his Masters in the study of Law from University of California, Hastings to enable him to impact the food industry through policy change. Dr. Lustig has authored 125 peer-reviewed articles and 73 reviews. He has mentored 20 pediatric endocrine fellows, and trained numerous other allied health professionals. He provides endocrinologic support to several protocols of the Children's Oncology Group. He is the former Chairman of the Ad hoc Obesity Task Force of the Lawson Wilkins Pediatric Endocrine Society, a member of the Pediatric Obesity Practice Guidelines Subcommittee of The Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration, a member of the Bay Area Board of Directors of the American Heart Association, and a member of the Steering Committee of Health Foods, Healthy Kids of the Culinary Institute of America. He also consults for several childhood obesity advocacy groups. Dr. Lustig lives in San Francisco with his wife Julie and two daughters. Spare time (what little there is) is spent cooking, theater-going, and traveling. To Contact Dr Robert Lustig, M.D.  go to robertlustig.com Disclaimer:Medical and Health information changes constantly. Therefore, the information provided in this podcast should not be considered current, complete, or exhaustive. Reliance on any information provided in this podcast is solely at your own risk. The Real Truth About Health does not recommend or endorse any specific tests, products, procedures, or opinions referenced in the following podcasts, nor does it exercise any authority or editorial control over that material. The Real Truth About Health provides a forum for discussion of public health issues. The views and opinions of our panelists do not necessarily reflect those of The Real Truth About Health and are provided by those panelists in their individual capacities. The Real Truth About Health has not reviewed or evaluated those statements or claims. 

Reading the science changed Nina Teicholz's perspective on nutrition. She's a journalist and author who is known for her work on nutrition and health. As a vegetarian with a food review column, she had to eat red meat—exactly the dishes she stayed away from. However, upon checking with her doctor, she was surprised to find that her cholesterol actually improved. This experience led Nina to read the science behind nutrition.  In this conversation, she tells us why saturated fats are not the villain, how easy it is to fall into the trap of believing popular narratives, and through her writing and advocacy, inspires us to question what we know and seek the truth. Nina understands the cost of speaking up against the nutrition industry and she remains committed to sharing the truth. She's not giving up on that.Quick Guide03:09 Introduction 06:27 How saturated fat became the villain11:13 Reading the science 17:38 The oils that can cause cancer and heart attack 30:37 No journalists are questioning the findings of the American Heart Association 35:44 Getting the message out there 39:15 Journalists stopped acting as the fourth estate 43:56 Average consumers need access to information51:57 Closing and contactsGet to know our guestNina Teicholz, the journalist who wrote The Big Fat Suprise, is the founder of Nutrition Coalition. She believes that there should be a unified movement to educate people and to provide organized advocacy efforts for more people to hear the message."Low carb comes out better on almost all metrics in terms of fighting heart disease, weight loss, metabolic glycemic control of your blood sugars, I mean, low-carb almost always looks better in those review papers. So, it's just really mystifying and hard to understand how the science is, I mean, I think it's hard to use a word other than suppress. At this point, it's literally being suppressed and ignored. And that's very disturbing state of affairs." - Nina Teicholz Connect with herTwitter: https://twitter.com/bigfatsurpriseFacebook: https://www.facebook.com/NinaTeicholz/Website: https://ninateicholz.com/LinkedIn: https://www.linkedin.com/in/ninateicholz/Substack: https://unsettledscience.substack.com/ Continuous Glucose Monitors are the best way to monitor your own metabolic health and learn how to better care for yourself. Get a Continuous Glucose Monitor for yourself through the Stay Off My Operating Table* podcast.Go to iFixHearts.com/UltraHuman for details.*Offer good for residents of the United States only. Contact Stay Off My Operating TableTweet with us: Dr. Ovadia: @iFixHearts Jack Heald: @JackHeald5 Learn more: Get Dr. Ovadia's book Stay Off My Operating Table on Amazon. Take Dr. Ovadia's metabolic health quiz: iFixHearts visit Dr. Ovadia's website: Ovadia Heart Health visit Jack Heald's website: CultYourBrand.com Theme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey(c) 2016 Mercury Retro Recordings

In this week's episode, our guest is Nancy Brown,  CEO, American Heart Association (AHA). In this interview, we cover Nancy's amazing career and discuss what has kept her engaged and motivated to keep working with American Heart Association's critical mission. We also learn more about the work that AHA is doing to spread awareness about heart disease and stroke in America. Have questions/comments/suggestions? Email our Podcast Manager at mdebnath@give.org. Don't forget to follow or subscribe and leave a comment on iTunes.

Hey Pickles!This week's episode has a lot going on!Christine attended The Humane Hoax Conference, and tells you all about it. We have a new recipe From Our Vegan Kitchen.We talk about how your salad dressing could be making your salads unhealthy.In our Main Topic, we discuss how Beyond Steak lands certification from American Heart Association. What does this verification mean? How do foods achieve it?We'll let you know!We also have a reason to be vegan, a LISTENER SHOUT OUT, and so much more!Thank you so much for listening! We really appreciate you taking some time out of your day to spend with us!Here are the links:Sign Up For Our Live Vegan Trivia Event!  https://ticketbud.com/events/1bc95c6a-f65f-11ed-8c8b-42010a717025The Humane Hoax Conference Replay   https://fb.watch/kHNBioiLzQ/The Hume Hoax Website    https://www.humanehoax.orgKeep Your Salads From Being Unhealthy   https://www.ewg.org/news-insights/news/2022/09/turn-over-new-leaf-ditch-your-salads-harmful-chemicals-healthierBeyond Steak AHA Certification    https://www.veganfoodandliving.com/news/beyond-steak-lands-certification-from-american-heart-association-after-rigorous-review/More Info On AHA Certification Process   https://animaloutlook.org/press-release-organization-challenges-american-heart-association-over-healthy-certification-seal/Support the showJoin Our Patreon https://www.patreon.com/CompassionandcucumbersSign Up For Our Newsletterhttps://www.compassionandcucumbers.comDonate To Food Empowerment Project https://www.buymeacoffee.com/CucumbersOur YouTube https://www.youtube.com/@compassioncucumbersveganpod/videos72 Reasons To Be Vegan *paid link https://amzn.to/3W8ZwsUVisit Our Website https://www.compassionandcucumbers.comSam's Etsy https://www.etsy.com/shop/CucumberCraftworksJoin the AFA Vegan Voter Hub https://agriculturefairnessalliance.org/vegan-voter-hub/

Courtney is joined this week by Mary Crafts, Thought Leader and Founder of Culinary Crafts. Mary started her business in 1984, that later became the top catering company in the state, with no money and a dream! After retiring from her catering business, she has become a highly sought after media contributor and speaker and recently wrote a book titled “Unbounded.” She serves on multiple community boards and served with organizations including Silicon Slopes, Visit Salt Lake, Utah Valley University Foundation, Intermountain Healthcare, International Caterers Association, the American Heart Association, Salt Lake Chamber of Commerce, United Way, Habitat for Humanity. She is also the host of her own podcast called “Crafting A Meaningful Life". Tune in to hear her inspiring story!   Instagram:  @marycrafts @courtneyspatrouve @spatrouve @theglowbosspodcast   TikTok: @spatrouve   Website:  marycraftsinc.com spatrouve.com   ** Interested in business mentoring with Courtney? DM her on instagram or email courtney@spatrouve.com for more info.   

Joining Coffee, Country & Cody on this episode is Emmy-winning actress and television personality Susan Lucci. Susan visited Nashville and the Opry last weekend, serving in her role as an ambassador for the American Heart Association. Make the Grand Ole Opry part of YOUR Nashville experience! With at least three shows every week, there are plenty of opportunities to see The Show That Made Country Music Famous -- plus, take the Opry Backstage Tour while you're there, and you'll get to stand in the world-famous circle where so many country greats have performed. Thanks for listening to the Coffee, Country & Cody podcast from WSM Radio! Download the official WSM Radio App (for Apple or Android devices) to hear WSM in digital clarity, plus two additional streaming stations -- Opry Nashville and Route 650 -- as well as thousands of hours of archived programming. And now you can hear WSM on iHeartRadio as well!

The best diets for heart health go under the microscope.    Dr. Neal Barnard discusses the American Heart Association's heart-healthy diet rankings and shares his expert opinion on each diet mentioned.   Diets Examined - DASH Diet - Keto Diet - Low-Carb Diet - Mediterranean Diet - Paleo Diet - Pescatarian Diet - Vegan Diet - Vegetarian Diet   Additionally, he shares why he ranks a low-fat plant-based diet at the top of his list for heart health when he joins "The Weight Loss Champion" Chuck Carroll on The Exam Room LIVE.   Have a gut health question? Post it in the comments or chat and we'll answer as many as possible during the live broadcast.   This episode of The Exam Room™ Podcast is sponsored by The Gregory J. Reiter Memorial Fund, which supports organizations like the Physicians Committee that carry on Greg's passion and love for animals through rescue efforts, veganism, and wildlife conservation.   Gregory J. Reiter Memorial Fund https://gregoryreiterfund.org — — UPCOMING EVENTS — — Exam Room LIVE in New York Tickets: https://bit.ly/ERLiveNYC2023 When: July 12 Where: Museum of the City of New York Who: Dr. Neal Barnard, Rip Esselstyn, Dr. Robert Ostfeld, Chuck and others! — — — Planet Bethesda When: June 4 Where: Bethesda, MD Website: https://planetbethesda.com   — — FOLLOW US — — Dr. Neal Barnard Twitter: https://www.twitter.com/drnealbarnard Instagram: https://www.instagram.com/drnealbarnard Facebook: http://bit.ly/DrBarnardFB Your Body In Balance: https://amzn.to/2UvAfxW — — — Chuck Carroll Instagram: https://www.instagram.com/ChuckCarrollWLC Twitter: https://www.twitter.com/ChuckCarrollWLC Facebook: http://wghtloss.cc/ChuckFacebook — — — Physicians Committee Instagram: https://www.instagram.com/physicianscommittee Facebook: https://www.facebook.com/PCRM.org Twitter: https://www.twitter.com/pcrm — — — 5-Star Success: Share Your Story Apple: https://apple.co/2JXBkpy​​ Spotify: https://spoti.fi/2pMLoY3 — — — Share the Show Please subscribe and give the show a 5-star rating on Apple Podcasts, Spotify, or many other podcast providers. Don't forget to share it with a friend for inspiration!

How many hours a day do you spend sitting at your desk? Six hours? Eight hours? Ten hours? According to a study by the American Heart Association, the average American worker spends 6.4 hours a day sitting at their desk. With stats like that, it's more important than ever to have a productive desk setup that allows you to stay focused and get your work done efficiently. Whether you work from home or in an office, having the right tools and a well-organized workspace can make a big difference in your productivity and overall well-being. With that in mind, we've put together this guide to share seven essential rules for creating a productive desk setup that will help you stay on top of your game. From ergonomic considerations to organization and lighting, we'll cover all the bases so you can optimize your workspace for maximum productivity. So if you're ready to take your productivity to the next level, read on for our top tips and tricks. Podcast Links Join the Pod Squad + Get Your Free Gift: https://www.strangecharmed.com/shop/product/from-to-do-to-done-pod-squad-gift/ Buy My Best-Selling Productivity Book: https://www.strangecharmed.com/shop/the-functional-planning-handbook/ Read My Blog: https://strangecharmed.com Watch My YouTube Videos: https://www.youtube.com/user/MissTrenchcoat Follow Me on Instagram: https://www.instagram.com/misstrenchcoat/

This month on Episode 48 of Discover CircRes, host Cynthia St. Hilaire highlights three original research articles featured in the April 28th issue of Circulation Research. This Episode also includes a discussion between Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova, who all contributed to manuscripts to the May 12th Compendium on Covid-19 and the Cardiovascular System.     Article highlights:   Heijman, et al. Mechanisms of Enhanced SK-Channel Current in AF   Chen, et al. IL-37 Attenuates Platelet Activation   Enzan, et al. ZBP1 Protects Against Myocardial Inflammation   Compendium on Covid-19 and the Cardiovascular System.   Cindy St. Hilaire: Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's journal, Circulation Research. I'm your host, Dr Cindy St. Hilaire, from the Vascular Medicine Institute at the University of Pittsburgh. Today, I'm going to be highlighting articles from our April 28th and May 12th issues of Circulation Research. I'm also going to have a chat with Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova, who all contributed to articles in the May 12th COVID Compendium. But before we have that interview, let's first talk about some highlights.   The first article I want to present is titled Enhanced Calcium-Dependent SK-Channel Gating and Membrane Trafficking in Human Atrial Fibrillation. This article is coming from the University of Essen by Heijman and Zhou, et al. Atrial fibrillation is one of the most common forms of heart arrhythmia in humans and is characterized by irregular, often rapid heartbeats that can cause palpitations, dizziness and extreme fatigue. Atrial fibrillation can increase a person's risk of heart failure, and though treatments exist such as beta blockers, blood thinners and antiarrhythmia medications, they can have limited efficacy and side effects. A new family of drugs in development are those blocking small-conductance calcium-activated potassium channels called SK channels, which exhibit increased activity in animal models of AF and suppression of which attenuates the arrhythmia. In humans however, the relationship between SK channels and atrial fibrillation is less clear, at least in terms of SK channel mRNA levels. Because mRNA might not reflect actual channel activity, this group looked at just that and they found indeed that channel activity was increased in cardiomyocytes from atrial fibrillation patients compared to those from controls even though the mRNA and protein levels themselves were similar. The altered currents were instead due to changes in SK channel trafficking and membrane targeting. By confirming that SK channels play a role in human atrial fibrillation, this work supports the pursuit of SK channel inhibitors as possible new atrial fibrillation treatments.   The next article I want to present is titled IL-37 Attenuates Platelet Activation and Thrombosis Through IL-1R8 Pathway. This article comes from Fudan University by Chen and Hong, et al. Thrombus formation followed by the rupture of a coronary plaque is a major pathophysiological step in the development of a myocardial infarction. Understanding the endogenous antithrombotic factors at play could provide insights and opportunities for developing treatments. With this in mind, Chen and Hong, et al. investigated the role of interleukin-1 receptor 8, or IL-1R8, which suppresses platelet aggregation in mice, and of IL-37, a newly discovered human interleukin that forms a complex with IL-1R8 and is found at increased levels in the blood of patients with myocardial infarction. Indeed, the amount of IL-37 in myocardial infarction patients negatively correlates with platelet aggregation. They also show that treatment of human platelets in vitro with IL-37 suppresses the cell's aggregation and does so in a concentration-dependent manner. Moreover, injection of the protein into the veins of mice inhibits thrombus development and better preserves heart function even after myocardial infarction. Such effects were not seen in mice lacking IL-1R8. This suggests IL-37's antithrombotic action depends on its interaction with the receptor. Together, the results suggest IL-37 could be developed as a antithrombotic agent for use in MI patients or indeed perhaps other thrombotic conditions.   The last article I want to present before our interview is titled ZBP1 Protects Against Mitochondrial DNA-Induced Myocardial Inflammation in Failing Hearts. This article is coming from Kyushu University and is by Enzan, et al. Myocardial inflammation is a key factor in the pathological progression of heart failure and occurs when damaged mitochondria within the stricken cardiomyocyte release their DNA, triggering an innate inflammatory reaction. In a variety of cells, DNA sensors such as Z-DNA-binding protein 1 or ZBP1 are responsible for such mitochondrial DNA-induced inflammation. In theory then, it's conceivable that therapeutic suppression of ZBP1 might reduce myocardial inflammation in heart failure and preserve function. But as Enzan and colleagues have now discovered to their surprise, mice lacking ZBP1 exhibited worse, not better heart inflammation and more failure after induced myocardial infarction. Indeed, the test animals' hearts had increased infiltration of immune cells, production of inflammatory cytokines and fibrosis together with decreased function compared with the hearts of mice with normal ZBP1 levels. Experiments in rodent cardiomyocytes further confirmed that loss of ZBP1 exacerbated mitochondrial DNA-induced inflammatory cytokine production while overexpression of ZBP1 had the opposite effect. While the reason behind ZBP1's opposing roles in different cells is not yet clear, the finding suggests that boosting ZBP1 activity in the heart might be a strategy for mitigating heart inflammation after infarction.   Cindy St. Hilaire:         The May 12th issue of Circulation Research is our COVID compendium, which consists of a series of 10 reviews on all angles of COVID-19 as it relates to cardiovascular health and disease. Today, three of the authors of the articles in this series are here with me. Dr Mina Chung is a professor of medicine at the Cleveland Clinic. She and Dr Tamanna Singh and their colleagues wrote the article, A Post Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2. Dr DeLisa Fairweather, professor of medicine, immunology and clinical and translational science at the Mayo Clinic, and she and her colleagues penned the article, COVID-19 Myocarditis and Pericarditis. Dr Milka Koupenova is an assistant professor of medicine at the UMass Chan School of Medical and she led the group writing the article, Platelets and SARS-CoV-2 During COVID-19: Immunity, Thrombosis, and Beyond. Thank you all for joining me today.   DeLisa Fairweather:    Thank you so much for having us.   Mina Chung:   Thank you.   Milka Koupenova:       Thank you for having us, Cindy.   Cindy St. Hilaire:         In addition to these three articles, we have another seven that are on all different aspects of COVID. Dr Messinger's group wrote the article, Interaction of COVID-19 With Common Cardiovascular Disorders. Emily Tsai covered cell-specific mechanisms in the heart of COVID-19 patients. Mark Chappell and colleagues wrote about the renin-angiotensin system and sex differences in COVID-19. Michael Bristow covered vaccination-associated myocarditis and myocardial injury. Jow Loacalzo and colleagues covered repurposing drugs for the treatment of COVID-19 and its cardiovascular manifestations. Dr Stephen Holby covered multimodality cardiac imaging in COVID, and Arun Sharma covered microfluidic organ chips in stem cell models in the fight against COVID-19.   Cindy St. Hilaire          As of today, worldwide, there have been over six hundred million individuals infected with the virus and more than six and a half million have died from COVID-19. In the US, we are about a sixth of all of those deaths. Obviously now we're in 2023, the numbers of individuals getting infected and dying are much, much lower. As my husband read to me this morning, one doctor in Boston was quoted saying, "People are still getting wicked sick." In 75% of deaths, people have had underlying conditions and cardiovascular disease is found in about 60% of all those deaths. In the introduction to the compendium, you mentioned that the remarkable COVID-19 rapid response initiative released by the AHA, which again is the parent organization of Circ Research and this podcast, if I were to guess when that rapid response initiative started, I would've guessed well into the pandemic, but it was actually March 26th, 2020. I know in Pittsburgh, our labs have barely shut down. So how soon after we knew of SARS-CoV-2 and COVID, how soon after that did we know that there were cardiovascular complications?   Mina Chung:               I think we saw cardiovascular complications happening pretty early. We saw troponin increases very early. It was really amazing what AHA did in terms of this rapid response grant mechanism. You mentioned that the RFA was announced, first of all, putting it together by March 26th when we were just shutting down in March was pretty incredible to get even the RFA out. Then the grants were supposed to be submitted by April 6th and there were 750 grants that were put together and submitted. They were all reviewed within 10 days from 150 volunteer reviewers. The notices were distributed April 23rd, less than a month out.   Cindy St. Hilaire:         Amazing.   Mina Chung:               So this is an amazing, you're right, paradigm for grant requests and submissions and reviews.   DeLisa Fairweather:    For myocarditis, reports of that occurred almost immediately coming out of China, so it was incredibly rapid.   Cindy St. Hilaire:         Yeah, and that was a perfect lead up to my next question. Was myocarditis, I guess, the first link or the first clue that this was not just going to be a respiratory infection?   DeLisa Fairweather:    I think myocarditis appearing very early, especially it has a history both of being induced by viruses, but being strongly an autoimmune disease, the combination of both of those, I think, started to hint that something different was going to happen, although a lot of people probably didn't realize the significance of that right away.   Cindy St. Hilaire:         What other disease states, I guess I'm thinking viruses, but anything, what causes myocarditis and pericarditis normally and how unique is it that we are seeing this as a sequelae of COVID?   DeLisa Fairweather:    I think it's not surprising that we find it. Viruses around the world are the primary cause of myocarditis, although in South America, it's the parasite Trypanosoma cruzi. Really, many viruses that also we think target mitochondria, including SARS-CoV-2, have an important role in driving myocarditis. Also, we know that SARS-CoV-1 and MERS also reported myocarditis in those previous infections. We knew about it beforehand that they could cause myocarditis.   Cindy St. Hilaire:        Is it presenting differently in a COVID patient than say those South American patients with the... I forget the name of the organism you said, but does it come quickly or get worse quickly or is it all once you get it, it's the same progression?   DeLisa Fairweather:    Yeah. That's a good question. Basically, what we find is that no matter what the viral infection is, that myocarditis really appears for signs and symptoms and how we treat it identically and we see that with COVID-19. So that really isn't any different.   Cindy St. Hilaire:         Another huge observation that we noticed in COVID-19 patients, which was the increased risk of thrombic outcomes in the patients. Dr Koupenova, Milka, you are a world expert in platelets and viruses and so you and your team were leading the writing of that article. My guess is knowing what you know about platelets and viruses, this wasn't so surprising to you, but could you at least tell us the state of the field in terms of what we knew about viruses and platelets before COVID, before Feb 2020?   Milka Koupenova:       Before Feb 2020, we actually knew that influenza gets inside in platelets. It leads to not directly prothrombotic events, but it would lead to release of complement 3 from them. That complement 3 would actually increase the immunothrombosis by pushing neutrophils to release their DNA, forming aggregates. In cases when you have compromised endothelium and people with underlying conditions, you would expect certain thrombotic outcomes. That, we actually published 2019 and then 2020 hit. The difference between influenza and SARS-CoV-2, they're different viruses. They carry their genome in a different RNA strand. I remember thinking perhaps viruses are getting inside in platelets, but perhaps they do not. So we went through surprising discoveries that it seemed like it is another RNA virus. It also got into platelets. It was a bit hard to tweak things surrounding BSL-3 to tell you if the response was the same. It is still not very clear how much SARS or rather what receptor, particularly when it gets inside would induce an immune response. There are some literature showing the MDA5, but not for sure, may be responsible. But what we found is that once it gets in platelets, it just induces this profound activation of programmed cell death pathways and release of extracellular vesicles and all these prothrombotic, procoagulant form of content that can induce damage around, because platelets are everywhere. So that how it started in 2019 and surprisingly progressed to 2021 or 2020 without the plan of really studying this virus.   Cindy St. Hilaire:         How similar and how different is what you observe in platelets infected, obviously in the lab, so I know it's not exactly the same, but how similar and how different is it between the flu? Do you know all the differences yet?   Milka Koupenova:       No offense here, they don't get infected.   Cindy St. Hilaire:         Okay.   Milka Koupenova:       Done the proper research. The virus does not impact platelets, but induces the response.   Cindy St. Hilaire:         Okay.   Milka Koupenova:       That goes back to sensing mechanism. Thank goodness platelets don't get infected because we would be in a particularly bad situation, but they remove the infectious virus from the plasma from what we can see with function.   Cindy St. Hilaire:         Got it. So they're helping the cleanup process and in that cleaning up is where the virus within them activates. That is a really complicated mechanism.    Milka Koupenova:       Oh, they're sensing it in some form to alert the environment. It's hard to say how similar and how different they are unless you study them hint by hint next to each other. All I can tell is that particularly with SARS-C, you definitely see a lot more various kinds of extracellular vesicles coming out of them that you don't see the same way or rather through the same proportion with influenza. But what that means in how platelet activates the immune system with one versus the other, and that goes back to the prothrombotic mechanisms. That is exactly what needs to be studied and that was the call for this COVID compendium is to point out how much we have done as a team. As scientists who put heads together, as Mina said, superfast response, it's an amazing going back and looking at what happened to think of what we achieved. There is so much more, so much more that we do not understand how one contributes to all of these profound responses in the organs themselves, such as myocarditis. We see it's important and that will be the problem that we're dealing from here on trying to figure it out and then long COVID, right?   Cindy St. Hilaire:         Yeah. Related to what you just said about the mechanism, this cleanup by the platelets or the act of cleaning up helps trigger their activation, is that partly why the antiplatelet and anticoagulant therapies failed in patients? Can you speculate on that? I know the jury's still out and there's a lot of work to be done, but is that part of why those therapies weren't beneficial?   Milka Koupenova:       The answer to that in my personally biased opinion is yes. Clearly, the antiplatelet therapies couldn't really control the classical activation of a platelet. So what I think we need to do from here on is to look at things that we don't understand that non-classically contribute to the thrombotic response downstream. If we manage to control the immune response in some way or the inflammation of the infection or how a platelet responds to a virus, then perhaps we can ameliorate a little bit of the downstream prothrombotic effect. So it's a lot more for us to trickle down and to understand in my personal opinion.   DeLisa Fairweather:    There is one thing that was really remarkable to me in hearing your experience, Milka, is that I had developed an autoimmune viral model of myocarditis in mice during my postdoc. So I've been studying that for the last 20 years. What is unique about that model is rather than using an adjuvant, we use a mild viral infection so it doesn't take very much virus at all going to the heart to induce it. I also, more recently, started studying extracellular vesicles really as a therapy, and in doing that, inadvertently found out that actually, the model that I'd created where we passage the virus through the heart to induce this autoimmune model, we were actually injecting extracellular vesicles into the mice and that's what was really driving the disease. This is really brought out. So from early days, I did my postdoc with Dr Noel Rose. If you've heard of him, he came up with the idea of autoimmune disease in the '50s. We had always, in that environment, really believed that viruses were triggering autoimmune disease and yet it took COVID before we could really prove that because no one could identify them. Here we have an example and I think the incidence rates with COVID were so high for myocarditis because for the first time, we had distinguished symptoms of patients going to the doctor right at the beginning of their infection having an actual test to examine the virus, knowing whether it's present or not, whether PCR or antibody test, and then being able to see when myocarditis happened.   Cindy St. Hilaire:         Yeah. I think one thing we can all appreciate now is just some of the basic biology we've learned on the backend of this. Actually, those last comments really led well to the article that your team led, Dr Chung, about what we call long COVID, which I guess I didn't realize has an actual name, post-acute sequelae of SARS-CoV-2 or PASC is the now more formal name for long COVID. But what is it? We hinted at it that there's these bits about autoimmune and things like that. What counts as long COVID?   Mina Chung:   Yeah. Our article was led by Tamanna Singh. She did a fantastic job of putting this together. We've had, and others, theorized that the huge palette of symptoms that you can experience post-COVID, they can affect all these organ systems with brain fog, these atypical chest pains, postural orthostatic tachycardia, a lot of palpitations, atrial fibrillation, many weakness and fatigue. To us, really, you can get GI symptoms. We've been very interested in, is this an autoimmune phenomenon directed against nerves and all those things. It's also very interesting because many of the non-COVID syndromes that existed pre-COVID like POTS and chronic fatigue syndrome and a lot of other syndromes are associated with autoantibodies. So that is a very interesting area to explore. Is there a persistence of viral fragments. Is there autoimmunity? Is it also a component of persistence of the damage from the initial infection? So it's an area that still needs a lot of work and a lot of work is going into it, but this is like a post or inter pandemic of itself, so hopefully we'll get more insights into that.   Cindy St. Hilaire:         Yeah, it's really interesting. I have a friend who has very debilitating long COVID and one of her doctors had said, "If I didn't know any better, I would just describe this as a autoimmune type X." What do we know, I guess, about the current hypothesis of the pathogenesis of PASC? Are there any prevailing theories right now as to why it's occurring? Is the virus still active or is it these domino effects that are leading to multi-organ collapse of some sort?   Mina Chung:   Yeah. In some people, persistent viral particles can be identified for months, but whether or not that's what's triggering it, it's hard to know. We see more autoimmune disease that's been reported and various antibodies being reported. So those are clearly processes to be investigated. The microthrombosis is still up there in terms of potentially playing a role in long COVID.   Milka Koupenova:       Mina, you probably know better because you see patients, but to all I have been exposed to, long COVID does not really have a homogeneous symptom presentation and then a few theories as to what may be going on in these patients. Not everybody has a microthrombosis. Not everybody have a D-dimer elevated, but some people do. Some people have, as you pointed out, these spectacularly profound brain fog. People can't function. It's probably your friend, Cindy, right?   Cindy St. Hilaire:         Yeah.   Milka Koupenova:       So one of the theories that I have been, from a viral perspective, very interested in is that a lot of the symptoms in certain individuals such as fatigue, brain fog, sensitivity to light and skin can very well be explained by a flare-up of Epstein-Barr virus that may be what SARS-CoV-2 somehow is inducing. I don't know, DeLisa, what your experience with long COVID is as a scientist. I hope only. But I would like to hear your perspective too because it's so heterogeneous and it is amazing what happens.   DeLisa Fairweather:    I have a very interesting perspective from a number of different directions. One, as I mentioned before, my long history with Dr Rose and I've written many articles theorizing how viruses could cause autoimmune disease. This has grown and really, I think this has been extremely revealing during COVID for many of those theories. One thing that I write about in the review for this article is that mast cells, from all the research I've done with myocarditis in our model, mast cells are central to what is driving everything. We show they're the first innate immune cell acting as an antigen-presenting cell, completely driving the response in a susceptible pattern. One of the things that's very important in autoimmune disease is both sex and race. I'd say one of the big weaknesses we have in myocarditis pre-COVID and post-COVID has been ignoring what's going on with race. In the United States, myocarditis is 90%, 95% white men that are under 50 years of age and most of the cases are under 40 or some of the ones really associated with sudden cardiac death are under 30. So it's very specific. I've been studying sex and race differences and we see those exact differences in our animal models. In animal models, whether you're susceptible or not depends on how many mast cells you have. Well, I've proposed from the beginning, looking, I've written a lot of different sex difference reviews looking at viruses and autoimmune disease with different autoimmune diseases and hypothesizing and really seeing that mast cells do a lot of the things we're talking about. They have all of the receptors, the whole group of them that have been related to SARS-CoV-2 so they can be activated or stimulated by the virus itself. They act as a antigen-presenting cell. They're critical in the complement pathway as well as macrophages. We see the dominant immune phenotype really being macrophages. Mast cells just are usually not counted anywhere. And of course, these receptors, a lot of them have to do with enzymes and things that are all related to mast cells pathways. Then how they activate the immune response and lead it towards the pathway that leads to chronic autoimmune disease with increased autoantibodies in females, mast cells are very different by sex. This has to do also when we talked in the Review about myocarditis and pericarditis. It's both those appearing. Although clinically, we have really boxed them as separate things, because there is some definite clinical pericarditis phenotypes that are different, myocarditis in animal models is always myopericarditis. It always then, in that outer pericardial areas where mast cells sit, they sit around the vascular area in most concentrated. So when they degranulate, we see inflammation coming in the vessel, but really concentrated with fibrosis there and along the pericardium. So that's very typical of what's going on. When we shift anything that shifts that, it changes whether you have more pericarditis or less pericarditis and the vascular inflammation by altering anything that affects the mast cells. I talk a little bit about in the review, I think there's only been a few recent things looking at it in COVID, but I think mast cells and certain susceptibility to autoimmune diseases that occur more often in women can really predispose.We need to pay more attention to mast cells and what they might indicate for all these pathways.   Milka Koupenova:       I think we should study the platelet mast cell access at this point.   DeLisa Fairweather:    Yes.   Milka Koupenova:       Because as you're talking about these sex differences, which is spectacular, these things to me are so mind-boggling how one, the infection itself would be more prevalent in men, but then long COVID is more prevalent in women. All of these things and why we understand so very little, what we found about a few years ago in the Framingham Heart Study in the platelets from those people is that all toll-like receptors are expressed at the higher level in women and they associate with different things between men and female. For instance, toll-like receptors in women will associate more with a prothrombotic response while in male with pro-inflammatory response. I think they grossly underestimate the amount of our sex differences from cell to cell.   DeLisa Fairweather:    It is, yeah.   Mina Chung:   One other thing that I learned about the sex differences from this compendium is Mark Chappell also notes, you mentioned TLR and TLR7 and ACE2 are X chromosome in an area that he says escapes X-linked inactivation. So it could very well be involved in further.   DeLisa Fairweather: Further, yeah. And ACE2 is expressed more highly in male cells for what's been researched because of the sex difference in COVID, both the COVID infection   Cindy St. Hilaire:         So a variety of organ systems are impacted in patients with PASC, also referred to as long COVID, the lungs, the heart, the pancreas, the GI system, pretty much any system, the brain, nervous system. We've just been talking about the mast cell impact. I was really thinking in my head, well, the one thing that connects all of it is the vasculature. I'm a vascular biologist, so I have certain biases, I'm sure, but how much of the sequelae that we see is a function of vascular phenotypes?       Milka Koupenova:       I do think the vasculature is super important. It's clear that not all endothelial cells, for instance, will pick up the virus and respond to it. That's why you have this patchy breakage when you look at autopsies. Hence, platelets will respond according to what's local. That's why you find these micro thrombotic events at certain places. Why does it happen in each organ? How does the virus get to each organ to respond? Or is it just inflammation, but why is it in specific places? That's what we don't understand. That's where we need to go. Perhaps, as DeLisa points out, perhaps it's a lot more complicated than how we traditionally think of thrombosis. Actually, my personal bias, again 100% sure that it is a lot more complicated than the traditional mechanisms that we have understood, and that's where the immune system comes and autoimmunity perhaps stems from and they probably speak to each other, right? It's not just one thing.   DeLisa Fairweather:    Yeah. I think really, EVs are bringing lots of understanding. A lot of things we used to just think were maybe free-floating and the serum are inside EVs. I think that the immune response is perhaps even more specific than we ever thought and more regulated than we ever understood.   When an EV comes through a cardiomyocyte, whether it's from the mitochondria or through a lysosome, is part of what goes into its outer membrane, something that tells the immune system that that came from the heart, so it knows to go. This will solve a lot of our questions with autoimmune disease if it's very specific like that. It doesn't just have to be the release of free-floating cardiac myosin. We know cardiac myosin is the driver of the autoimmune response in myocarditis, but they're probably  much more fine-tuned.   Cindy St. Hilaire:         Yeah. I just would love to end with hearing from each of you. You each have your own domain of specialty. If I gave you a massive pot of money, what would be the question you would want to tackle? What's the gap you would love to answer?   Milka Koupenova:       We still don't understand specifically what kind of vesicles are coming out, what are their contents in addition to those vesicles. We don't understand. When it comes to platelets, what comes from their granules? We see these breakages of the membrane. Those are non-granule proteins, and non-granule proteins, they serve as dangerous associated molecular pattern signals and can be profoundly inflammatory to the surrounding environment, can be procoagulant. What are those? How are they affecting the surrounding environment? Ultimately, why is there a microthrombi? Why is there not a profound thrombosis everywhere? Thank goodness there isn't, but why isn't? That's what I would do with my money.   DeLisa Fairweather:    I think I would do something very similar. All of our research in our animal model, on the one side, we are looking in this viral myocarditis animal model and finding the EVs that come from that are driving myocarditis. On the other hand, we're using EVs that come from healthy human plasma or fat, and we're seeing a profound downregulation of everything if you give it early and we're trying to see how late you can give it and still get an effect. So looking at those and really understanding the components in the context of COVID and COVID vaccines to understand those components, I really think that's the future of where we're going to find what's causing disease and also how we can find therapies. They may be able to reverse this.   Mina Chung:   Yeah, I'm interested very much in the autoimmunity and the autoantibodies that are    and how they may react with those microthrombi. Perhaps there's autoantibodies within a lot of that material. We're looking at using human and pluripotent stem cell-derived cell models to study the effects of those. That is what I would use our money for.   Cindy St. Hilaire:        Well, Dr Mina Chung, Dr DeLisa Fairweather, Dr Milka Koupenova, thank you all so much for joining me today and talking about not only the articles that you wrote and with your colleagues, but also other articles in this amazing compendium. I do think this is one of the first all-encompassing compendiums or group of articles that focus specifically on COVID and cardiovascular disease. So thank you all so much.   Mina Chung:   Thank you.   DeLisa Fairweather:    Thank you.   Milka Koupenova:       You're welcome.   Cindy St. Hilaire:         That's it for highlights from the April 28th and May 12th issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle @circres and #DiscoverCircRes. Thank you to our guests, Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova. This podcast is produced by Ishara Ratnayaka, edited by Melissa Stoner and supported by the editorial team of Circulation Research. Some of the copy text for the highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire, and this is Discover CircRes, your on-the-go source for the most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, visit ahajournals.org.    

Marketers don't have enough time to do content marketing well. Sarah Panus helps you check storytelling projects off your marketing to-do list using 20 years of frameworks and methods, so you get your time back while confidently engaging new + existing customers.  ​ It shouldn't feel like you're falling behind because you can't get your content work done.  Sarah understands how hard it is to juggle your demands.  Clients: Sleep Number, Starbucks, LegalZoom, Katie Couric Media, Thrive Global, Nestle Waters, Lindt Chocolate, American Heart Association, Alta Tech, King Technology, Christos Bridal, etc. She's a brand storytelling consultant, podcast host of Marketing With Empathy® (top 5% of all marketing podcasts), Certified StoryBrand Guide, and owner of Kindred Speak® consulting. Sarah works with clients by either doing the work for them through her freelance consulting services; OR, coaching them to think like Editorial Content Directors in one of her online courses. Visit www.kindredspeak.com to learn more.  Sarah joins me to have a literal masterclass on blending logic and emotion into your video strategy. We deep dive into where people get stuck when it comes to their marketing strategy, ways to break the cycle of stuck, and successfully growing your audience, sales, and income. Join the Women of Video Mastermind here: womenofvideo.uscreen.io  Join the Money and Youtube Clubhouse room on Fridays: https://www.clubhouse.com/club/talking-youtube-by-vidiq Join our Facebook Group: http://t.ly/Nl9T  Finding what will perform well isn't easy, but VidIQ is my go to solution for tracking trends, key words, and what my viewers are looking for. When you download the VidIQ extension you will be able to level up your content! Get vidIQ to blow up your channel at womeonofvideo.com/vidiq Our community is focused on helping women not only to be better creators but to also make money doing it. Spreadshop allows for you to start making money as soon as you have merch to sell. You can open your FREE online merch store with Spreadshop in minutes! Cost-free, hassle-free, it's merchandising made easy. Click this link to get started for FREE! Get started with Spreadshop at https://womenofyoutube.com/Spreadshop Follow Desiree at http://t.ly/GbY4  Follow Sarah at Marketing With Empathy Check out My Story Brand  Check out kinderedspeak.com  Time Stamps: 00:00 - Podcast Intro 00:54 - Meet Sarah 04:01 - What leads people to Sarah 08:40 - Why you need help with what to sell 15:15 - The 7 Parts of Storytelling 20:10 - 4 empathy filters 25:41 - Brainstory telling blueprint process 27:42 - 3 storytelling pillars 32:05 - Think holistically about your content plan 42:01 - The first step you can take today --- Send in a voice message: https://podcasters.spotify.com/pod/show/womenofvideo/message

Today we speak with an expert on sugar and things meant to replace it. The stakes are high. Very high. Sugar consumption in the population is astronomical and so is the use of sugar replacements. Knowing the impacts of both could help experts provide dietary guidance and help consumers make decisions. Dr. Robert Lustig is Professor Emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco. He specializes on the regulation of energy balance by the central nervous system; body weight regulation, appetite, metabolism, and is very well known for his work on sugar and their substitutes and on policies aimed at improving the diet of the population. A YouTube video on the effects of consuming sugar called “Sugar: The Bitter Truth,” has now been viewed 24 million times. Interview Summary   URL for “The Bitter Truth video (https://youtu.be/dBnniua6-oM)   Let's start out with this - so the big hope is that sugar replacements, artificial sweeteners, non-nutritive sweeteners, all known as different things, replace sugar and that people can enjoy sweet taste without the calories. But, of course, the picture is way more complicated. Being an endocrinologist, you are in a good position to explain what happens when the sweeteners enter the body. I'd like to get to that in just a moment, but let's lead off with another question. Why is it so important for people to consume less sugar?   First, let's talk about what sugar is. The food industry tells you that sugar is just empty calories. I wish that were true. If that were true, then you could basically spend your discretionary calories on sugar with no problem. But it's not true. There are two molecules in dietary sugar: the sucrose or the high fructose corn syrup or honey maple syrup agave. They are all basically the same. One molecule of something called glucose, one molecule of something called fructose. Glucose is the energy of life. Glucose is metabolizable by every cell on the planet. Glucose is so important that if you don't consume it, your body makes it. The liver will take fats and turn it into glucose. It will take amino acids and turn it into glucose process called gluconeogenesis. Glucose actually makes your cells work better. It makes your mitochondria function better, the mitochondria being the little energy burning factories inside each of your cells. Glucose, for lack of a better word, we can call good. Fructose, on the other hand, it is completely different, is metabolized completely differently inside the body and inside the liver. What fructose does is it inhibits mitochondrial function. It actually inhibits three separate enzymes necessary for mitochondria to do their job. So, fructose inhibits energy generation. Now, the food industry will tell you fructose is four calories per gram. Fructose is ready energy. That is why they put high fructose corn syrup in the sports drinks, for example. Well, turns out, that fructose may be ready energy for a bomb calorimeter, but it is not ready energy for your mitochondria. You don't burn in a bomb calorimeter (a laboratory instrument), you burn via your mitochondria. It turns out, mitochondria are actually poisoned by fructose. So in fact, fructose is a chronic, dose-dependent mitochondrial toxin and this is why we have to eat less of it. But the problem is the food industry keeps putting it in anyway despite the fact that it is killing us.   How much more of it are people consuming than what you might suggest?   The American Heart Association years ago came up with a upper limit per day of about 25 grams, which would be about six teaspoons per day. I was actually part of that group that came up with that and I stick to it because that's what the data show. We are currently consuming 94 grams. We are consuming almost quadruple the amount that is the upper limit. Now, the notion that something could have empty calories but still be bad for you is not a crazy one. We have two things in our diet that we know are calories but are clearly toxic to us. One is alcohol. Alcohol, seven calories per gram, but alcohol is a poison. And then also trans fats. Trans fats are nine calories per gram, but trans fats are a poison. So just because something has calories doesn't have anything to do with its metabolic impact.   Where are people getting all the sugar from? I'm assuming it's not from their sugar bowl.   Exactly. It is not the sugar they add. It is the sugar the food industry adds. Now, where is it? Well, the obvious source is soft drinks. That's number one by far and away. I mean soft drinks are basically, you know, the devil incarnate. Several municipalities have actually figured that out, and it's one of the reasons we have soda taxes because it's actually directed at the problem. A lot of it is in other things that we identify as sweet: candy, cakes, ice cream. A lot of it is in other things like breakfast, cereal, yogurt, even cured meats. It is in a whole host of other things. When you add it all up, 65% of the sugar you consume is in ultra-processed foods. It is not in regular food. It is not in sugar you added to your own food. It is in ultra-processed foods. An ultra-processed food is the vehicle by which the payload, that is that fructose, is doing its damage.   Thanks for that background. We're really here to talk about the artificial sweeteners but it is irresistible talking to you about sugar in general because you described the whole picture in such a compelling way. So thank you for that. So, onto the artificial sweeteners. What are the main ones in the food supply?   Well, there are a whole bunch. The most common ones that the food industry uses the most, obviously aspartame, which is Equal. And also sucralose, which is Splenda. But there are others now out on the market: Neotame, there's Acesulfame-K, there's monk fruit, there's Stevia, and all the Steviol glycoside derivatives. There's now Allulose, and there's Tagatose. There's a whole host of different sweeteners that are considered "non-nutritive” meaning they don't have calories.   These things show up in ways that people don't necessarily recognize. I mean Diet Coke, Diet Pepsi, those sort of things, it's obvious they're artificially sweetened. But these things are showing up in a lot of places, aren't they?   Indeed. The food industry now understands that sugar is a problem and people have been calling for less sugar but what they're not calling for is less sweet. And so the industry has a job. It has to deal with that dichotomy.   I know understanding their impacts is complicated by the fact that there are a lot of these things and they're all chemically different from one another. I'm imagining they have different metabolic effects. What happens when these things get into the body?   Right, and that is the issue. It has nothing to do with calories. People think calories are the issue. This has nothing to do with calories. That's one of the reasons, Kelly, that I'm committed to one concept: kill the calorie. Kill the calorie as a unit of measure. It was never appropriate. It was actually subterfuge, and it was actually promoted and promulgated by the food industry because if it is about calories, they can assuage their culpability for what they've done to our food supply. This has nothing to do with calories. This has to do with metabolic health.   Now, the World Economic Forum just published a white paper called the, "True Purpose of Nutrition," and it comes down to two words: metabolic health. That is what is going on inside the cell and that's where the artificial sweeteners do their damage, inside the cell. That's what we have to talk about. There are several places in the body where artificial sweeteners can do damage that have absolutely nothing to do with calories. The first, you put something sweet on your tongue. Message goes tongue to brain, "Sugar's coming." Brain sends a message to the pancreas, "Sugar's coming, release the insulin." Then the sugar never comes because it was a diet sweetener. What does the pancreas do? It turns out it releases the insulin anyway even though it had no calories, even though it wasn't sugar, just because of the sweet taste. So this is known as the cephalic phase of insulin secretion. That insulin is driving energy storage into fat, number one, and it's also driving cell proliferation in your coronary arteries, cell proliferation in your breast tissue, in other words, cardiovascular disease and cancer and ultimately leading to burnout of your pancreas, and now you've got diabetes too. Even though these artificial sweeteners have no calories, they still generate an insulin response, which is still problematic from a metabolic standpoint.   So because of the sweet taste and the body's response to that, I'm assuming what you're saying would be true to all of sweeteners?   Exactly. All of them do that. The next step is the artificial sweetener goes down your gullet, goes into your intestine, and the intestine has these bacteria in it called the microbiome. Most people have now heard of that. Different bacteria lead to different effects in the intestine. But think of your intestine - I mean it's a sewer. It has a whole lot of S-H-you-know-what in there. The goal of the intestine is to keep the S-H-you-know-what IN the lumen of the intestine and not allow it into the bloodstream. It uses three barriers. It has a physical barrier called the mucin layer. It has a biochemical barrier known as tight junctions or zonulins. It also has an immunological barrier called Th17 cells. Those three barriers have to work right to keep the junk out of your bloodstream because if the junk gets into your bloodstream, you now have systemic inflammation, which drives insulin resistance and drives chronic metabolic disease as well. So keeping your intestine in tiptop shape is really important. Well, it turns out those diet sweeteners alter the microbiome. Some of those bacteria like those sweeteners and utilize them to make toxic byproducts, which damage the mucin layer, damage that biochemical tight junction barrier and allow for things to seep through. This is a process called leaky gut. For reasons that are still unclear, sugar tends to deplete those Th17 cells, rendering the immunologic barrier devoid of function. The sum total of which means all the you-know-what in your intestine ends up in your bloodstream, goes to your liver, generates insulin resistance, and you are off to the chronic metabolic disease races as well, from diet sweeteners having nothing to do with calories.   What an amazing picture your painting of these things.   We've got one more mechanism. At the fat cell, now this I really don't understand and it's early data but seems to be consistent. Turns out adipocytes, fat cells, have receptors for diet sweeteners. Don't ask me why. I don't know why. But it turns out, diet sweeteners can act like insulin right at the fat cell to increase energy deposition into the fat cell. Growing those fat cells all by themselves, due to the diet sweetener rather than due to insulin. Now how dumb is that? As a result, there are a lot of different ways diet sweeteners might end up causing problems as well, having nothing to do with calories, having nothing to do with fructose. There was a paper that came out in the European Journal of Clinical Nutrition. It was a meta-analysis of sugar and also of diet sweeteners in terms of diabetes and heart disease. What I can say in one sentence to sum up what this paper showed is that the toxicity of one Coca-Cola equals the toxicity of two diet Coca-Colas. Half as bad. That doesn't mean good. It means half as bad.   Boy, I mean, any one of the three major pathways to harm would be of concern. If you add them all together, it is a pretty striking picture, isn't it? I imagine, even if somebody knew about this, they might say, well, you know, I'm willing to accept those risks. I mean, even though you are making them sound substantial, but I'm willing to accept those risks if these products help me control my weight. Do they?   Well, they don't. That's part of the problem. There is not one study, not one study in the entire world's literature, that shows that switching from sugared beverages to diet beverages actually controls weight. The reason is because even though the diet sweeteners don't release as much insulin now, when you drink the diet sweetener, the pancreas releases it later. That's actually been shown in several studies now. You get a delayed insulin response, so that the 24-hour insulin burden is the same whether you consume the sugar or the diet sweetener.   Let's talk about safety for a minute. What about sort of the typical toxicology concerns that people have had for years about these substances, irrespective of what they're doing to the pancreas and to the other, the microbiome, et cetera? What about the just kind of pure safety of them?   Right, so the one that has generated the most heat, not too much light, unfortunately, is aspartame, NutraSweet. It turns out that aspartame has a very long and checkered history. Did you know that aspartame was made by Searle, G.D. Searle? And, do you know who the CEO of G.D. Searle was at the time that aspartame was approved by the FDA?   I do not.   His name was Donald Rumsfeld.   An interesting character in history.   Indeed, wouldn't you think? It turns out that G.D. Searle actually buried most of the toxicology of aspartame in order to get it approved. It is a long complicated and involved story, which we don't have time for. I'm not even privy to most of the details on that. The bottom line was it ultimately did get approved despite the fact that there was a significant amount of concern about toxicology of this compound. Those questions still remain today. That is one. Another one that is a big issue is sucralose. Sucralose is also called Splenda. Sucralose is a chlorinated poly-fructose and it's extremely sweet, no question about that. It seems to have some GI side effects that a lot of people don't like. It also has now been associated with cancer. And most recently, the one that's gotten the most attention and almost assuredly, Kelly, the reason you called me is the paper that came out about three weeks ago in science about erythritol. So erythritol is a sugar alcohol, and now the meta-analysis of erythritol consumption suggests that it may in fact contribute to heart disease. Now, is that true? Meta-analysis are complicated. People think meta-analysis are the piece de resistance, the highest bar of medical information and analysis. I have four words for meta-analysis: garbage in, garbage out. Meta-analyses are only as good as the studies that they base the data on. If those studies were done by the food industry, which almost all of these are, because that's who stands to benefit from them. These are almost never NIH studies. These are almost always food industry studies, as you know, the odds are 7.61 times more likely to find in favor of the compound of interest. So all of these are, shall we say, biased. All of these are tainted, and meta-analyses are basically a conglomeration of tainted studies. So what do you expect the result to be?   Thanks for that background. I'm imagining also regarding toxicology and safety, that some of the newer sweeteners like Splenda for example, sucralose, there hasn't been enough years of use to pick up long-term chronic effects.   Well certainly, if you're using cardiovascular or cancer events, you're absolutely right. A lot of these events, you know, take a long time to manifest themselves. Sometimes, a generation or even two generations for that matter, especially for heart disease and cancer. The 15-year-old is drinking 10 diet sodas. When do you expect the heart attack to show up? You know, it's complicated.   So we use biomarkers to try to answer these questions, but then the biomarker has to actually be a good proxy for those events and often they're not. Let me give you an example, LDL. Everybody thought LDL was the bad guy. Turns out triglycerides are the way worse guy. LDL has a hazard risk ratio for heart disease of 1.3. Triglycerides have a hazard risk ratio of 1.8. Triglycerides are 50% more important in determining heart disease than LDL is, but we use LDL as the biomarker because it's more stable. So you have to use the right biomarker and you have to interpret it properly and it actually has to mean something and it has to change relatively acutely. All of which are problematic for all of these biomarkers. It's hard. It's hard to do these kinds of analyses. Having said that, my group, a scientific advisory team that I convened to help an offshore ultra-processed food company improve the health of their products. We've published this just last month in Frontiers in Nutrition. The company is called Kuwaiti Danish Dairy Company, or KDD. The title of the paper is, "The Metabolic Matrix: Re-Engineering Ultra-processed Foods to Protect the Liver, Feed the Gut, and Support the Brain." We did a deep dive on diet sweeteners. We looked at all of these diet sweeteners and their proxies, all the biomarkers. The one that actually popped out that looked to be the most beneficial, at least acutely, is a new one that we're actually kind of interested in and is picking up speed and it's called allulose. Allulose currently is 12 times the cost of sugar, but that's coming down. It turns out allulose lowers LDL and raises HDL. So it may have a better cardiovascular profile, but again, all the caveats that we mentioned before.   That's very interesting. So given your interest in pediatrics, what about children using these sweeteners?   I am totally against children using sugar because they get fatty liver disease and Type 2 diabetes, and I am totally against them using diet sweeteners because, number one, we don't know what they're going to do. Number two, they don't actually lead to weight loss. That data we do have. So as far as I'm concerned, we really only have one option and that is de-sweeten our lives. We have to de-sweeten the food.   Perfect lead in to the next question I was going to ask. So do you think it is possible for people to become accustomed to less sweetness? I mean, let's say the food industry is required to gradually reduce sugar and sweetness from the sweeteners. What do you think would happen?   Absolutely. It is not only possible, it is eminently doable. And I know why and we have the data for why that is. So there is a very smart lady, neuroscientist at the University of Michigan by the name of Monica Dus, who has done all this work in fruit flies of all places. She has shown the desensitization of the tongue to sugar has to do with changes in receptors and changes in specific substrates in the taste buds of the tongue. When you stop the sugar availability, it takes three weeks for those receptors to increase and repopulate, and for those problematic substrates to go away. You can actually retrain your tongue in three weeks to be much more sensitive to the sugar that is in the food naturally. After a three-week abstinence period or a reduction or a weaning period, a blueberry will taste like a sugar bomb in your mouth. So we know this can happen and we actually have proven this for salt previously. The UK, as you know Kelly, back in 2003, the Blair government convened all the food industry concerns in Great Britain. So Marks & Spencer, and Weight Rose, and Tesco, et cetera, all around the big table, didn't let media in, and basically said to every single food industry concerned in Great Britain, "Look, we have a hypertension and stroke problem and it's because of the salt content of the food and we are going to play referee here in the government. And each of you is going to reduce the salt content of your food by 10% per year over a three-year period so that you'll reduce your salt by 30% at the end of this and everyone's going to play together, so that there's no competitive disadvantage and most importantly, we're not going to tell anybody." That's what they did. Sure enough, in 2011, a paper appeared in Burge Medical Journal, demonstrating a 40% reduction in hypertension and stroke because of the public health effort that the Blair government made in terms of reducing the amount of salt in processed food. We can do the same with sugar today.   The salt example is a good one because I think many people have sort of experienced this in their day-to-day lives, even in the United States, where industry hasn't done exactly what's happening in Britain. People have tried to reduce salt in their diet, add less salt, and buy products with less salt. And then sometimes they'll go back and consume something that they had before and find it extremely salty, even unpleasantly salty. It's interesting to hear on the sugar front that that same experience might be possible and that there's a biological reason for it. It is not just that you psychologically get accustomed to different levels of sugar, in this case, but there's a biological change occurring that might help keep that going.   Absolutely. You can change people's behavior by changing their biochemistry. This is how I got into this field by using a drug that suppressed insulin and getting kids who were 400 pounds due to their brain tumor to actually lose weight and start exercising because we got their insulin down. You can fix the biochemistry and the behavior will follow suit. The food industry could do that and we wouldn't even notice.   So I'm guessing I know the answer to this question before I even ask it, but let's go ahead. Would you suggest the food industry be mandated to make gradual reductions in sugar, just like you mentioned with salt in the UK?   Absolutely, I'm working toward that. The only thing that I say is we should not tell anybody.   So it would be sort of a stealth move then. You would not necessarily have to make a big deal of it to the public, because they might assume there's going to be a change in the desirability and the pleasure of the products when that's not necessarily the case.   As soon as you do something to their food, someone's going to scream, "Nanny state!" This is not nanny state. Ultimately, this is a public health problem. We have to deal with it with a public health solution. You know, that means changing things. If the amount of sugar in our food supply went down, say by 3% every six months down, so that we were able to cut our sugar consumption by 25%, which would be the same basically as what a tax would do. We would save so many billions of dollars in healthcare costs, and we would increase productivity so much. We actually published a paper, a microsimulation analysis in BMJ years ago where we quantified the savings to government, to insurers, to the public. If we actually got sugar down and, you know, actually listened to what the USDA told us, it would be amazing. There is data, there's a pathway forward, there's precedent for doing it. I absolutely think that is where we need to go.   Rob, you're making me feel very smart at the moment, because I figured this was going to be a podcast filled with information and helpful bits of knowledge and it sure was. I'm really grateful that you were able to join us and the topic couldn't be more important. Thank you again for being with us.     Bio   Robert H. Lustig, M.D., M.S.L. is Emeritus Professor of Pediatrics in the Division of Endocrinology, and Member of the Institute for Health Policy Studies at UCSF. Dr. Lustig is a neuroendocrinologist, with expertise in metabolism, obesity, and nutrition. He is one of the leaders of the current “anti-sugar” movement that is changing the food industry. He has dedicated his retirement from clinical medicine to help to fix the food supply any way he can, to reduce human suffering and to salvage the environment. Dr. Lustig graduated from MIT in 1976, and received his M.D. from Cornell University Medical College in 1980. He also received his Masters of Studies in Law (MSL) degree at University of California, Hastings College of the Law in 2013. He is the author of the popular books Fat Chance (2012), The Hacking of the American Mind (2017), and Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (2021). He is the Chief Science Officer of the non-profit Eat REAL, he is on the Advisory Boards of the UC Davis Innovation Institute for Food and Health, the Center for Humane Technology, Simplex Health, Levels Health, and ReadOut Health, and he is the Chief Medical Officer of BioLumen Technologies, Foogal, Perfact, and Kalin Health.  

“Heart Care is the New Self-Care” – Dr. Suzanne Steinbaum This interview could save your life or the life of a woman you know. Please share it with every woman in your life. Heart disease is the number one killer of women but so many women are unaware of this information. Today's show is going to spotlight the importance of taking care of your heart health, what the key risk factors are, and how to focus on prevention. While on the show notes page, I'd love for you to join our community. You'll receive more inspiration and tips to love yourself and your life. You'll get a FREE copy of Michele's Book, Design a Life You Love. *This interview is for entertainment purposes only. For medical advice, seek out your trusted healthcare provider. WHAT WE DISCUSS: The statistics about heart disease and how it is the #1 killer of women. 70% of women don't realize they are at risk. The role research, the doctors, and even women have played and not changing this statistic in the last twenty years. How we can take ownership of our health since 80% of heart disease is preventable. The importance of preventative care. The blood tests we need as well as the other factors that play into our heart health. The symptoms that women may have and how they differ from men. Knowledge is power here to advocate for yourself. Women still die in the hospital of heart attacks. The importance of exercise, sleep, and meditation. Why Dr. Steinbaum is launching Adesso (means now in Italian) and how it is going to change the landscape of heart health, and more. RESOURCES MENTIONED Websites: https://www.drsuzannesteinbaum.com/ www.adesso.health Book: Dr. Suzanne Steinbaum's Heart Book: Every Woman's Guide to a Heart-Healthy Life IG: Dr. Steinbaum on IG Adesso on IG Connect with Michele on Instagram “Since the dawn of recorded time in almost every culture, our heart has been the symbol of our ultimate essence as human beings. Cupid, St. Valentine, the source of songs, poetry and art, our heart elevates that which makes us fully alive: our capacity for love, passion, romance, purpose. Life at its fullest. And yet heart disease is the #1 killer of women. 1 in 3 women will die of heart disease and for the past 20 years, over the course of my entire career as a preventive cardiologist, that figure hasn't changed. This disconnect, this Grand Canyon from the abstract idea of our hearts and the real working function of the organ at the center of our being, is what needs to change. We know now that preventing heart disease is not defined just by medical data like blood pressure, cholesterol, BMI, sugars and medication. True heart health stems from every aspect of our lives, like stress, relationships, sleep, how we nourish ourselves, how we move and yes, even how we love. As we fully put ourselves and our heart at the center of our lives, we will fully change the course of this disease that 80 percent of the time is preventable. We can and will change this. When we live from the heart, we live! Life at its fullest.” MORE ABOUT OUR GUEST Dr. Suzanne Steinbaum is a leader in preventive cardiology, now in private practice in New York. She launched heart prevention programs at Mt. Sinai Heart, Northwell Lenox Hill and Beth Israel. She is the CEO/Founder of Adesso, a technology-based prevention model. She is also the author of “Dr. Suzanne Steinbaum's Heart Book: Every Woman's Guide to a Heart Healthy Life”, and has been a national spokesperson for Go Red through the American Heart Association for 18 years. Thank you for listening to the show. Be sure to share it with a friend!  We love when women empower other women. If you enjoyed this interview, please take a moment to rate and review it on Apple podcasts. Your reviews are so appreciated! Not sure how to do it? Instructions are below. XO, Michele

Welcome to MedEvidence: Two Docs Talk Allergies and Asthma. In this part 4 series, Dr. Michael Koren and Dr. Sunil Joshi bring expert insights and valuable knowledge on allergies and asthma. Today's Part 1- Pollen Season and Symptoms Associated with Pollen Allergies: As pollen season approaches, many people experience a range of symptoms associated with pollen allergies. The doctors discuss the common symptoms of pollen allergies, such as itchy eyes, runny nose, and congestion. They also cover the types of pollen that cause allergies and ways to avoid exposure.This series is the perfect resource for learning about allergies and asthma. Tune in to gain a deeper understanding of these important healthcare topics.Listen to the whole series:Two Docs Talk: Allergies and Asthma Pt 2Two Docs Talk: Allergies and Asthma Pt 3Two Docs Talk: Allergies and Asthma Pt 4Common medications:The anti-IL5 products that affect eosinophil survival are mepolizumab (Nucala), benralizumab (Fasenra), reslizumab (Cinqair). The anti-IL4/IL13 product is dupilumab (Dupixent)The anti-IgE agent is omalizumab (Xolair)The anti-TSLP agent is Tezepelumab. (Teszpire) Sunil Joshi, MD, is the President and Managing Partner of Family Allergy Asthma Consultants in Jacksonville, Florida. The Past-President of the Duval County Medical Society (the largest and oldest Medical Society in Florida) and a graduate for the University of Florida College of Medicine. Dr. Joshi received his Allergy/Immunology fellowship training at the University of Rochester in New York.  He truly enjoys treating patients with allergic disorders and believes that education about these disease processes can bring better care to the public.Michael J. Koren, MD, is a practicing cardiologist and Chief Executive Officer at Jacksonville Center for Clinical Research, which conducts clinical trials at 7 locations in Florida. He received his medical degree cum laude at Harvard Medical School and completed his residency in internal medicine and fellowship in cardiology at New York Hospital/Memorial Sloan-Kettering Cancer Center/Cornell Medical Center.He is a fellow of the American College of Cardiology, fellow and two-time president of the Academy of Physicians in Clinical Research, and the regional chapter of the American Heart Association. Original Air Date: April 14, 2023Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedIn Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

Sponsored by the American Heart Association Center for TelehealthIn this episode, David McSwain, M.D., chief medical informatics officer at UNC Health, and Craig Beam, president of Beam & Associates and chief financial officer of Worksite Labs, discuss the research landscape regarding telehealth, the data on integrating this service into clinical care, and how telehealth research can be put into practice.This episode is sponsored by the Intelligo Professional Educational Hub™ powered by the American Heart Association Center for Telehealth, formerly the American Board of Telehealth.These views do not necessarily reflect American Heart Association policy.

I don't include cardio and strength training on the same day in all of my programs, but I do in some. The question, then, becomes, should you do strength training before or after cardio? In this article, I'll review the research behind each approach and then share some practical insights based on my experience working with clients over the past couple of decades. Cardio vs. Strength Training As I wrote about in The 3 Pillars of VIGOR, you can get most of the benefits of cardiovascular exercise from a well-designed strength and conditioning program. However, there are cases where including cardio in addition to strength training is beneficial. Women, in general, tend to respond better to programs with a moderate amount of cardio. For women with PCOS, cardio can be especially important. And even for men, including cardio can help them get through fat loss plateaus, or get rid of the last 15 pounds of body fat to see a complete six-pack. But just to be clear, I do not advocate doing cardio instead of strength training. If it comes down to doing one or the other on a given day, always do your strength training. With that in mind, here are some of the most significant benefits of each form of exercise. Benefits of Strength Training Strength training obviously makes you stronger (hence, the name), but it does much more, whether you're 18 or 81. Some of resistance training's key benefits include: Increased muscle mass: Strength training promotes muscle growth, which can improve your overall body composition and appearance.Schoenfeld, B. J. (2010). The mechanisms of muscle hypertrophy and their application to resistance training. Journal of Strength and Conditioning Research, 24(10), 2857-2872. Improved bone density: Resistance training helps to maintain and improve bone density, reducing the risk of osteoporosis.Layne, J. E., & Nelson, M. E. (1999). The effects of progressive resistance training on bone density: a review. Medicine & Science in Sports & Exercise, 31(1), 25-30. Boosted metabolism: Building muscle increases your resting metabolic rate, which means you'll burn more calories at rest.Campbell, W. W., Crim, M. C., Young, V. R., & Evans, W. J. (1994). Increased energy requirements and changes in body composition with resistance training in older adults. American Journal of Clinical Nutrition, 60(2), 167-175. Enhanced functional fitness: Strength training improves your ability to perform everyday tasks, making you more functionally fit.Rantanen, T., Guralnik, J. M., Sakari-Rantala, R., Leveille, S., Simonsick, E. M., Ling, S., & Fried, L. P. (1999). Disability, physical activity, and muscle strength in older women: the Women's Health and Aging Study. Archives of Physical Medicine and Rehabilitation, 80(2), 130-135. Benefits of Cardiovascular Exercise When you look at most research and medical publications, you find a consistent set of benefits from cardio. They include: Improved heart health: Regular cardio can reduce the risk of heart disease by improving circulation and lowering blood pressure.Mora, S., Cook, N., Buring, J. E., Ridker, P. M., & Lee, I. M. (2007). Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation, 116(19), 2110-2118. Increased endurance: Cardio helps to build stamina, allowing you to exercise for longer periods without fatigue.Fletcher, GF., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., ... & Sibley, C. (2013). Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation, 128(8), 873-934. Weight management: Engaging in regular cardio can help you maintain a healthy weight or lose weight when combined with a proper diet.Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., & Smith, B. K. (2009). Appropriate physical activity intervention strategies for weight loss and prevention of weight regain fo...