Podcasts about cardiovascular

Back for part 2, Naila takes you through 15 papers pertaining to health conditions associated with AD and dementia. You'll hear about infections, cardiovascular and metabolic risk factors, and a few miscellaneous diseases.  Sections in this episode:  Epidemiology / Multiple Factors (1:00)  Immune Conditions (8:00)  Metabolic and Cardiovascular (15:00)  Neurological Comorbidities (24:50) -------------------------------------------------------------- You can find the numbered bibliography for this episode by clicking here, or the link below:https://drive.google.com/file/d/1Pgl18mXwvDG2xZK9fijICMtfEhI7BXUG/view?usp=sharingTo access the folder with all the bibliographies for 2021 so far, follow this link (it will be updated as we publish episodes and process bibliographies), or click the following link below:https://drive.google.com/drive/folders/1N1zx_itPkCDNYE1yFGZzQxDDR-NiRx3p?usp=sharingYou can also join our mailing list to receive a newsletter by filling this form. Or tweet at us: @AMiNDR_podcast  --------------------------------------------------------------Follow-up on social media for more updates!Facebook:  AMiNDR  Twitter: @AMiNDR_podcastInstagram: @AMiNDR.podcastYoutube: AMiNDR PodcastLinkedIn: AMiNDR PodcastEmail: amindrpodcast@gmail.com  -------------------------------------------------------------- Please help us by spreading the word about AMiNDR to your friends, colleagues, and networks! Another way you can help us reach more listeners who would benefit from the show is by leaving us a review on Apple Podcasts or wherever you listen to podcasts. It helps us a lot and we thank you in advance for leaving a review! Our team of volunteers works tirelessly each month to bring you every episode of AMiNDR. This episode was scripted and hosted by Naila Kuhlmann, edited by Alexandra Pavel, and reviewed by Marcia Jude and Ellen Koch. The bibliography was made by Anjana Rajendran and the wordcloud by Sarah Louadi (www.wordart.com). Big thanks to the sorting team for taking on the enormous task of sorting all of the Alzheimer's Disease papers into episodes each month. For September 2021, the sorters were Jacques Ferreira, Ellen Koch, Christy Yu, Sarah Louadi, Kate Van Pelt, Nicole Corso, Eden Dubchak, Kira Tosefsky, Dana Clausen, and Elyn Rowe.Also, props to our management team, which includes Sarah Louadi, Ellen Koch, Naila Kuhlmann, Elyn Rowe, Anusha Kamesh, Jacques Ferreira, and Shruti Kocchar for keeping everything running smoothly.Our music is from "Journey of a Neurotransmitter" by musician and fellow neuroscientist Anusha Kamesh; you can find the original piece and her other music on soundcloud under Anusha Kamesh or on her YouTube channel, AKMusic.   https://www.youtube.com/channel/UCMH7chrAdtCUZuGia16FR4w   -------------------------------------------------------------- If you are interested in joining the team, send us your CV by email. We are specifically looking for help with sorting abstracts by topic, abstract summaries and hosting, audio editing, creating bibliographies, and outreach/marketing. However, if you are interested in helping in other ways, don't hesitate to apply anyways.  --------------------------------------------------------------*About AMiNDR: *  Learn more about this project and the team behind it by listening to our first episode: "Welcome to AMiNDR!" 

Commentary by Dr. Valentin Fuster

With Lavanya Kondapalli, University of Colorado School of Medicine, Aurora - USA & Tomas Neilan, Massachusetts General Hospital, Boston - USA Link to paper Link to editorial    

RICH CELENZA talks about how a lot of people become depressed because they are aging. A lot of people also may not like the way they are aging. Or they may not have liked the way they looked in their past. Rich thinks people need to stop getting caught up in the past and do their best to look and feel their best right now. This may take some time, but if they take out of their day to make improvements on themselves, they may be shocked at what they start to conform into.   

A 2019 survey of over 3,000 participants noted considerable improvements in the following conditions by avoiding genetically modified organisms (GMOs)... Digestive issues (85.2%) Fatigue (60.4%) Overweight or obesity (54.6%) Brain fog (51.7%) Food allergies/sensitivities (50.2%) Mood issues (51.1%) Memory (48.1%) Joint pain (47.5%) Gluten sensitivities (42.2%) Insomnia (33.2%) Skin conditions 30.9% Hormonal problems (30.4%) Musculoskeletal pain (25.2%) Autoimmune disease (21.4%) Eczema (20.8%) Cardiovascular problems (high blood pressure) 19.8% And while this survey was conducted in a group that may be more sensitive to GMOs, I think it's important to acknowledge that GMOs do have health and environmental risks. According to Jeffrey Smith, GMO advocate and this week's podcast guest, novel developments in genetic engineering may possibly contribute to future pandemics. Listen in to learn why GMOs are dangerous, how to identify them, how to get involved in regulating their use and so much more! Here are some highlights from our important discussion… Why GMOs are dangerous The difference between organic and non-GMO 4 “healthy” foods that have high levels of glyphosate The children's cereals with high levels of glyphosate How GMO companies control research How GMOs affect digestive health and mental health  Why Roundup is even more dangerous than people think How GMO research is rigged  What is gene editing and why it's dangerous How and why GMOs could contribute to future pandemics How you can stop gene editing How to avoid GMOs How to detox from glyphosate What to know to avoid GMOs when you eat at restaurants New GMO foods to watch out for And so much more! I sincerely hope you love this podcast as much as I did and please share with everyone you think it may benefit. Valuable Resources: Protect Nature Now
 >>> Learn More About Jeffrey & Safeguarding Biological Evolution from GMOs HERE!
 Genetically Modified Microbes White Paper
 >>> Access the Research on Technological & Legislative Challenges & National Security Implications HERE!
 Paleovalley Essential C 
>>> Upgrade your conventional GMO-derived (ascorbic acid) vitamin C supplement and try Paleovalley's Essential C HERE!

With Kevin C Maki, Indiana University School of Public Health, Bloomington - USA & Carl E Orringer, University of Miami Miller School of Medicine, Miami - USA Link to paper Link to editorial

If you've followed the NBT podcast for a while you probably heard Dr. Malcolm Kendrick talking about the tenuous connection between cholesterol levels and cardiovascular disease. Malcolm has published with The International Network of Cholesterol Skeptics on this topic, including a recent review paper entitled LDL-C does not cause cardiovascular disease. In the paper, they include both total cholesterol and LDL-C in their discussions, and if you look at epidemiological data, I think they make a good point. For instance, total cholesterol had almost no effect on mortality in the HUNT-2 study in Norway, and higher levels were associated with lower mortality risk in women. Or the ESCARVAL-RISK study, where higher LDL-C is associated with lower all-cause mortality until it's well above 200 mg/dl. Or the In-Chianti study, where people over 64 had the lowest mortality rates if they had an LDL-C greater than 130mg/dl. The question then becomes, if not cholesterol, then what? To answer that we must resist monomania and acknowledge the very notion of causation in a complex system is suspicious. Ask not what but how. Malcolm argues in his new book The Clot Thickens that if you maintain metabolic health, manage stress, and mind your endothelial function, cholesterol levels become largely irrelevant. Simple enough, but as you'll discover in this interview, the devil is in the details. Here's the outline of this episode with Malcolm Kendrick: [00:00:24] Previous NBT podcasts with Malcolm Kendrick: Why Cholesterol Levels Have No Effect on Cardiovascular Disease (And Things to Think About Instead) and A Statin Nation: Damaging Millions in a Brave New Post-health World. [00:00:42] Book: The Clot Thickens: The enduring mystery of heart disease, by Malcolm Kendrick. [00:03:04] 5-part series with lipidologist Thomas Dayspring (Part 1, 2, 3, 4, 5);  2-hour interview with Ron Krauss on The Drive Podcast. [00:04:23] Book: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. [00:06:12] LDL Cholesterol - challenging mainstream thought. [00:17:16] Fatty streaks never become atherosclerotic plaques; Review: Velican, C., M. Anghelescu, and D. Velican. "Preliminary study on the natural history of cerebral atherosclerosis." Medicine interne 19.2 (1981): 137-145. [00:18:54] Genetic influences; familial hypercholesterolemia (FH) and high clotting factors; Case study of patient with untreated FH but no presence of atherosclerosis: Johnson, Kipp W., Joel T. Dudley, and Jason R. Bobe. "A 72-year-old patient with longstanding, untreated familial hypercholesterolemia but no coronary artery calcification: a case report." Cureus 10.4 (2018). [00:21:22] Clotting factors more important than high LDL; Paper: Ravnskov, Uffe, et al. "Inborn coagulation factors are more important cardiovascular risk factors than high LDL-cholesterol in familial hypercholesterolemia." Medical hypotheses 121 (2018): 60-63. [00:25:03] UK Biobank Study: Mora, Samia, Seth S. Martin, and Salim S. Virani. "Cholesterol Insights and Controversies From the UK Biobank Study: Three Take-Home Messages for the Busy Clinician." (2019): 553-555. [00:25:51] Machine learning used to predict cardiovascular disease; Study: Weng, Stephen F., et al. "Can machine-learning improve cardiovascular risk prediction using routine clinical data?." PloS one 12.4 (2017): e0174944. [00:30:54] FOURIER PCSK9-inhibitor study: More deaths in the treatment group; Study: Sabatine, Marc S., et al. "Evolocumab and clinical outcomes in patients with cardiovascular disease." New England Journal of Medicine 376.18 (2017): 1713-1722. [00:31:26] Evolocumab also reduces Lp(a); Study: O'Donoghue, Michelle L., et al. "Lipoprotein (a), PCSK9 inhibition, and cardiovascular risk: insights from the FOURIER trial." Circulation 139.12 (2019): 1483-1492. [00:34:02] APOA-1 Milano and HDL cholesterol. [00:38:45] Lp(a) and Vitamin C, plasminogen and clotting. [00:47:02] Rudolf Virchow, the father of the cholesterol hypothesis. [00:48:42] So what causes CVD? [00:49:53] Biomechanical stress; High blood pressure. [00:52:16] Endothelial and glycocalyx damage. [01:02:19] Steroids, immunosuppressants. [01:03:52] Avastin (bevacizumab) increases the risk of CVD; Study: Totzeck, Matthias, Raluca Ileana Mincu, and Tienush Rassaf. "Cardiovascular adverse events in patients with cancer treated with bevacizumab: a meta‐analysis of more than 20 000 patients." Journal of the American Heart Association 6.8 (2017): e006278. [01:06:07] Clotting disorders. [01:10:41] Sickle cell anemia - 50,000% increased risk of CVD. [01:11:36] Case study of 14-year old boy: Study: Elsharawy, M. A., and K. M. Moghazy. "Peripheral arterial lesions in patient with sickle cell disease." EJVES Extra 14.2 (2007): 15-18. [01:13:25] Air pollution, smoking, lead. [01:15:57] Biggest risk factors for CVD. [01:20:09] Supplements that strengthen the glycocalyx; Chondroitin Sulfate. [01:22:12] Malcolm's blog.

Luis Herrero entrevista a la doctora Miriam Sandín, vocal de la Asociación de Riesgo Vascular y Rehabilitación Cardíaca.

With Martha Gulati, University of Arizona College of Medicine - Phoenix - USA & Anastasia Mihailidou, Royal North Shore Hospital, Sydney - Australia Link to paper Link to editorial

James Davies, Jr MD, Mustafa Ahmed and Riem Hawi MD discuss the evaluation and management of hypertrophic cardiomyopathy at UAB. In this round table podcast they include medical management, catheter based therapies and surgical strategies.

An interview with Dr. Pauline Funchain from Cleveland Clinic, author on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” She reviews the recommendations for cardiovascular toxicities in patients receiving ICPis, including overall cardiac toxicities (i.e., myocarditis, pericarditis & arrhythmias), and VTE in Part 11 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines   TRANSCRIPT SPEAKER 1: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today we're continuing our series on the management of immune related adverse events. I am joined by Dr. Pauline Fontaine from the Cleveland Clinic in Cleveland, Ohio, author on "Management of Immune Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy, ASCO Guideline Update," and Management of Immune Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T Cell Therapy, ASCO Guideline." And today we're focusing on the cardiovascular toxicities in patients treated with immune checkpoint inhibitor therapy. Thank you for being here, Dr. Fontaine. PAULINE FONTAINE: Thank you, Brittany, for the invitation. BRITTANY HARVEY: First, I'd like to note that ASCO takes great care in the development of its guidelines, and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Fontaine, do you have any relevant disclosures that are directly related to these guidelines? PAULINE FONTAINE: So I do. My institution receives research funding from Pfizer and Bristol Myers Squibb for clinical trials where I'm a primary investigator. And I have done some consultation work with Eisai. BRITTANY HARVEY: OK. thank you for those disclosures. Then talking about the content of this guideline, what are the immune related cardiovascular toxicities addressed in this guideline? PAULINE FONTAINE: So there are two major categories. One is an overall cardiovascular category. That includes myocarditis, pericarditis, arrhythmias, impaired ventricular function with heart failure, and vasculitis. That's overall. And there's a second category of venous thromboembolism. BRITTANY HARVEY: Great. Then starting with that overall category, what are the key recommendations for identification, evaluation, and management of myocarditis, pericarditis, arrhythmias, impaired ventricular function with heart failure, and vasculitis? PAULINE FONTAINE: So in that overall category, I think it's important to recognize that there are symptoms that are a little bit more general. They may be cardiovascular. They may be pulmonary. But we have to be aware that some of these can be cardiovascular. So that would include worsening fatigue, progressive or acute dyspnea. I think they're generally going to be other things, but you really have to recognize a potential cardiac IRE, as those can have major medical consequences. I mean there are other things that are more obviously cardiac, like chest pain, arrhythmia, palpitations, acute onset peripheral edema. And it is important to note that they can, like every other IRE, happen at any time. In the literature, the median time to onset is 6 weeks, but the range is somewhere between 1.4 to 54, and we know that it can be all over the place with IREs in terms of presentation. Then next would be evaluation. So with evaluation, whenever you see this type of side effect, fatigue, dyspnea, chest pain, it's natural to want to get an EKG troponin. I think that's a great place to start. And I think if there's more concern for cardiac type of IRE, then an echocardiogram, a chest X-ray, I think, are probably the next easiest evaluations to assess for cardiac IRE. One of the important things to note is that cardiac IREs, especially myocarditis, tend to happen along with concurrent myocytis, so it's important to check a CPK to rule that in or rule that out. And typically, then if people need more evaluation, the cardiac MRI is the next step, but things like cardiac catheterization may be involved. And so that's where I think it's really important with management to have cardiology involved early. I mentioned this briefly before, but it's really important to know that myocarditis has a very high fatality rate, up to about 50% in published series. I think as we get better at recognizing myocarditis, that fatality rate will likely go down, but catching a cardiac IRE late can have some very serious implications for our patients. So immediately recognizing that a cardiac workup is necessary, and referring early to cardiology is really important, no matter what grade of cardiac IRE we see. And I do think that with cardiac IREs, it's really, is it an inpatient workup? Does it require immediate cardiac consultation and workup? If there are elevated troponins that are going up, or conduction abnormalities, does that patient need to be in a cardiac unit? I think those are the major things to keep in mind with management. Another thing, I think, that is really important because of the high fatality rate: starting corticosteroids early. So like our other IREs, you can start corticosteroids that 1 to 2 mgs per kg per day. And doing that early has the potential to quickly improve cardiac inflammation, keep people from the very serious and potentially fatal side effects for cardiac IREs. And it really doesn't have that much of a consequence in the short term. So I think in discussions about this guideline, we all felt that if a patient has a Grade 2 or higher IRE-- so that's anything that has a cardiac biomarker that's abnormal plus symptoms of any kind-- it's important to keep in mind early steroids and early cardiac consultation. For very, very severe cases where management with corticosteroids is not improving the patient's status, then we highly recommend considering cardiac transplant rejection doses, which would be methyl pred at 1 gram daily, or adding other immunosuppressants. So there are not as many studies as we would like, but mycophenolate, infliximab, antithymocyte globulin have all been reported. There have also been case reports on abatacept or alemtuzumab, with good outcomes. So those are things to consider, of course, with cardiology input for severe cases. BRITTANY HARVEY: Thank you. Those are important notes for clinicians to keep in mind for management and evaluation. So then, the second category that you mentioned, what are the key recommendations for identification, evaluation, and management of venous thromboembolism? PAULINE FONTAINE: So for identification, most everyone listening to this podcast knows what a venous thromboembolism looks like. That's extremity swelling, extremity pain, sometimes accompanied by fever, pleuritic pain, cough, dyspnea. And the evaluation is the same as what you would see in clinic. That would be venous ultrasounds for any suspected deep vein thromboembolisms. And CT, PE for any suspected pulmonary embolism. And of course, a VQ scan if you can't do that type of CT. And the management is the same as what you would normally do in clinic. So if it's a superficial thrombosis, that would be a grade 1. You would do a warm compress, do supportive care. But importantly, you can continue the immune checkpoint inhibitor per our recommendations. For grade 2, so a symptomatic thrombosis, a deep vein thrombosis, that would require anticoagulation. But again, once anticoagulation has been started, the recommendation is that it is safe to continue the immune checkpoint inhibitor therapy, because at this point, you're protected. Should be, in theory, protected from future embolic events. And then, I think the major thing is that for management in general once there is anticoagulation on board, then there isn't necessarily a reason to hold immune checkpoint inhibitor therapy. I think that the major reasons we would recommend to hold it are life threatening consequences, organ damage. So grade 4 embolic event, where you would have to admit the patient. And then it becomes a risk benefit discussion after an admission. In general, I think the recognition and treatment are the same in terms of venous thromboemboli that are identified in the context of immune checkpoint inhibitor therapy. The major thing is just to know that it exists as a potential side effect, that the incidences appear to be higher, and that there is something about immune checkpoint inhibitor therapy that may put our patients at higher risk for these embolic events. BRITTANY HARVEY: Definitely. That's key to know, and particularly also when to hold or continue ICPI therapy. So then in your view, Dr. Fontaine, how will these recommendations for management of cardiovascular toxicities impact both clinicians and patients? PAULINE FONTAINE: I think the major thing is to know that these exist. The overall cardiac toxicities are less common, so if we're talking about myocarditis, that is a pretty rare event. But it's important to know that this is an event that is potentially fatal, that that fatality happens often, and that myocarditis can occur along with a myositis, and in some cases with myasthenia gravis. So these are three different rare side effects that can happen together, sometimes in pairs, sometimes in triplets, sometimes just one of them. But any one of these three has a higher risk for fatality. So I think just to know that it's out there. So that that is just hanging around in the differential for someone who is tired or out of breath. It may be pulmonary, but also keep in mind that it could be cardiac, and that is serious, and that should be worked up early and treated early. I think that's the major thing that I hope these guidelines do, is put these important but rare side effects out there and potentially save lives. I will say for VTEs, for venous thromboemboli, again, so PE can happen, and it can be fatal. I think this is not as rare, but of course, it's not rare in our patient population either. So these are things that we already look out for. Just, I think, if this podcast and the guidelines can add to the education that immune checkpoint inhibitors will increase the risk of thromboembolism, I think that those are the important takeaways. BRITTANY HARVEY: Absolutely. Recognition of these IREs is a common theme across the affected organ sites that we've heard in many of these podcast episodes. So I want to thank you for your work on these guidelines and for taking the time to speak with me today, Dr. Fontaine. PAULINE FONTAINE: Thank you for having me. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. Stay tuned for additional episodes on the management of immune related adverse events. To read the full guideline, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in iTunes or the Google Play store. If you've enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.

Cardiovascular disease is the #1 cause of death in America and indeed the whole world.The conventional approach to heart health, where doctors rely only on pills and procedures, isn't leading to better outcomes.But there is hope, and there is a better approach to a healthier life.And just like we do in other episodes, we have invited the nation's number one natural heart health doctor to shed more light on this topic.Dr. Jack Wolfson is a board-certified cardiologist and author of Amazon's best-selling book, The Paleo Cardiologist: The Natural Way to Heart Health, and five-time winner of the Natural Choice Award as a Holistic M.DHe uses in-depth testing and targeted nutrition to prevent and treat cardiovascular disease at his integrative cardiology practice.Dr. Wolfson is a believer in finding and eliminating the cause of disease rather than managing symptoms.This is a great conversation that will enlighten you on the common sense approach to health, which ultimately leads to a healthy heart and a long, happy life.Tune in to hear from the world's foremost natural heart health doctor!Key Takeaways- Major contributing factors to heart disease (05:00)- Cholesterol is king (10:48)- The markers for cardiovascular disease (14:43)- Why the statin approach is wrong (16:59)- The complicating factor of fear (20:58)- The best nutrition for your heart (23:37)- Your skin is a solar panel- embrace the power of the sun (25:39)- Efficacy of natural approaches to cardiovascular disease (33:08)- Common sense approach to heart health (34:44)Additional ResourcesGet The Paleo Cardiologist book FREEDr. Jack Wolfson Website---------ditchthequickfix.com/Do you want to improve your physical health? Learn More Here---------You can find the podcast on Apple, Google, Spotify, Stitcher, or wherever you listen to podcasts.If you haven't already, please rate and review the podcast on Apple Podcasts!

With Perry Elliott, University College London - UK  and Alexandros Protonotarios, UCL Institute of Cardiovascular Science London - UK Link to paper Link to editorial

CardioNerds (Amit Goyal and Daniel Ambinder), Cardio-OB series co-chair and University of Texas Southwestern Cardiology Fellow, Dr. Sonia Shah, and episode FIT lead and UT Southwestern Cardiology Fellow Dr. Laurie Femnou discuss valvular heart disease in pregnancy with cardio-obstetrics expert Dr. Uri Elkayam, Professor of Medicine and OB Gyn at the University of Southern California. In this pearl-packed episode, we discuss the diagnosis, acute management, and long-term considerations of valvular heart disease in pregnancy. Through a series of cases, we review the physiologic changes in pregnancy that make certain valvular lesions well-tolerated, while others are associated with a much higher risk of peripartum complications. We also discuss which patients to consider referring for valvular intervention, the ideal timing, and which valvular interventions are safest in the peripartum period. We promise, you won't want to miss this clinically high-yield episode with Dr. Elkayam, the father of cardio-obstetrics and an absolute legend in the field! Audio editing by CardioNerds Academy Intern, Adriana Mares. Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardio-Obstetrics Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Most women with severe valvular heart disease can be managed medically throughout pregnancy.Right sided valvular lesions are generally better tolerated than left-sides lesions, and regurgitant lesions are generally better tolerated than stenotic lesions. However, the context and etiology of the valve dysfunction must be taken into consideration. Severe tricuspid valve regurgitation, for example, can be associated with a failing right ventricle and undiagnosed pulmonary hypertension. Changes in BNP, severity of symptoms, and right ventricular systolic pressure (RVSP) assessed by echocardiography can be helpful in differentiating normal pregnancy-related symptoms from symptoms due to hemodynamically significant valvular lesions.Valvular interventions during pregnancy are safe when well-planned and performed by experienced operators, and they can significantly improve morbidity and mortality in women who remain symptomatic despite medical management.A multidisciplinary team-based approach is important when managing patients with valvular heart disease during pregnancy. Quatables “We do not need to perform prophylactic valvular intervention in women prior to pregnancy if they do not meet criteria for intervention otherwise. A patient with regurgitant lesion will tolerate pregnancy well, provided that they are not                candidates for surgery already.” “Valvuloplasty during pregnancy is a great and effective procedure, but restenosis occurs. For women who desire future pregnancies, preconception evaluation is important to determine if valve intervention is indicated prior to conceiving.” Show notes What is the epidemiology of valvular heart disease in pregnancy?Cardiovascular conditions affect up to 4% of pregnancies, with valvular heart disease being the most common cardiac pathology encountered during pregnancy worldwide.In the developing world, rheumatic valve disease is still the most common etiology, with mitral valve most commonly affected, followed by the aortic valve.In the developed world, congenital aortic valve pathology is most common. What are the hemodynamic effects of stenotic vs. regurgitant lesions during pregnancy?In normal pregnancy, there is a significant drop in systemic vascular resistance as early as 5 weeks gestational age. This drop leads to a transient decrease in perfusion to the kidneys, causing an increase in fluid retention and expansion of plasma volume. At the same time, there is an increase in heart rate which becomes more pronounced la...

We are replaying one of our most popular episodes for you this week!   Is strength training enough for longevity and quality of life? That's the question Brian and Dr. James Fisher explore in the final episode of the What About Cardio? series. Learn about the difference between how athletes and the average person train and why achieving high levels of sports performance and everyday fitness are not accomplished the same way. Can strength training and whole food nutrition be enough to transform someone's fitness results? Where does cardio fit into fitness and sports performance? Fitness is about our body's ability to perform a physical task, whether that's moving a weight or speed or flexibility. Cardiovascular fitness is our body's ability to move oxygen around the body efficiently, and one of the major benefits of cardio is an increased rate of recovery from exercise. Intensity is key. If you want to perform at a higher level in a sport, long duration and low intensity will not achieve the results you desire. Even with a long duration, low intensity sport, a greater intensity is required to increase performance. There was a study that was published in the late 90's that showed that the best way to become better at a sport is to practice the sport. A lot of the exercise and training that athletes do to become better at their sport is actually superficial. Specificity of movement is vital. Fisher trains athletes for the positions they are going to play, and the best way to get better at a certain sport is to do exactly that. Resistance training can be a great supplement as a way to prevent injury, but it won't do much to directly improve someone's sport performance. The average person shouldn't be looking to sports training to help prevent the aging process. There are a couple of things to remember: when you are looking at a high level athlete on television, they are genetically gifted. They probably achieved what they have relatively early on in life and with less training than the average person. The second thing to remember is that they are paid to do that and have a short career. The best athletes have a short shelf life. The average career in the NFL is less than 7 years. Are you willing to do all the training and exercise that they put themselves through to perform at that level? Brief, intense strength training can improve cardiovascular fitness. A study by a group of Spanish authors showed a 10% increase in cardiorespiratory fitness over 12 weeks with a program of strength training. If you're already a Tour de France cyclist, adding resistance training isn't going to do much to improve your performance. It all depends on who you are. Resistance training can definitely improve our health, improve our cardiovascular fitness, and improve our longevity and quality of life.   Link: exercisecoach.com     This podcast and blog are provided to you for entertainment and informational purposes only. By accessing either, you agree that neither constitute medical advice nor should they be substituted for professional medical advice or care. Use of this podcast or blog to treat any medical condition is strictly prohibited. Consult your physician for any medical condition you may be having. In no event will any podcast or blog hosts, guests, or contributors, Exercise Coach USA, LLC, Gymbot LLC, any subsidiaries or affiliates of same, or any of their respective directors, officers, employees, or agents, be responsible for any injury, loss, or damage to you or others due to any podcast or blog content.

Today, we are talking about a few apps and websites that are helping people with dementia keep their brains active. In previous episodes, we've talked about how an active brain can potentially slow the progression of Alzheimer's and other forms of dementia. If you are interested in learning more about this, visit our website for more information. We are going to be highlighting a few options we have found that you and your loved one may want to explore. Now let's move on to the rest of the show.   An active brain can help slow the progress of dementia and other memory-impairing diseases. Doing daily exercises may help a person with dementia recall memories longer. One easy way to keep your brain active is by using the technology around you. In today's world, we can access almost anything using a smartphone or computer, so why not use technology to help people with dementia?   The majority of people with Alzheimer's or other dementias today are over 65. Many of these individuals are not what you would call tech-savvy, but many apps and websites today are designed specifically for seniors with dementia. They are easy to use and engaging.   The first app we want to tell you about today is called MindMate. It was created by three volunteer caregivers, Patrick, Suzanne, and Roger. The three have said they created MindMate because “Watching people we cared for succumb to memory loss left us with the belief that there must be something we can do to help the ones we love. Why weren't there any tools to help care for those with Alzheimer's and Dementia and keep caregivers sane?”   According to MindMate.com, united in their dedication to creating more resources, the three decided to develop a mobile app for other caregivers like themselves. With the help of Dr. Terry Quinn from the University of Glasgow's Institute of Cardiovascular and Medical Sciences, the team began to translate contemporary research in Dementia care into an actionable, digital platform. Based on this research, the MindMate App was born.   Estate Planning and Elder Law Services says that this free app, available for Apple, Android, and computers, offers brain games and workouts to help with attention, memory, problem-solving, and cognitive speed. MindMate also features other tools to stimulate brain and general health, promoting good nutrition, physical exercise, mental stimulation, and social interaction. The site allows you to take a memory test online and promptly emails you your results.   Another app similar to MindMate that you may be familiar with is Lumosity. It is one of the earlier brain-training apps in the market and there's a reason that it is still widely used today.   According to Lumosity, there have been over 20 peer-reviewed publications in academic journals using Lumosity games or assessments. In one study, our scientists conducted a randomized trial involving 4,715 participants in order to study whether cognitive performance improves after training with Lumosity. The test group trained with Lumosity, while the control group trained using crossword puzzles. Both groups trained five days per week, for fifteen minutes a day.   After ten weeks, the Lumosity group improved in performance across a battery of cognitive assessments. In fact, they improved more than twice as much as the control group did.* More specifically, the Lumosity group showed statistically significant improvements on subtests of working memory, arithmetic reasoning, and processing speed.   There is a free version of the app, or you can pay $11.95 a month to have access to all that the app offers.   Another unique app we came across is the Spaced Retrieval App by Tactus Therapy. Tactus Therapy explains that this Spaced Retrieval Therapy app uses the scientifically proven method of spaced retrieval training to help people with dementia or other memory impairments to recall important information. Recalling an answer over multiplying intervals of time, such as 1 minute, 2 minutes, 8 minutes, and so on, helps to cement the information in memory.   Spaced Retrieval Therapy is an enhanced interval timer with independent data tracking and prompts. It automatically increases the time between prompts with correct responses and decreases it with incorrect ones. This app will help clinicians, family members, and students keep track of the intervals and performance as they practice up to 3 memory targets.   This app is specifically geared towards helping people with dementia remember new information longer. The app requires a one-time payment of $4.99.   Communication and strengthening existing social connections and relationships can help improve someone with dementia's overall health. Many people with dementia want to maintain their relationships, but find themselves pulling away from their loved ones because they may not be able to easily follow conversations or stress over what others will think of them after a dementia diagnosis.   According to the creators of AmuseIT, isolation can be a problem for those living with dementia, and it can be difficult for those who care for them to know how to engage.   AmuseIT is an app designed to promote conversation. It contains over 1000 simple quiz questions with a strong visual component.   In addition to facilitating connection between dementia patients and caregivers who use the app, AmuseIT stimulates memory and reasoning and is easy to use, even for those intimidated by technology. You can buy the app for $3.49.   Your loved one may repeatedly call you or others as their disease progresses. Someone with dementia may not remember calling you only two minutes prior and call you several times. If your loved one is in a care facility and is having trouble adjusting to a new environment, they may also want to call you repeatedly and become agitated when they are unable to talk with you.   According to Estate Planning and Elder Law Services, Alz Calls is a chatbot designed for patients who repeatedly ask for their family, struggle with transitions to new environments, or need social interaction. Family members can record their voice, add a photo that will pop up for the patient to recognize, and answer frequent questions so that the patient can have an interactive conversation when the caregiver is not available to talk.   You can record yourself saying numerous phrases by following prompts provided by Alz Calls or making them yourself. A caregiver will help your loved one use the patient side of Alz Calls and will respond to their calls using your recordings. You have full access to all calls that your loved one makes through Alz Calls. Recordings are stored for two weeks at a time.   One therapy app that we are interested in is Constant Therapy. Constant Therapy Health talks about their app, saying that by combining AI and real-world evidence in our easy-to-use app, we're delivering clinically proven, personalized brain exercises that can help people reignite their cognitive, speech, and language abilities. And we're continuously optimizing the world's understanding of the factors contributing to brain health so that we can serve people across a range of neurological conditions.   You can use the app on your own or with a clinician. The app is $24.99 a month but has a yearly option that includes an Amazon tablet, too.   The last thing we want to bring up today is a website called MEternally. This website is best suited for those that are not used to technology and would rather participate in offline activities. MEternally offers activity cards, videos, games, and other physical products that help people with dementia connect and reminisce with those around them.   MEternally tells us that they believe that our mix of life experiences, professional expertise and willingness to speak honestly about dementia, creates an environment where we are able to create products that are meaningful and thoughtful. Our own personal experiences with family members affected by Alzheimer's, Huntington's and Parkinson's Diseases reinforces our personal commitment to not just those with diagnosis of one of these horrific diseases but to those with other forms of dementia.   Reminiscence benefits not only those with dementia. When we tell people about our lives, we are sharing our history and our identity. By viewing photo collections we initiate conversations about our favorite things and share our life stories with others. This allows us to reflect on the things and people in our present and past. By doing so we are preserving and sharing our history and reflecting on our worth and the importance of our own existence.   If you would like to learn more about any of the apps or websites we talked about today, visit our show notes for the resources we used today. Do you have any favorite apps or websites that you or a loved one with dementia uses? Let us know on our website or social media pages!   We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form there where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode please make sure to share it with them.   Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.   Sources: https://www.formyplan.com/elder-law/alzheimers-dementia/2020/02/26/ten-apps-and-other-activities-for-people-with-dementia-and-alzheimers/   https://www.mindmate-app.com/   https://www.lumosity.com/en/   https://tactustherapy.com/app/srt/   https://play.google.com/store/apps/details?id=com.tactustherapy.srt   http://www.amuseit.nz/?fbclid=IwAR2EE9Gz0U_yiHgFompLtaVwvljj1l4lcm0llSj_GKaVF55NwNuq11Z91A4   https://alzcalls.com/instructions   https://constanttherapyhealth.com/constant-therapy/   https://meternally.com/                    

With Mehmet Birhan YILMAZ, Dokuz Eylul University, Izmir - Turkey & Ahmet Celik, Mersin University - Turkey Link to paper Link to editorial

This week we replay an episode reviewing a large administrative database study from Sweden on risk for cancer amongst patients with CHD. Why are cancer rates different in the CHD patient? What are the most important factors? What actions should be taken by cardiologists caring for ACHD patients in order to properly screen for cancer? We discuss these issues with Assistant Professor of Pediatrics, Harvard Medical School, Dr. Michelle Gurvitz. doi:10.1001/jamanetworkopen.2019.6782

????Episódio #45 Podcast @LadoBdaCiencia1 @leotorresleal e @augustocesarfm conversam com Prof. Dr. @PauloLotufo sobre consequências do Covid-19 sobre a saúde cardiovascular e sazonalidade dos eventos cardiovasculares. #epitwitter #COVID19 #todospelasvacinas Estamos em todos os agregadores! Compartilhe a palavra da ciência! #publichealth #covid19 #podcast #epitwitter #vacina #vaccine Tópicos Debatidos ⇒ Recados (agradecer audiência; compartilhar com amigos, etc.). ⇒ O que sabemos entre Saúde Cardiovascular e um individuo positivo para COVID-19? ⇒ E quais as consequências do Covid-19 sobre a saúde cardiovascular? ⇒ A pandemia alterou a sazonalidade dos eventos cardiovasculares?O que a pandemia nos ensina na formação médica? ⇒ Quais as maiores deficiências hoje para os acadêmicos de medicina? ⇒ Dicas culturais Dicas Culturais Augusto: Série Ted Lasso: Paulo Lotufo: série: Succession - Livro a história da Amazonia. Lado B da Ciencia Podcast - https://twitter.com/LadoBdaCiencia1 A ciência em nosso dia-a-dia -https://podcasts.apple.com/us/podcast/lado-b-da-ciencia-podcast/id1523585746 Sigam nossas redes sociais: Twitter: https://twitter.com/augustocesarfm Twitter: https://twitter.com/leotorresleal Twitter: https://twitter.com/LadoBdaCiencia1 Instagram: https://www.instagram.com/ladobdaciencia Instagram: https://www.instagram.com/ycare_rg/ Instagram: https://www.instagram.com/domen_rg/ This podcast is hosted by ZenCast.fm

Part 2 of 2. We're back inside the human body! Lauren, the Reading Bug and the Spelling Bee are touring inner space on an adventure through the digestive, respiratory, cardiovascular and nervous systems. Join them for part 2 and see how our adventure ends. Explore the books in the Reading Bug's book bag at www.thereadingbug.com/adventures/innerspace

Hypertension is a leading cause of kidney disease and in part four of this multipart podcast series, Dr. Benjamin Broome, a nephrologist with Nephrology Associates in Birmingham, Alabama, is joined by Dr. Donald DiPette, who serves on faculty in the department of internal medicine at the University of South Carolina in Columbia to discuss the clinical implications of hypertension as a significant cardiovascular risk factor. They will also review the clinical care implications of the recent hypertension management and treatment guidelines.

Commentary by Dr. Valentin Fuster

Host Aaron Lohr talks about cardiovascular disease and type 2 diabetes with Jonathan Purnell, MD, from Oregon Health & Science University. Dr. Purnell chaired the Endocrine Society's recent educational series, "Current and Future State of Cardiovascular Disease in Type 2 Diabetes," which is available through December 2021. For more information, including helpful links and other episodes, visit our website at https://www.endocrine.org/podcast

In this ultra HY podcast, I continue our series on cardiovascular pharmacology as relevant to the 2 exams described above. I encourage you to master the material from this podcast and the previous one. It will come in big on your test. For more details on the Step 2CK/3/COMLEX 2/3 course taking place next week, … Continue reading Divine Intervention Episode 347 – Cardiovascular Pharmacology for The USMLE Step 2CK/3 Exams Part 2.

With Cecilia Linde, Karolinska Institute, Danderyd Hospital, Stockholm - Sweden Link to paper Link to editorial

Dr Guerra carries out the synthesis of multiple pathobiochemical events into an architechtonic of the aging human co-morbidity resulting in a sickness unto death. Authentic Biochemistry Production 22 October 2021 References Cardiovasc Diabetol. 2020; 19: 33. Cytometry A. 2006 Mar;69(3):189-91 Nat Rev Dis Primers. 2019 Mar 7;5(1):16 J Lipid Res. 2007 Jan;48(1):19-29. doi: 10.1194 Mech Ageing Dev. 2001 Sep 15;122(13):1413-30 --- Send in a voice message: https://anchor.fm/dr-daniel-j-guerra/message Support this podcast: https://anchor.fm/dr-daniel-j-guerra/support

Dr. Jit Choudhuri is the founder and CEO of MediCardia Health, a digital health platform that aggregates and visualizes healthcare data, and applies intelligence and automation at the clinician-patient interface, to drive value for patients, providers, practices, and payers. By using technology to deliver big wins to all stake holders, MediCardia is developing the healthcare platform of tomorrow, to drive digital transformation today, starting with Cardiology and Cardiovascular disease. Jit is a Cardiac Electrophysiologist and Electrical Engineer, and today has more than 10 years experience in Clinical Operations, applied Value-based Care and population health, and cardiovascular Informatics. Here are some key insights from this week's show: The vision of success is to transition healthcare from being one of the least digitized industries to one in which digitization is at the center of how we maintain and act upon data. Digital transformation and data driven healthcare is the true solution that will enable transition into value based care. Digital care doesn't mean impersonal care. Always challenge a simple premise. A solution should never be a compromise. Prefer to watch the video? Watch it here: https://youtu.be/wtLJlzGynhw

Half of those with psoriasis have undiagnosed cardiovascular risk factors. Hear how to go beyond the skin or joint disease to address comorbidities associated with psoriatic disease with dermatologist Dr. John Barbieri, Brigham and Women's Hospital in Boston, and NPF Board Chair Ron Grau. For disclosures/credit: https://www.eeds.com/em/3354. This program is supported by educational grants from Bristol Myers Squibb, Lilly, Novartis and Ortho Dermatologics. 

I bet your idea of self-care is flawed.  Listen to Episode 82 “Finding Your Caregiving Self Care Style: Part One” to find out if it is and learn two ways you can bring self-care into your day. Show Notes If you have listened to any of my episodes that focus on self-care you know that I believe it is required of all caregivers to care for themselves. When I asked caregivers what they needed the most, the answer I got was - learn how to care for themselves. So for the next few episodes, we are going to do just that.  Let's talk about ways caregivers can support themselves. I get it.. you might be skeptical right now but give me just 10 minutes of your time. Don't worry about writing anything down if you are driving or on a walk. All of this information is on the website so you can always reference that to find everything I talk about on this episode today. Self Care is Essential Self-care is essential for caregivers. If you listened to episodes 13   and episode 43  you know that I feel it is a requirement. Not only is it essential for your own health it also allows you to be the best caregiver you can be. It allows you to release the stress that builds up every day, allows you to become resilient so you find yourself feeling overwhelmed less often and it allows you to love your life while caregiving. There is scientific data that proves chronic stress is linked to Cardiovascular disease, depression and anxiety, and a weakened immune system. Doing things that keep you from chronic stress is essential for keeping you healthy.  What is self-care? There are three problems that caregivers have when addressing self-care.  1. They don't feel that self-care is for people like them. 2. They don't have any time to do anything for themselves. 3. They don't know what they would do even if they wanted to. My answer to those objections are  We need to work on your definition of self-care  The problem isn't not having the time it's in how you prioritize your day.  Self-care doesn't have to be complicated. Definition of self-care Let's start with the actual definition of self-care. According to the dictionary self-care is: The practice of taking action to preserve or improve one's own health. and  The practice of taking an active role in protecting one's own well-being and happiness, in particular during periods of stress. Nowhere in this definition do I see any specific events or activities listed. If we use this definition of self-care then it is open to interpretation. It is anything that you could do to protect your own well-being and happiness.  The problem is that companies have decided to tell you what self-care should look like. Social media accounts promote what they want you to think self-care is. It can feel like the world is trying to tell you that you need self-care and the thing they are selling or the place they are promoting is the answer and almost always the person they use for their messaging is a young, healthy person wearing beautiful expensive clothing or hardly anything at all.  You don't see yourself in that messaging. That is why I meet so many caregivers that tell me self-care isn't for them. I get that. If you think self-care is what you buy for yourself or what you go to do it's going to feel out of reach for you.  Now, I'm not saying that taking a trip, getting a massage, or buying that expensive cream aren't good ways to release caregiver stress but most of those things are not daily forms of self-care. I'd consider them the extra things you do if you can. The problem is, you can't sell the act of doing nothing. It isn't glamorous but for some people taking a moment to sit and do absolutely nothing is their form of self-care.  The other problem is, no one reaches out to help you learn what self-care means for you. You know you should be caring for yourself because people are always telling you that you should do it… usually when you are at a breaking point. Which is extremely unhelpful. Everyone telling you to take care of yourself but no one to give you ideas of what to do! Keep listening because we are going to get to that.  You are the only person that can determine what self-care is for you. No matter what it is, the focus of it should be protecting your own well-being and happiness. Protecting your well-being means protecting your health. For caregivers, one of the most important things that need to be done is to find ways to deal with the stress of caregiving. I am going to give you options over the next three episodes for you to consider so you can find one thing that can be brought into your life consistently. Time for self-care Self-care needs to be a part of your daily life. It needs to become what you do every day, like going to the bathroom or brushing your teeth. It has to be non-negotiable. That means it has to be something you will actually do. I can spend hours talking to you about the benefits of meditation but if you don't believe you'd find that enjoyable it'll never work for you.  You have to believe in yourself care and it needs to be as big or as small and you think it should be. However, if you tell me there is absolutely no time for you to do anything for yourself what I hear is you don't think you are worthy of being a priority. Some of the things that I am going to suggest you consider taking less than 5 minutes. You have that much time. It can take more than 5 minutes to find something to watch on Netflix and you probably spend more than 5 minutes a day on social media.  Self-care is what you actively do to protect your own well-being and happiness and it can take as much or as little time out of your day but it needs to happen daily. I am positive you can do this. Let's look at two self-care options and see if any of them are things you would consider doing.  Finding your self-care tool Self-care tool #1 - Stop It's as simple as that… just stop and do absolutely nothing. Stop for a couple of minutes, no phone, no book, don't add to your to-do list. Just stop. Stop doing, stop talking, stop trying to fix things. Stop and sit or simply lie down on the floor. Get to that place you are driving to, park, and stop. Turn off the radio and lean that seat back for a minute.  We spend so much of our time doing. Take a minute to not do that. Just stop. Don't get ready to stop. Don't cue up something on the radio so you can stop. JUST STOP. Turn everything off. Just don't do anything.  Just be. Let your thoughts float by. Don't try to change them or fix them. Don't try to stuff the ones down that see this as an opportunity to come up. There's nothing to analyze right now. Just stop and do nothing.  I know I'm repeating myself because this is by far, the easiest thing for you to do, and most of you will not end up even trying it!  You don't have any time for yourself? Just stop. Take a seat. Just a minute. You have a minute. Self-care isn't for you? Just lie down on the floor or sit in your car and recline the seat when you get to the grocery store. Everyone can take a break for a minute. Just a minute of doing nothing. No special breathing (although this would be a great time for that). No meditation. No assessing your emotions. Just stop doing!  Give your brain a chance to catch up with you. Let your nervous system have a moment when it doesn't feel like it's under attack. Just stop! Self-care tool #2 - Walk/Get outside The next tool I would suggest trying is having a specific time of the day when you get out of the house. I know some of you are already thinking you don't have time for that or you can't do that because of the person you care for needs you around all the time. Even more of a reason to really listen to this one if that is the case. Oftentimes a caregiver's house can feel oppressive. Have you ever felt claustrophobic in your house because you've been in it for too long? Maybe you aren't confined to the house by your responsibilities but when you do leave it, is to do something specific and not to do something for yourself.  Getting out of your house is a very good self-care tool. It shifts your focus to something other than what you were probably hyper-focused on at home. If there is a lot of stress in your life, getting out of the house can give you a break from that. It can be the distraction you need before making a big decision or having that conversation you don't really want to have.  Getting out of the house can be a reset for you. It can remind you that you are part of a community. You have a chance to see other human beings and notice birds, the smell of the air, and the sounds of the world you live in. Have you ever left your house and noticed how everything feels different? All the things your mind was trying to fix, figure out and formulate move off to the side and you might feel a little bit more clear-headed. Or maybe you're just tired of hearing the same show on tv with the volume up 100% higher than it needs to. Before you pick up that bat and destroy the tv simply get out of the house. That's the why, here's the how.  5 min version  Let's say you feel you can't really leave. If you really think this is something you'd like to do I would suggest seeing if there aren't 5 minutes in your day where things would be ok if you weren't there. If not, ask yourself if it is because your loved one needs you or you are scared to leave? Not in an effort to judge but to understand why you feel you can't leave. If you do find 5 minutes you might not be needed then try being out of the house for two minutes. Just step out the door and walk in one direction for one minute and then turn around. As you feel more comfortable you can try going out for longer. If you can't get away for that long the option for you would be to open the front door of your house and focus on what is outside. Stand there. Maybe you do this when you grab your coffee in the morning, or while you are waiting for lunch or dinner to finish. Find a time you would be by the door every day and see if you can take a minute to stand there and notice what is right outside. You can always do this with a window instead.  10 min version  Get out and take a walk. It doesn't need to be fast. You don't have to wear workout clothes to do it. Just get out and walk away from the house for 5 minutes and then turn around. Can the walk be longer or shorter? Of course. Also, take into mind the safety of your surroundings, the weather, and please don't wear all black if you're going out in the dark. Ask yourself after the first time if you enjoyed it and could you do it every day? Be honest with yourself. If not every day then maybe a couple of times a week or a month but that would mean this isn't the thing you do daily for yourself.  Maybe you find out you feel free when you go out for a short walk. Maybe this is the time you get to think through things. A time for you to be alone. Maybe even a time to listen to a short podcast or music. This short break could end up being something you get excited about every day but you won't know if you don't try it.  30 min version This might be something you don't do every day but it's worth mentioning because I know it feels good to do. Take a drive or take a long walk somewhere. Maybe you drive to a park or a place that has a scenic view and you just sit there for a couple of minutes. My favorite is to drive to grab some coffee. I turn my favorite music up loud in the car and I sing as loudly as I want. Or if classical music is your jam I'm with ya. Make this all about you and not about any chores or errands you need to do.  Longer Of course you can do any of these things for longer periods of time. What we're focussing on here is a daily activity you can integrate into your day. Keep that in mind. If there are things you would love to try but you know you wouldn't do every day by all means make a note of it and do it when you can. We are just working on slowing down with the options I am giving you today. Both of these forms of self-care are free. You don't need anything to do them. In fact, the first one is about doing absolutely nothing. While doing nothing for a couple of minutes or sticking your head out of the door may seem inconsequential I challenge you to try them.  For those of us who feel like we always need to be doing something to prove our worth, stopping is the best thing to do. It helps you catch up with how you are feeling and gives you the opportunity to see if there are things that you need to do for yourself that you've been too busy to notice. Slowing down allows your nervous system to take a break. Feeling that constant underlying stress and anxiety is not sustainable long term but you probably already know that.  I know it's difficult to do things for yourself. Even thinking about taking some time for your own self-care can be uncomfortable. Next week I am going to share two more ways you can bring self-care into your day and why your self-care is important for the person you care for.  For now, take a moment to think through how this isn't about you being selfish. Caring for yourself is about keeping you healthy, mentally and physically. It doesn't require you to buy or go anywhere if you don't want to. You just have to find the thing that will work for you and that you will do every day. Try just stopping. Maybe after listening to this you turn it off and sit in silence for a moment or maybe you go for a walk or stand outside for a bit.  Experience these two things and see if it is possible for you to do and if it is something you'd actually do. Then next week there will be a new set of two things to try.  If you want any feedback or have questions feel free to send me an email or ask in the FB group. These links are in the show notes at www.loveyourcaregivinglife.com

Eating leafy greens could help prevent macular degeneration Westmead Institute for Medical Research (Australia), October 13, 2021    A new study has shown that eating vegetable nitrates, found mainly in green leafy vegetables and beetroot, could help reduce your risk of developing early-stage age-related macular degeneration (AMD). Researchers at the Westmead Institute for Medical Research interviewed more than 2,000 Australian adults aged over 49 and followed them over a 15-year period. The research showed that people who ate between 100 to 142 mgs of vegetable nitrates each day had a 35% lower risk of developing early AMD than people who ate less than 69mgs of vegetable nitrates each day. Lead Researcher Associate Professor Bamini Gopinath from the Westmead Institute and the University of Sydney said the link between vegetable nitrates and macular degeneration could have important implications. "This is the first time the effects of dietary nitrates on macular degeneration risk has been measured. "Essentially we found that people who ate 100 to 142 mgs of vegetable nitrates every day had a reduced risk of developing early signs of macular degeneration compared with people who ate fewer nitrates. "If our findings are confirmed, incorporating a range of foods rich in dietary nitrates - like green leafy vegetables and beetroot - could be a simple strategy to reduce the risk of early macular degeneration," Associate Professor Gopinath said. Spinach has approximately 20mg of nitrate per 100g, while beetroot has nearly 15mg of nitrate per 100g. The research did not show any additional benefits for people who exceeded 142mgs of dietary nitrate each day. It also did not show any significant connections between vegetable nitrates and late stage AMD, or between non-vegetable nitrates and AMD risk. One in seven Australians over 50 have some signs of macular degeneration. Age is the strongest known risk factor and the disease is more likely to occur after the age of 50. There is currently no cure for the disease. The research compiled data from the Blue Mountains Eye Study, a benchmark population-based study that started in 1992. It is one of the world's largest epidemiology studies, measuring diet and lifestyle factors against health outcomes and a range of chronic diseases. "Our research aims to understand why eye diseases occur, as well as the genetic and environmental conditions that may threaten vision," Associate Professor Gopinath concluded.     Research review shows intermittent fasting works for weight loss, health changes University of Illinois Chicago, October 13, 2021 Intermittent fasting can produce clinically significant weight loss as well as improve metabolic health in individuals with obesity, according to a new study review led by University of Illinois Chicago researchers. "We noted that intermittent fasting is not better than regular dieting; both produce the same amount of weight loss and similar changes in blood pressure, cholesterol and inflammation," said Krista Varady, professor of nutrition at the UIC College of Applied Health Sciences and author of "Cardiometabolic Benefits of Intermittent Fasting."  According to the analysis published in the Annual Review of Nutrition, all forms of fasting reviewed produced mild to moderate weight loss, 1 percent to 8 percent from baseline weight, which represents results that are similar to that of more traditional, calorie-restrictive diets. Intermittent fasting regimens may also benefit health by decreasing blood pressure and insulin resistance, and in some cases, cholesterol and triglyceride levels are also lowered. Other health benefits, such as improved appetite regulation and positive changes in the gut microbiome, have also been demonstrated.  The review looked at over 25 research studies involving three types of intermittent fasting:  Alternate day fasting, which typically involves a feast day alternated with a fast day where 500 calories are consumed in one meal.  5:2 diet, a modified version of alternate day fasting that involves five feast days and two fast days per week.  Time-restricted eating, which confines eating to a specified number of hours per day, usually four to 10 hours, with no calorie restrictions during the eating period.  Various studies of time-restricted eating show participants with obesity losing an average of 3 percent of their body weight, regardless of the time of the eating window.  Studies showed alternate day fasting resulted in weight loss of 3 percent to 8 percent of body weight over three to eight weeks, with results peaking at 12 weeks. Individuals on alternate day fasting typically do not overeat or binge on feast days, which results in mild to moderate weight loss, according to the review.  Studies for the 5:2 diet showed similar results to alternate day fasting, which surprised the study's reviewers. The subjects who participate in the 5:2 diet fast much less frequently than alternate-day fasting participants do, but the weight loss results are similar.  Weight loss with alternate day and 5:2 fasting are comparable to more traditional daily calorie-restrictive diets. And, both fasting diets showed individuals were able to maintain an average of 7 percent weight loss for a year.  "You're fooling your body into eating a little bit less and that's why people are losing weight," Varady said.  Varady added the review set out to debunk some myths regarding intermittent fasting. Intermittent fasting does not negatively affect metabolism, nor does it cause disordered eating, according to the studies reviewed.  "Fasting people are worried about feeling lethargic and not being able to concentrate. Even though you are not eating, it won't affect your energy," Varady said. "A lot of people experience a boost of energy on fasting days. Don't worry, you won't feel crappy. You may even feel better."  The study review includes a summary of practical considerations for those who may want to try intermittent fasting. Among the considerations are:  Adjustment time—Side effects such as headaches, dizziness and constipation subside after one to two weeks of fasting. Increased water intake can help alleviate headaches caused by dehydration during this time.  Exercise—Moderate to high-intensity endurance or resistance training during food abstention can be done, and some study participants reported having more energy on fast days. However, studies recommend those following alternate day fasting eat their fasting day meal after exercise.  Diet during fasting—There are no specific recommendations for food consumption during intermittent fasting, but eating fruits, vegetables and whole grains can help boost fiber intake and help relieve constipation that sometimes accompanies fasting.  Alcohol and caffeine—For those using an alternate day or 5:2 fasting plan, alcohol is not recommended on fast days as the limited calories should be used on healthy foods that provide nutrition.  There are several groups who should not intermittent fast, according to the studies. Those individuals include:  Those who are pregnant or lactating.  Children under 12.  Those with a history of disordered eating.  Those with a body mass index, or BMI, less than 18.5. Shift workers. Studies have shown they may struggle with fasting regimens because of shifting work schedules.  Those who need to take medication with food at regimented times.  "People love intermittent fasting because it's easy. People need to find diets that they can stick to long term. It's definitely effective for weight loss and it's gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto," Varady said.  Varady has recently been awarded a National Institutes of Health grant to study time-restricted eating for 12 months to see if it works long term.   Antioxidants to prevent Alzheimer's disease A balanced intake of antioxidants could prevent the development of Alzheimer's disease. Institut National de la Recherche Scientifique (France), October 13, 2021 Research conducted by the Ph.D student Mohamed Raâfet Ben Khedher and the postdoctoral researcher Mohamed Haddad of the Institut national de la recherche scientifique (INRS) has shown that an oxidation-antioxidant imbalance in the blood is an early indicator of Alzheimer's disease, rather than a consequence. This breakthrough made by researchers under the supervision of the Professor Charles Ramassamy provides an avenue for preventive intervention: the antioxidants intake.  The research team showed that oxidative markers, known to be involved in Alzheimer's disease, show an increase up to five years before the onset of the disease. The results of this study, published in the Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring (DADM) journal, suggest that oxidation may be an early marker of this disease that affects more than 500,000 Canadians. “Given that there is an increase in oxidative stress in people who develop the disease, we may regulate the antioxidant systems. For example, we could modulate the antioxidant systems, such as apolipoproteins J and D, which transport lipids and cholesterol in the blood and play an important role in brain function and Alzheimer's disease. Another avenue would be to increase the intake of antioxidants through nutrition”, says Professor Ramassamy.  Accessible biomarkers Unlike the current set of invasive and expensive tests used to diagnose Alzheimer's disease, the oxidative markers discovered by Professor Ramassamy's research team can be detected by a blood test. These markers are found in plasma extracellular vesicles, which are pockets released by all cells in the body, including those in the brain.     The research team focused specifically on the "sporadic" Alzheimer's disease, the most common form of the disease which results primarily from the presence of the APOE4 susceptibility gene. This same form of the disease had been studied by the team for other early markers. “By identifying oxidative markers in the blood of individuals at risk five years before the onset of the disease, we could make recommendations to slow the onset of the disease and limit the risks”, scientists noted. This breakthrough brings new hope to Alzheimer's research. Once the disease is symptomatic, it is difficult, if not impossible, to reverse it.         Meditation training reduces long-term stress, according to hair analysis Max Planck Institute for Human Cognitive and Brain Sciences (Germany), October 11, 2021 Mental training that promotes skills such as mindfulness, gratitude or compassion reduces the concentration of the stress hormone cortisol in hair. This is what scientists from the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig and the Social Neuroscience Research Group of the Max Planck Society in Berlin have found out. The amount of cortisol in hair provides information about how much a person is burdened by persistent stress. Earlier positive training effects had been shown in acutely stressful situations or on individual days—or were based on study participants' self-reports. According to a study by the Techniker Krankenkasse, 23 percent of people in Germany frequently suffer from stress. This condition not only puts a strain on the well-being of those affected, but it is also linked to a number of physiological diseases, including diabetes, cardiovascular diseases and psychological disorders such as depression, one of the world's leading causes of disease burden (Global Burden of Disease Study, 2017). Therefore, effective methods are being sought to reduce everyday stress in the long term. One promising option is mindfulness training, in which participants train their cognitive and social skills, including attention, gratitude and compassion, through various meditation and behavioral exercises. Various studies have already shown that even healthy people feel less stressed after a typical eight-week training program. Until now, however, it has been unclear how much the training actually contributes to reducing the constant burden of everyday stress. The problem with many previous studies on chronic stress is that the study participants were usually asked to self-assess their stress levels after the training. However, this self-reporting by means of questionnaires could have distorted the effects and made the results appear more positive than they actually were. The reason for such a bias: The participants knew they were training their mindfulness, and a reduction in stress levels was a desired effect of this training. This awareness alone has an impact on subsequent information. "If you are asked whether you are stressed after a training session that is declared as stress-reducing, even addressing this question can distort the statements," explains Lara Puhlmann, doctoral student at the Max Planck Institute for Human Cognitive and Brain Sciences and first author of the underlying publication, which has now appeared in the journal Psychosomatic Medicine. Factors such as social desirability and placebo effects played a role here. Unlike pharmacological studies, for example, in which the study participants do not know whether they have actually received the active substance or not, so-called blinded studies are not possible in mental training. "The participants know that they are ingesting the 'antidote,'" says Puhlmann. "In mindfulness research, we are therefore increasingly using more objective, i.e. physiological, methods to measure the stress-reducing effect more precisely." The concentration of cortisol in hair is considered a suitable measure of exposure to prolonged stress. Cortisol is a hormone that is released when we are confronted with an overwhelming challenge, for example. In that particular situation, it helps put our body on alert and mobilize energy to overcome the challenge. The longer the stress lasts, the longer an increased concentration of cortisol circulates around our body—and the more it accumulates in our hair. On average, hair grows one centimeter per month. To measure the study participants' stress levels during the 9-month training, the researchers, in cooperation with the working group of Clemens Kirschbaum at the University of Dresden, analyzed the amount of cortisol every three months in the first three centimeters of hair, starting at the scalp. The mental training itself was developed as part of a large-scale longitudinal study on the effects of mental training, the ReSource project, led by Tania Singer, scientific director of the Social Neuroscience Research Group. This 9-month mental training program consisted of three 3-month sessions, each designed to train a specific skill area using Western and Far Eastern mental exercises. The focus was either on the factors of attention and mindfulness, on socio-affective skills such as compassion and gratitude, or on so-called socio-cognitive skills, in particular the ability to take perspective on one's own and others' thoughts. Three groups of about 80 participants each completed the training modules in different order. The training lasted up to nine months, 30 minutes a day, six days a week. Less stress, less cortisol And it really showed: After six months of training, the amount of cortisol in the subjects' hair had decreased significantly, on average by 25 percent. In the first three months, slight effects were seen at first, which increased over the following three months. In the last third, the concentration remained at a low level. The researchers therefore assume that only sufficiently long training leads to the desired stress-reducing effects. The effect did not seem to depend on the content of the training. It is therefore possible that several of the mental approaches studied are similarly effective in improving the way people deal with chronic everyday stress. In an earlier study from the ReSource project with the same sample, the researchers had investigated the effects of training on dealing with acute stressful situations. In this study, the participants were placed in a stressful job interview and had to solve difficult maths problems under observation. The results showed that people who had undergone socio-cognitive or socio-affective training released up to 51 percent less cortisol under stress than those who had not been trained. In this case, they did not measure the amount of cortisol in the subjects' hair, but instead acute cortisolsurges in their saliva. Overall, the researchers conclude that training can improve the handling of acute particularly stressful social situations as well as chronic everyday stress. "We assume that different training aspects are particularly helpful for these different forms of stress," says Veronika Engert, head of the research group "Social Stress and Family Health" at the Max Planck Institute for Human Cognitive and Brain Sciences. "There are many diseases worldwide, including depression, that are directly or indirectly related to long-term stress," explains Puhlmann. "We need to work on counteracting the effects of chronic stress in a preventive way. Our study uses physiological measurements to prove that meditation-based training interventions can alleviate general stress levels even in healthy individuals."   Study: Moderate carbohydrate intake is a cardiovascular benefit for women Monash University (Australia), October 13, 2021 Women's heart health has been the focus of a recent study by Monash University, with researchers finding that proportional carbohydrate intake and not saturated fat was significantly associated with cardiovascular disease benefit in Australian women. Cardiovascular disease (CVD) is the leading cause of death in women. Poor diet is recognized as both an independent CVD risk factor and a contributor to other CVD risk factors, such as obesity, diabetes mellitus (DM), hypertension, and dyslipidaemia. The research found that in middle-aged Australian women, increasing the percentage of carbohydrate intake was significantly associated with reduced odds of CVD, hypertension, diabetes mellitus, and obesity. Furthermore, a moderate carbohydrate intake between 41.0 percent—44.3 percent of total energy intake was associated with the lowest risk of CVD compared to women who consumed less than 37 percent energy as carbohydrates. No significant relationship was demonstrated between proportional carbohydrate intake and all-cause mortality. In addition, increasing proportional saturated fat intake was not associated with cardiovascular disease or mortality in women; rather, increasing saturated fat intakecorrelated with lower odds of developing diabetes mellitus, hypertension, and obesity. The findings are now published in the British Medical Journal. The results contradict much of the historical epidemiological research that supported a link between saturated fat and CVD. Instead, the results mirror contemporary meta-analysis of prospective cohort studies where saturated fat was found to have no significant relationship with total mortality or CVD. While the cause of this inconsistency in the literature is unclear, it has been suggested that historical studies neglected to adjust for fiber, which is known to help prevent plaque from forming in the arteries. "Controversy still exists surrounding the best diet to prevent CVD," said Sarah Zaman, a former Monash University professor who is now an associate professor at the University of Sydney. "A low-fat diet has historically been the mainstay of primary prevention guidelines, but the major issue within our dietary guidelines is that many dietary trials have predominately involved male participants or lacked sex-specific analyses." She adds: "Further research is needed to tailor our dietary guidelines according to sex." The study's first author Sarah Gribbin, a Doctor of Medicine and BMedSc (Hons) student, says: "As an observational study, our findings only show association and not causation. Our research is purely hypothesis-generating. We are hoping that our findings will spark future research into sex-specific dietary research." The Heart Foundation, which is one of the study's funders, welcomed the focus on women and CVD, which has historically been under-researched. Heart Foundation manager, food and nutrition, Eithne Cahill, cautioned that "not all carbohydrates are created equal." "We know that quality carbohydrate foods such as vegetables and whole grains—including whole grain bread, cereals, and pasta—are beneficial for heart health, whereas poor quality carbohydrates such as white bread, biscuits, cakes, and pastries can increase risk," she said. "Similarly, different fats have different effects on heart health. That is why the Heart Foundation focuses on healthy eating patterns—that is, a combination of foods, chosen regularly over time—rather than a single nutrient or food. Include plenty of vegetables, fruit, and whole grains, and heart-healthy fat choices such as nuts, seeds, avocados, olives and their oils for cooking and a variety of healthy proteins especially seafood, beans and lentils, eggs and dairy."   Anti-cancer effects found in natural compound derived from onions   Kumamoto University (Japan), October 18, 2021   Research from Kumamoto University, Japan has found that a natural compound isolated from onions, onionin A (ONA), has several anti-ovarian cancer properties. This discovery is a result of research on the effects of ONA on a preclinical model of epithelial ovarian cancer (EOC) both in vivo and in vitro. This research comes from the same group that found ONA suppressed pro-tumor activation of host myeloid cells.   According to a 2014 review of cancer medicines from the World Health Organization, EOC is the most common type of ovarian cancer and has a 5-year survival rate of approximately 40%. It has a relatively low lifetime risk that is less than 1%, but that can increase up to 40% if there is a family history of the disease. A majority of patients (80%) experience a relapse after their initial treatment with chemotherapy, therefore a more effective line of treatment is needed.   Kumamoto University researchers found that ONA has several effects on EOC. The group's in vitro experiments showed that EOCs, which usually proliferate in the presence of pro-tumor M2 macrophages, showed inhibited growth after introduction of ONA. This was thought to be due to ONAs influence on STAT3, a transcription factor known to be involved in both M2 polarization and cancer cell proliferation. Furthermore, the team found that ONA inhibited the pro-tumor functions of myeloid derived suppressor cells (MDSC), which are closely associated with the suppression of the anti-tumor immune response of host lymphocytes, by using preclinical sarcoma model. ONA was also found to enhance the effects of anti-cancer drugs by strengthening their anti-proliferation capabilities. Moreover, experiments on an ovarian cancer murine model that investigated the effects of orally administered ONA resulted in longer lifespans and inhibited ovarian cancer tumor development. This was considered to be a result of ONA's suppression of M2 polarized macrophages.   The research shows that ONA reduces the progression of malignant ovarian cancer tumors by interfering with the pro-tumor function of myeloid cells. ONA appears to activate anti-tumor immune responses by nullifying the immunosuppressive function of myeloid cells. ONA has the potential to enhance existing anti-cancer drugs while also having little to no cytotoxic effects on normal cells. Additionally, side effects in animals have not been seen. With a little more testing, an oral ONA supplement should greatly benefit cancer patients.     Risk of chronic diseases caused by exogenous chemical residues Dalian Institute of Chemical Physics (China), October 13, 2021 Chronic diseases are main killers affecting the health of human. The morbidities of major chronic diseases such as obesity, hypertension, diabetes, hyperuricemia and dyslipidemia are as high as 10% to 30%, showing a gradually upward trend as well. More and more studies have shown that environmental pollution is a major health risk factor that cannot be ignored. However, the evidence for their relationship is equivocal and the underlying mechanisms is unclear. Recently, a research group led by Prof. Xu Guowang from the Dalian Institute of Chemical Physics (DICP) of the Chinese Academy of Sciences (CAS) discovered the risk of chronic diseases caused by exogenous chemical residues through metabolome-wide association study. Their findings were published in Environment International on Oct. 8. Researchers from National Institute for Nutrition and Health of the Chinese Center for Disease Control and Prevention, and Tongji Medical College of Huazhong University of Science and Technology were also involved in this study. The researchers discovered positive associations of serum perfluoroalkyl substances (PFASs) with hyperuricemia, and revealed the mechanism of the relationship between the exogenous chemical residues in the serum and the risk of chronic diseases at the metabolic level. The researchers investigated the relationship between 106 exogenous chemical residues and five chronic diseases in 496 serum samples. They revealed the metabolic perturbations related to exogenous chemical residues and chronic diseases by the metabolome-wide association study combined with meeting-in-the-middle approach and mediation analysis, and investigated the further potential underlying mechanism at the metabolic level. "PFASs were the risk factor for hyperuricemia," said Prof. Xu. Lipid species including glycerophospholipids and glycerides presented the strongest correlation with exposure and disease, which were not only positively related to PFASs exposure but also the risk factor for hyperuricemia. "We also found that key mediation metabolites mediated 25% to 68% of the exposure-disease risk relationship," Prof. Xu added. This study provides in-depth etiological understanding for the occurrence and development of diseases, which may be helpful for the early detection of the disease and the identification of early warning markers.

Part 1 of 2. Lauren, the Reading Bug and the Spelling Bee are headed for an epic adventure inside the human body! Join them to explore all the interconnected systems that help our bodies to thrive. But how are we going to get inside? Guess you'll need to join us to find out!  Explore the books in the Reading Bug's book bag at www.thereadingbug.com/adventures/innerspace

Cardiovascular pharmacology is an area that the NBMEs have a strong focus on across all USMLE exams. Most people find this topic too nebulous to study (wrt Step 2CK/3) as it integrates with so many disciplines. If this is your problem, you have come to the right place. The goal of this podcast series is … Continue reading Divine Intervention Episode 346 – Cardiovascular Pharmacology for The USMLE Step 2CK/3 Exams Part 1 (+ 11/1-5 Step 2CK/3 Course Reminder)

With Carlo Gabriele Tocchetti & Alessandra Cuomo, Federico II University, Naples - Italy Link to paper Link to editorial

This week we delve into the world of cardiovascular surgery to review a recent work on outcomes of arch reconstruction in the newborn and small child. We speak with Dr. Ramana Dhannapuneni, lead cardiac surgeon of Alder Hey Children's Hospital in Liverpool, UK. How often in the present era is re-operation or reintervention required? How common is the recurrent laryngeal nerve or phrenic nerve injured or affected by surgery? Dr. Dhannapuneni provides us with the surgical perspective to this complex surgery this week. doi: 10.1017/S1047951121003747

Michael Markl, PhD, vice chair for research in the Department of Radiology and the Lester B. and Frances T. Knight Professor of Cardiac Imaging at Northwestern Medicine, discusses his research published in JACC Cardiovascular Imaging regarding the association of regional wall shear stress and progressive ascending aorta dilation in bicuspid aortic valve patients.

There's so many risk factors of COVID that are within your ability to control and improve:    Zinc deficiency 2x  Morbidly obese 3x  Metabolic syndrome 3.5x Type 2 diabetes 4.4x High blood pressure 4.5x Selenium deficiency 5x Cardiovascular disease 6x Older than 60 9.45x Severe vitamin D deficiency 15x    So, fix these and you'll have nothing to fear as you go back to living a normal life!  

Cardio. Love it or hate it, most moms feel compelled and obligated to make sure to do some form of cardio with their workouts. Maybe cardio is your main form of exercise, like running or the elliptical. Or perhaps it feels like it's the easiest thing to do or the thing that's going to make the most impact if you want to lose weight and get in better shape.    But what's the truth about cardio? Is it that important? Is it the best thing for fat loss? And if you should do cardio, or WANT to do it, what are the best ways to fit it into your routine?    At the end of the day, I want to make sure that when you're motivated and have the time to workout that you're doing the right things and seeing the best results. And traditional cardio may or may not be part of that picture.  MORE RESOURCES:  Jumpstart 30 – [Registration opens October 21st!!] 30 days of accountability and guidance to help you finally gain consistency!  The FREE Body Type Quiz

Elizabeth M. McNally, MD, PhD, cardiologist at Northwestern Medicine and the Elizabeth J. Ward Professor and Director of the Center for Genetic Medicine at Northwestern University, discusses the important role that genetic testing plays in cardiovascular care. Dr. McNally shares who can benefit from genetic testing, and what makes the genetic testing process at Northwestern Medicine Bluhm Cardiovascular Institute so unique.

Please join author Milton Packer and Associate Editor Justin Ezekowitz as they discuss the Perspective "Heart Failure and a Preserved Ejection Fraction: A Side-by-Side Examination of the PARAGON-HF and EMPEROR-Preserved Trials." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the Journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, it really is so great to be back with you chatting about the papers here in the Journal. Thank you for going solo and for just being the greatest partner on earth. Thank you for that. For everyone listening in, we are back with some gusto and especially with this feature discussion today. You are not going to want to miss it. We are talking to Dr. Milton Packer as well as Dr. Justin Ezekowitz. We are going to compare PARAGON and EMPEROR-Preserved trials in heart failure with preserved ejection fraction. A really interesting discussion you're not going to want to miss, but now let's start with some papers in today's issue. I'd like to start, please. Dr. Greg Hundley: You bet. Dr. Carolyn Lam: Greg, you know the optimal duration of antiplatelet therapy in patients with high bleeding risk with or without oral anticoagulation after coronary stenting? Well, that still remains a question. Today's paper is a pre-specified subgroup analysis of the MASTER DAPT trial and reports on the outcomes of patients with or without an oral anticoagulation indication in this study. Dr. Greg Hundley: Right, Carolyn. Remind us. What was the MASTER DAPT trial? What did it test? Dr. Carolyn Lam: Ah. MASTER DAPT investigated an abbreviated or one-month versus a non-abbreviated or three to 12-month dual antiplatelet therapy and a stopping of antiplatelet therapy at six months strategy after coronary stenting in an all-comer population at high bleeding risk. Dr. Greg Hundley: Carolyn, what did this subgroup analysis of outcomes in patients with and without oral anticoagulation show? Dr. Carolyn Lam: At 12 months of follow-up, ischemic and net risk did not differ with abbreviated versus non-abbreviated anti-platelet regimens in both subgroups, although significantly fewer clinically relevant bleeding events occurred in the group without an oral anticoagulation indication. Whereas only numerically fewer bleeding events occurred in the group with an oral anticoagulation indication that did not reach statistical significance. This subgroup analysis from the MASTER DAPT trial really adds additional evidence that dual antiplatelet therapy beyond one month in patients with or without an indication for oral anticoagulation really has no benefit and only increases bleeding risk. Dr. Greg Hundley: Oh, very important finding, Carolyn. Great research. Well, Carolyn, how the extracellular matrix microenvironment modulates the contractile phenotype of vascular smooth muscle cells and confers vascular homeostasis really remains elusive. Thus, these investigators led by Professor Wei Kong at Peking University applied protein-protein interaction network analysis to explore novel extracellular matrix proteins associated with the vascular smooth muscle cell phenotype. Dr. Carolyn Lam: Huh. Interesting. What did they find, Greg? Dr. Greg Hundley: Right, Carolyn. By combining an in-vitro and an in-vivo genetic mice vascular injury model, they identified nidogen-2, a basement membrane glycoprotein, as a key extracellular matrix protein for maintenance of vascular smooth muscle cell identity. Nidogen-2 exerted its protective function via direct interaction and modulation of Jagged1-Notch3 signaling. Dr. Carolyn Lam: Wow! Nidogen-2 and Jagged1-Notch3. I always learn so much. What are the clinical implications, Greg? Dr. Greg Hundley: Right, Carolyn. Perhaps targeting nidogen-2 to precisely modulate Jagged1-Notch3 signaling, well, that may provide novel therapeutic strategy for atherosclerosis and post-injury restenosis. Dr. Carolyn Lam: Very nice. Well, in the next paper, we discuss inflammation in heart failure. We know that inflammation contributes to the pathogenesis of heart failure, but there is limited understanding of inflammation's potential benefits. Interesting, huh? Well, these authors, Dr. Wollert and colleagues from Hannover Medical School in Germany, identified an adaptive crosstalk between inflammatory cells and cardiomyocytes that protects against persistent afterload stress-induced heart failure in mice. Monocytes and macrophages produced myeloid-derived growth factor in the pressure overloaded myocardium to augment SERCA2a expression in cardiomyocyte's calcium cycling and contractility. Myeloid-derived growth factor plasma concentrations were also found to be elevated in patients with aortic stenosis and to decline after aortic valve implantation indicating that pressure overload also triggers myeloid-derived growth factor release in humans. Dr. Greg Hundley: Carolyn, really informative preclinical science, but what are the clinical implications? Dr. Carolyn Lam: Ah. These observations molecularly defined a feature of the inflammatory response to hemodynamic overload that protects against heart failure development. Inflammation's beneficial trade therefore need to be considered when developing inflammation as a therapeutic target in heart failure. All of this is really discussed in a lovely editorial entitled Inflammation and Heart Failure: Friend or Foe? That's by Drs. Hajjar and Leopold. Dr. Greg Hundley: Great job, Carolyn. Well, my next paper focuses on resistant hypertension. Carolyn, although lifestyle modifications generally are effective in lowering blood pressure among patients with unmedicated hypertension or those treated with one to two antihypertensive agents, the value of exercise and diet for lowering blood pressure in patients with resistant hypertension is unknown. To address this, Professor James Blumenthal and co-authors at Duke University Medical Center enrolled 140 patients with resistant hypertension with an average age of 63 years, 48% women, 59% black, 31% diabetes, and 21% with chronic kidney disease and randomly assigned them to A, a four-month cardiac rehab center-based program of lifestyle modification. We're going to call that C-LIFE, consisting of dietary counseling, behavior and weight management, and exercise. Or number 2 or the B, a single counseling session providing standardized education and physician advice. We'll call that SEPA. Dr. Greg Hundley: The primary endpoint was clinic measured systolic blood pressure. Secondary endpoints included 24-hour ambulatory blood pressure and selective cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of baroreflex on heart rate; high-frequency heart rate variability to assess vagally-mediated modulation of heart rate; flow-mediated dilation to evaluate endothelial function; and pulse wave velocity to assess arterial stiffness; and then finally left ventricular mass to characterize left ventricular structure and remodeling. Dr. Carolyn Lam: Wow! That is a very, first of all, important clinical question. Then also, just very intricate methodology in assessing this. What did they find? Dr. Greg Hundley: Right, Carolyn. Between-group comparisons revealed that the reduction in clinic systolic blood pressure was greater in C-LIFE compared with SEPA. Next, 24-hour ambulatory systolic blood pressure also was reduced in C-LIFE with no change in SEPA. Then next, compared with SEPA, C-LIFE resulted in greater improvements in baroreflex sensitivity, high-frequency heart rate variability, and flow-mediated dilation. There was no between-group differences in pulse wave velocity or LV mass. Dr. Greg Hundley: Carolyn, diet and exercise can lower blood pressure in patients with resistant hypertension. When delivered in a cardiac rehabilitation setting, a four-month program of diet and exercise as adjunctive therapy, results in a significant reduction in clinic and ambulatory blood pressure, and improvement in selected cardiovascular disease biomarkers. Dr. Carolyn Lam: Wow! Really nice, Greg. Okay. Well, looks like we're all going to round up already with what else there is in today's issue. Let me start. There's an exchange of letters between Drs. Fang and Vinceti regarding the article Blood Pressure Effects on Sodium Reduction: Dose-Response Meta-analysis of Experimental Studies. Dr. Greg Hundley: Right, Carolyn. I've got a few things in the mail bag. First, Professor Anker has a Research Letter regarding the Kidney Function After Initiation and Discontinuation of Empagliflozin in Heart Failure Patients With and Without Type 2 Diabetes: Insights From the EMPERIAL Trials. Dr. Gerstenfeld has an ECG challenge entitled Atrioventricular Block with Narrow and Wide QRS: The Pause That Refreshes. Then lastly, Dr. Donald Lloyd-Jones has an AHA update regarding the American Heart Association's focus on primordial prevention. Well, Carolyn, I can't wait to hear this fantastic feature discussion with you and Dr. Packer. How about we jump to that? Dr. Carolyn Lam: Great. Let's go, Greg. Dr. Carolyn Lam: Because side-by-side exam of PARAGON and EMPEROR is like side-by-side of... Dr. Justin Ezekowitz: You can compare our new and our old prime minister much like your paper did. Dr. Milton Packer: Yeah, yeah. Dr. Justin Ezekowitz: There are [crosstalk] and it could be viewed until they perform in the broader world how it goes. You don't quite know. Dr. Milton Packer: The only problem is you can't do a head-to-head comparison of the old prime minister and the new prime minister. Dr. Justin Ezekowitz: That is true except that the head-to-head comparison includes excellent care by both the new and the old. I think that comparison's going to be pretty equal. I think we can case-control that one. Dr. Carolyn Lam: I really liked that that was politically correct because we are recording. Everybody, welcome to the feature discussion. I am here with Dr. Milton Packer from Baylor and he really needs no introduction. We're discussing heart failure with preserved ejection fraction. As well as our associate editor, Dr. Justin Ezekowitz from University of Alberta. Hence, in case anybody's wondering, we were talking about the Canadian elections. Let's just launch straight into it, a side-by-side comparison of PARAGON and EMPEROR-Preserved. Dr. Packer... Milton, if I may, what in the world drove you to do this? Dr. Milton Packer: My God. Oh, my God. Yes. Dr. Carolyn Lam: Tell us about what drove you to do this and please, if you could just summarize the results. Dr. Milton Packer: Well, let me just say from the outset that this was a commentary, not an original research article. Dr. Carolyn Lam: Yes. Dr. Milton Packer: The commentary was motivated by two very straightforward observations. We had two large scale outcome trials of two different drugs in heart failure with a preserved ejection fraction. I was privileged to serve as you were, Carolyn, on the leadership committees of both trials. It's not as if we have involvement in only one trial. We have involvement in both trials and we are very proud of that involvement. Dr. Milton Packer: One trial came in with a effect size of about 13% on its primary endpoint with a borderline P-value. A second trial, EMPEROR-Preserved, came in with a 21% reduction and its primary endpoint with a really small and persuasive P-value. The two patient populations in the two trials were really amazingly similar. We wanted to understand why it was 21% in one trial and persuasively so and why it appeared to be smaller in the PARAGON trial with sacubitril/valsartan. We thought, well, maybe that difference was related to how endpoints were defined or maybe that difference was related to the influence of ejection fraction. The reason we got excited about that was that as almost everyone knows, PARAGON found an influence of ejection fraction on the effect of sacubitril/valsartan in patients with HFpEF. We found an influence of ejection fraction on the effect of empagliflozin in HFpEF in EMPEROR-Preserved. We wanted to understand whether that influence was similar in the two trials. Dr. Milton Packer: Just to make life simple, PARAGON had created certain cut points for ejection fraction. They had presented and previously published in Circulation endpoints based on those cut points of ejection fraction. All we did was we used their endpoints and their cut points, and we put the two trials side by side. We did not do a statistical comparison of the effect size. There're actually no P-values in the whole commentary. But what we wanted to see was: Was the shape of the ejection fraction influence relationship similar or different in the two trials? Well, very simple. In PARAGON, as has been reported, there was a linear relationship: as ejection fraction increased, the effect of sacubitril/valsartan got smaller. In EMPEROR-Preserved, there was also an attenuation at a highest ejection fraction, but the relationship wasn't linear. It was like a hockey stick. It was flat and then went up at an ejection fraction over 62.5, which was the cut point that PARAGON used. Dr. Milton Packer: When we compared patients between the low 40s and the low 60s, the effect size in empagliflozin appeared to be larger than the effect size of sacubitril/valsartan in that ejection fraction group using the same endpoints. In fact, for hospitalizations for heart failure, which is really what SGLT2 inhibitors do, it was twice as great with empagliflozin in EMPEROR-Preserved than with sacubitril/valsartan in PARAGON-HF. We thought this was really interesting. We put the pictures up side by side. We wrote a commentary and Circulation was so kind to accept it. Dr. Carolyn Lam: Oh, but Milton, you were very, honestly as always, very clever to have done this analysis. But if I could reiterate a few things for the audience, which is very important. First of all, as you rightly first pointed out, it's a perspective piece. It is not a head-on comparison with P-values. It could not be. Let's just also give the audience a bit of background in that PARAGON included patients with an ejection fraction of 45% and above. EMPEROR-Preserved was above 40. PARAGON looked at total heart failure hospitalizations and cardiovascular death as a primary outcome. EMPEROR looked at first cardiovascular death or heart failure hospitalization. Dr. Carolyn Lam: Let's just remember the designs were different. Of course in the comparison, PARAGON compared sacubitril/valsartan versus valsartan. I like the way you very carefully wrote in your study that it was more a study of neprilysin inhibition since it's sacubitril/valsartan against valsartan and it was empagliflozin versus placebo. We know that it's important to state that as a basis. Then really important to say to everybody out there, pick up our journal. You must look at this bigger. I myself have already cited it at least twice already, Milton, because people will just naturally ask that. "Are the results different because of ejection fraction or different endpoints?" What you did there in that beautiful figure is that you tried as best as you can to match it up in terms of ejection fraction bins and match it up in terms of hospitalizations. There. I just wanted to state those few things, but I'm really- Dr. Milton Packer: Oh, no. No. Carolyn, you're 100% right. That's why there are couple of things. I just want to underscore what you said because I think your points were spot on. First of all, we really lined up the endpoints and the ejection fraction. We tried our best to compare apples and apples. It would not have been a useful exercise for us to compare different endpoints and different ejection fraction subgroups. But I just want to make sure that everyone understands: I'm a big fan of sacubitril/valsartan and I'm a big fan of neprilysin inhibition. As you know, both PARADIGM-HF and PARAGON-HF weren't really tests of sacubitril/valsartan; they were tests of neprilysin inhibition. They were great tests at that. PARAGON in particular was a great test of that. We're comparing neprilysin inhibition and SGLT2 inhibition. Dr. Milton Packer: But here's my most important point: we do not want people to choose one over the other. That was not the intent. We think that there are data in patients with certain ejection fractions, let's say between 40 and 60, I'm just creating a range, where both interventions are appropriate. Now I understand there are cost considerations and I don't want to minimize that, but we are not suggesting that anyone prefer one drug over the other. All we wanted to do was we wanted to ask the question: Since the effect size in one trial seemed to be different than the effect size in the other trial, what were the ejection fraction subgroups that represented that difference? We found that the patients with ejection fractions greater than 60, 65% did not contribute to that difference. It was the patients with lower ejection fractions that contributed to the difference. I hope that's helpful. Dr. Carolyn Lam: Ah. That's wonderful. Justin, have you recovered from the talk about the Canadian elections? Dr. Justin Ezekowitz: Oh. I have indeed. Dr. Carolyn Lam: I'm on swinging. Dr. Justin Ezekowitz: I have indeed. Thanks for recognizing that Canada just had a major election we carried out in six weeks. But, Milton, I really enjoyed reading this. Maybe I can just ask you about two elements within this perspective piece, which is number 1, what's incredibly concordant is a lack of difference across cardiovascular death for both agents in both trials regardless of the trial differences and the potential differences in patient populations recruited; that's number 1. It's incredibly flat for cardiovascular death. Dr. Justin Ezekowitz: But number 2 is there is a danger in comparing trials even non-statistically. That's often a pitfall we get into, but we have to put some frame of reference on that. What is the one or two key things you think differ between PARAGON and EMPEROR-Preserved that you say, "You really need to look at these trials differently"? Those two questions came to mind when looking at this great figure that you produced. Dr. Milton Packer: Okay. The first question is so much easier and that is that these drugs don't reduce cardiovascular deaths. Full stop. It's really interesting because sacubitril/valsartan reduces cardiovascular death in people with ejection fractions of 40% or less, but not in patients with ejection fraction greater than that. The primary effect is heart failure hospitalizations. Empagliflozin didn't reduce cardiovascular death even in patients with the ejection fraction less than 40% or greater than 40%. What we're really, really talking about two drugs where the major effect is a reduction in heart failure hospitalizations. That comes out whether you do the analysis as time-to-first-event or total heart failure hospitalizations. Dr. Milton Packer: Of course, we're looking forward to the DELIVER trial with dapagliflozin. My own personal expectation is they're going to come out with a very striking effect on heart failure hospitalizations and not on cardiovascular deaths. Cardiovascular deaths in patients with HFpEF is really... It's a hard goal because only half of the deaths are cardiovascular. These patients have so many comorbidities that influence prognosis. The other thing, which is really important, is that heart failure hospitalizations only represented 18% of all hospitalizations in these patients; it's really small. I think of empagliflozin as being a treatment of the heart failure of HFpEF, not a treatment for HFpEF. I hope that makes sense. Justin, what was your second question? Dr. Justin Ezekowitz: Absolutely. Dr. Milton Packer: Oh, the differences between- Dr. Justin Ezekowitz: Yeah. Thank you, Milton. Dr. Milton Packer: Okay. There's always differences between two trials. As I said before, Carol and I were involved in both trials. They were done slightly at different times. They didn't overlap. Remember that the cut points in the two trials, one was 40%, one was 45%, really didn't matter to our analysis because we corrected for that in our ejection fraction subgroups. I was actually really much more impressed by the similarities than by the differences, but here's the catch. HFpEF is an incredibly heterogeneous disease. When we look at baseline characteristics, we're looking at means, medians, percentages. We're not picking up on any heterogeneity and there's a lot of heterogeneity. I actually think that HFrEF is a reasonably homogeneous disease. I think HFpEF is an incredibly diverse disease with a whole host of different disorders. What I'm amazed by is that we actually got an effect size that was greater than 20% in an all-comers HFpEF analysis. Dr. Milton Packer: But in all honesty, Justin, it wasn't really all-comers. We excluded people with BMIs over 45. There are a lot of patients who are obese and had BMIs greater than 45 who have HFpEF. By the way, especially in Texas. I didn't say that. We didn't enroll those patients. In all honesty, if I had to do it all over again, I would have. By the way, PARAGON didn't enroll them either. Dr. Carolyn Lam: Well, this is an incredible conversation. I know that we could just do a whole hour of chatting about what this implies for the higher ejection fraction, what this implies for how we should be treating heart failure. I don't even dare to ask for some last words maybe from both Justin and Milton, but recognizing that the time is short, anything else to add? Dr. Milton Packer: I think Justin should do last words. Dr. Justin Ezekowitz: Well, let me summarize by saying there is a hockey stick. We love hockey sticks in Canada. A simple and an excellent comparison. I think people should really look at that figure to understand it, but do not undertreat your patients with HFpEF and look at these with a grain of salt. Thanks for joining us, Milton. Thanks, Carolyn. Dr. Milton Packer: Thank you so much. Dr. Carolyn Lam: On behalf of Greg and I, you've been listening to Circulation on the Run. Thank you so much for joining us today and don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2021. 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, visit ahajournals.org.

In this episode I review a host of HY cardiovascular anatomy scenarios that are especially relevant to the USMLE Step 1 exam. Audio Download

With Dong Zhao & Jing Liu, Beijing Anzhen Hospital, Beijing - China Link to EHJ paper Link to EHJ editorial  

In the New Science of Physical Health, the goal is simple - how do we bring two groups together. Those people that are completely disengages with their personal physical health status, and those that are already in love with improving their personal physical health status? The first group is the overwhelming majority. It's up to the second group to help inspire all of those who have not yet lowered their risk of disease so they can feel amazing.Today's episode is all about why do the people who came to watch the world heavyweight boxing championship in Las Vegas today - watch two pro athletes at the peak of their physical activity capabilities - yet at least 75% of the people watching do not even go close to completing similar levels of physical activity? To access our brand new book and a special offer for to access the Ultimate workbook for creating physical health: click this link.https://go.expertroadmaps.com/entry-page1616622099848The first mini-series is called: THE THOMAS EDISON OF HEALTH TECHNOLOGY  IN THE 2020'S.  It will be ready very soon for those who self-select and want to deep dive into Life Inside Your Body. CLICK THE LINK BELOWhttps://forms.gle/tdqUPskRCEosZiXG7 (THIS IS THE THOMAS EDISON MINI-SERIES LINK)

Heart disease in women is under recognized under treated, and under researched compared to men; although it is the number one killer of women in the world. In this podcast, Dr. Retu Sexena, a cardiologist with Minneapolis Heart Institute, discusses the epidemiology, symptoms and pathology of heart disease as it relates to women and cardio-obstetrics. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Summarize the historical nature of heart disease in women. Recognize the cardiovascular risks in women. Identify signs/symptoms of heart disease in women. Review prevention efforts for heart disease in women. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for the full chapter summaries.  Chapter 1:- History of cardiovascular disease in women - Symptoms - Risk factors Chapter 2:- Cardio-Obstetrics (CV-Ob) - Cardiomyopathies in pregnancy Chapter 3: - Treatment/Therapies and concerns - Hypertension - ICD guidelines, ASCVD risk scores, AHA guidelines, recommendations * For journal articles cited, and web links - see attached "Show Notes".

This week we enter the world of cardiac critical care to discuss delirium in the postoperative pediatric cardiac patient. We speak with nursing scientist, Professor Sandra Staveski of UCSF about a recent large multicenter study she conducted on this topic. How prevalent is this problem and why is it an important morbidity to tackle and reduce? How can nursing interventions reduce this problem and how can the ICU team working together identify and manage this problem? Dr. Staveski shares her deep nursing and critical care knowledge with us this week. DOI: 10.1097/PCC.0000000000002591

With Friedhelm Beyersdorf, University Heart Center Freiburg, Bad Krozingen - Germany & Alec Vahanian, University Paris-Descartes, Paris - France Link to paper

In this episode, we set up the background of the cardiovascular system! We'll discuss the biology of the heart, blood, and blood vessels!   Follow us @steministaspod on Twitter and Instagram. You can also email us at steministas@gmail.com or connect with us on Facebook!

In this episode, we will be talking about longevity, how to increase your life by optimizing your exercise and diet habits. Research shows that physical activity is the number 2 factor affecting lifespan, behind your diet. We will be discussing the best exercise routine for longevity and The Longevity Diet by Dr. Valter Longo: Discover the New Science Behind Stem Cell Activation and Regeneration to Slow Aging, Fight Disease and Optimize Weight Cup of Nurses: https://fanlink.to/CONsite Frontline Warriors: https://fanlink.to/FWsite Youtube https://fanlink.to/CONYT Apple https://fanlink.to/Applepodcast Spotify https://fanlink.to/Spotifypodcast Cup of Nurses Store https://fanlink.to/CONshop Frontline Warriors store https://fanlink.to/FWshop Interested in Travel Nursing? https://fanlink.to/TravelNurseNow Free Travel Nursing Guide  https://fanlink.to/Travelnursingchecklist Nclex Guide https://fanlink.to/NCLEXguide Cup of Nurses FB Group https://www.facebook.com/groups/cupofnurses Frontline Warriors FB group https://fanlink.to/FWFBgroup   0:00 Cup of Nurses Introduction 2:00 Episode Introduction 3:36 Exercise 6:07 Blue Zones 7:50 Walk fast for an hour a day 10:35 Cardiovascular exercise 13:25 Weight training 19:40 Best Diet for Longevity

Welcome back to this week's #FridayReview.   Today I'd like to share with you the best of the week with these reviews & research on: Fall Community Detox! Cold Brew Coffee Tiny Habits: The Small Changes That Change Everything (book review) Omega-3 & Migraines (research) Omega-3 & Cardiovascular health (research) We're going to review all this and much more on today's #CabralConcept 2058– Enjoy the show! - - -   Show Notes & Resources: http://StephenCabral.com/2058 - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -  Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Stress, Sleep & Hormones Test (Run your adrenal & hormone levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels)

In Episode #159 I sit down with nutrition scientist Alan Flanagan to take a deep dive into the history of the diet-heart-hypothesis with emphasis on the work of Ancel Keys.Specifically we cover:The context for researching heart disease in the post World War 2 periodMetabolic ward trials establishing how dietary components affect cholesterolTeasing out the effects of saturated fats, polyunsaturated fats and dietary cholesterolThe motivation for Ancel Keys' Seven Countries Study (SCS) - the worlds first multi-country nutritional epidemiological studyThe SCS study design and findingsCommon criticisms of the SCS and Ancel KeysThe North Karelia Project as an example of what lowering saturated fat intake can do to heart disease mortalityMore recent evidence speaking to the causal affect of LDL cholesterol in the development and progression of heart diseaseWhat we can take away from this large body of evidence to make heart healthy food decisions in our day to dayand much moreThis is by far one of my favourite conversations to date. Cardiovascular disease remains as the number one cause of death globally. In fact, in the US, someone dies of cardiovascular disease every 36 seconds - mind blowing given there is so much science showing how we can reduce risk through lifestyle changes.A lot of the information in this episode I had included in the first draft of my book 'The Proof is in the Plants' but removed due to word limit - if you have read my book this will provide some extra context behind all of the information in Chapter 5. It's probably a little more in depth than other episodes but I am sure if you listen through it will make sense - and towards the end we summarise and talk to the key takeaways from a more practical point of view (what foods to eat more and less of).Resources:Alan on InstagramAlinea NutritionSigma NutritionNutrikynd Essential 8 multi-nutrientGuidelines/Position Statements:https://www.jacc.org/doi/pdf/10.1016/j.jacc.2019.03.010https://academic.oup.com/eurheartj/article/41/24/2313/5735221?login=truehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837225/pdf/ehx144.pdfhttps://academic.oup.com/eurheartj/article/41/1/111/5556353https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510Mendelian Randomisation Studies:https://www.sciencedirect.com/science/article/pii/S0735109712047730?via%3Dihubhttps://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6101243/https://www.nejm.org/doi/full/10.1056/NEJMoa1604304https://www.cardiology.theclinics.com/article/S0733-8651(17)30151-0/fulltextWant to support the show?If you are enjoying the Plant Proof podcast a great way to support the show is by leaving a review on the Apple podcast app. It only takes a few minutes and helps more people find the episodes.Simon Hill, Nutritionist, Sports PhysiotherapistCreator of Plantproof.com and host of the Plant Proof PodcastAuthor of The Proof is in the PlantsConnect with me on Instagram and TwitterDownload my two week meal plan

Cardio exercising is one of the best things you can do for your body and overall health. In this episode, Ted will explain everything about cardio training. The ideal frequency, duration, and intensity for maximum fat loss. So, tune in to learn how to structure your sweat sessions in the most effective way to burn off your belly. Listen Now!