Podcasts about Circulation

In this episode of Resiliency Radio with Dr. Jill, Dr. Jill Carnahan welcomes Eric Fernandez, Senior Director of Hyperice's Rehab Division, for an exciting conversation about the science behind recovery, circulation, and nervous system regulation. From elite athletes to individuals living with chronic illness, they explore how technologies like Normatec compression therapy are transforming recovery, improving circulation, reducing inflammation, and supporting long-term health. Together they discuss the growing role of compression therapy in performance, lymphatic health, dysautonomia, longevity, and everyday wellness. Whether you're looking to recover faster, optimize performance, improve circulation, or simply age more gracefully, this episode offers practical, science-backed strategies to help your body recover and thrive.

Charles Berde, MD, PhD, is the Sara Page Mayo Chair in Pediatric Pain Medicine and a Professor of Anaesthesia at Harvard Medical School. As a co-founder of the Pain Treatment Center at Boston Children's Hospital, he has spent decades at the forefront of pediatric analgesic pharmacology and the development of novel local anesthetics. His extensive translational research focuses on local anesthetic mechanisms and prolonged-duration formulations, making him a preeminent authority on the physiological impacts and safety profiles of these agents in neonates and children. A recipient of the Myron Yaster Lifetime Achievement Award from the Society for Pediatric Anesthesia, Dr. Berde brings unparalleled expertise to the discussion of managing and preventing local anesthetic systemic toxicity (LAST) within the high-stakes environments of the PICU and pediatric operating rooms.Guest Conflicts of Interest (COI)Algavita Bio: Collaborator/Developer of novel, prolonged-duration local anesthetics.Quiver Bioscience: Unpaid Scientific Advisor and co-PI on an NINDS-HEAL grant focused on rare disease pain treatments.Latigo Biotherapeutics: Scientific Advisor and recipient of past research support for novel analgesics development.Algos: Scientific Advisor for non-opioid analgesics development.Learning Objective: By the end of this podcast, listeners should be able to discuss an evidence-based and expert-guided approach to the management of local anesthetic systemic toxicity (LAST) in children.References:Patient and Doctor Reconcile for Greater GoodBerde CB. Toxicity of local anesthetics in infants and children. J Pediatr. 1993 May;122(5 Pt 2):S14-20. doi: 10.1016/s0022-3476(11)80004-1.McMahon K, Paster J, Baker KA. Local anesthetic systemic toxicity in the pediatric patient. Am J Emerg Med. 2022 Apr;54:325.e3-325.e6. doi: 10.1016/j.ajem.2021.10.021. Epub 2021 Oct 25. Lavonas et al. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023 Oct 17;148(16):e149-e184. doi: 10.1161/CIR.0000000000001161. Epub 2023 Sep 18. Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Each week, join Editor-in-Chief Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week, join Mercedes and Brad as Fatima Rodriguez joins the podcast for a discussion on the recently released CKM Guidelines. Then, Mercedes welcomes Deputy Editor Tiffany Powell-Wiley as they discuss the Clinician's Corner article type and what prospective authors should consider when submitting a manuscript for this article type. For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20260727.885623

If you reach for a caffeine-filled drink first thing every morning, you've probably heard conflicting advice over the years. Caffeine is good for you, caffeine is bad for you. So which is it? A new scientific review published in the journal Circulation suggests we've been asking the wrong question. Instead of asking whether caffeine is healthy, we should be asking what the caffeine comes packaged with. Your morning coffee and an energy drink might contain similar amounts of caffeine, but they are not the same when it comes to your heart. Studying caffeine sounds simple, give people caffeine and see what happens. The problem is that researchers usually aren't studying caffeine in isolation, they're studying coffee. And coffee isn't simply a caffeine delivery system, it's a remarkably complex drink containing hundreds of biologically active compounds, including antioxidants and anti-inflammatory molecules that appear to have health effects of their own. Rather than conducting one new experiment, researchers reviewed decades of evidence, bringing together large population studies involving hundreds of thousands of people, randomised controlled trials, genetic research and laboratory experiments to build the clearest picture yet of caffeine and heart health. The findings were reassuring for coffee drinkers. For most healthy adults, consuming up to 400 milligrams of caffeine a day (3-4 cups of regular coffee) appears to be safe. Surprisingly people who drank moderate amounts of coffee (even decaf) consistently showed lower risks of heart disease, stroke, heart failure and Type 2 diabetes. Scientists think those benefits may have less to do with caffeine itself and more to do with the antioxidants in coffee which appear to improve blood vessel function, increase insulin sensitivity and even influence the bacteria living inside our gut. Coffee isn't just delivering caffeine; it's delivering an entire chemical cocktail that may help offset some of caffeine's effects. Energy drinks contain similar amounts of caffeine to coffee, but they also contain ingredients such as taurine that may increase how quickly caffeine is absorbed. Unlike coffee, these highly concentrated caffeine drinks were associated with: increased blood pressure abnormal heart rhythms cardiovascular problems, even in otherwise healthy young adults. The caffeine molecule may be identical, but the delivery system isn't. Ever wondered why one person can drink an espresso after dinner and sleep perfectly, while someone else lies awake after a lunchtime coffee? Researchers estimate that 30–50 percent of the differences in how people tolerate caffeine are inherited. Much of that comes down to variations in a liver enzyme called CYP1A2, which controls how quickly caffeine is broken down. Fast metabolisers clear caffeine quickly, slow metabolisers can experience stronger and longer-lasting effects, even after drinking exactly the same cup of coffee. That's why there is no universal "safe" amount that works for everyone. Finally, how you brew your coffee matters. Unfiltered coffee, including French press, Turkish coffee and some espresso preparations contains higher amounts of a compound called cafestol, which can raise LDL ("bad") cholesterol. Paper filters remove most of it meaning your brewing method may influence your heart health just as much as the amount of coffee you drink. This study doesn't suggest everyone should start drinking coffee, but instead, highlights that foods are more than the sum of their ingredients. Coffee delivers caffeine alongside hundreds of naturally occurring compounds that may work together to produce health benefits. Energy drinks often deliver concentrated caffeine alongside ingredients that appear to amplify cardiovascular stress. The stimulant may be the same, but the biology isn't. LISTEN ABOVESee omnystudio.com/listener for privacy information.

CardioNerds (Drs. Apoorva Gangavelli, Jenna Skowronski, and Hannah Every) discuss the continuum of prevention and heart failure with Drs. Anu Lala and Martha Gulati. Grounded in a clinical case of a 55-year-old woman with uncontrolled hypertension, type 2 diabetes, and obesity who is on the trajectory toward heart failure, this episode unpacks a paradigm-shifting framework from a joint HFSA/ASPC Scientific Statement. The discussion explores how prevention should not be siloed from heart failure management but rather integrated across a patient’s lifespan—from primary prevention in at-risk individuals, to secondary prevention in those with established heart failure, to tertiary prevention in patients with advanced therapies such as LVADs and heart transplantation. The experts highlight the importance of aggressive risk factor management, biomarker-guided screening, the AHA’s Life’s Essential 8, and the need for multidisciplinary collaboration and systems-level change to shift heart failure care from reactive to proactive. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Systemic inflammatory diseases are associated with an elevated CVD risk that has significant implications for early detection, risk Heart failure prevention is a continuum, not a checkpoint. Prevention applies at every stage—from at-risk (Stage A) through advanced/post-transplant care—and every clinical encounter is an opportunity to intervene. The AHA’s Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep, BMI, blood lipids, blood glucose, blood pressure) forms the foundation at every stage. Hypertension carries the highest population-attributable risk for heart failure of any modifiable risk factor. In the Framingham Heart Study, 91% of patients with newly diagnosed HF had pre-existing hypertension. The SPRINT trial demonstrated a 38% reduction in HF incidence with intensive blood pressure targets (30 ng/L or NT-proBNP >125 ng/L) identify individuals at heightened risk for progression to symptomatic HF. The ACC/AHA/HFSA guidelines give a Class IIa recommendation for natriuretic peptide screening in at-risk patients. Urine albumin-to-creatinine ratio (UACR) is an underutilized screening tool that provides additional insight into CKM risk. The heart failure label does not close the prevention window—it accentuates it. Secondary prevention through GDMT optimization (quadruple therapy in HFrEF) and continued risk factor management remains critical. Tertiary prevention extends to post-LVAD and post-transplant patients, where hypertension, diabetes, obesity, and CKD management remain essential to long-term outcomes. Show notes For a comprehensive review, please review the full HFSA/ASPC Joint Scientific Statement: Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine. J Card Fail. 2026;32:75-105. doi:10.1016/j.cardfail.2025.06.013 1. What is the “continuum of prevention” framework, and how does it differ from traditional approaches to heart failure prevention? Historically, prevention and heart failure management have been treated as separate disciplines—primary prevention handled by preventive cardiologists and treatment managed by heart failure specialists. This joint HFSA/ASPC Scientific Statement reframes prevention as a dynamic, continuous process that spans a patient’s entire lifespan, regardless of HF stage or ejection fraction. The framework maps onto the ACC/AHA HF staging system: Primary prevention targets Stage A (“at risk”) and Stage B (“pre-HF”) patients to reduce the burden of incident HF. Secondary prevention targets Stage C (symptomatic) and Stage D (advanced) patients to reduce the impact of established HF through GDMT optimization and ongoing risk factor management. Tertiary prevention encompasses risk factor management in patients with LVADs or heart transplants—populations where hypertension, diabetes, and obesity still drive outcomes. The Central Figure of the statement illustrates that Life’s Essential 8 (blood pressure and lipid control, diabetes management, exercise, sleep, smoking cessation, weight management, and diet/nutrition counseling) forms the foundation at every stage, with pharmacologic and device-based therapies layered on top as disease progresses (Figure) 2. How do traditional risk factors drive heart failure, and what should clinicians prioritize? Hypertension carries the greatest population-attributable risk for HF. In the Framingham Heart Study (N=5,143), HTN was associated with a 2- to 3-fold increased risk of HF, with a population-attributable risk of 39% in men and 59% in women. The SPRINT trial showed a 38% reduction in HF incidence and 25% reduction in the primary composite outcome with intensive BP targets (30 ng/L or NT-proBNP >125 ng/L) are associated with heightened risk for progression to symptomatic HF. In the ARIC study, incorporating NT-proBNP reclassified 20% of older adults without HF into Stage B. Factors that affect interpretation include age, sex, obesity (lower values), and CKD (higher values). High-sensitivity cardiac troponin (hs-cTn): Concentrations above the 99th percentile are now included in the definition of Stage B HF. Troponin testing may complement natriuretic peptides, particularly when BNP/NT-proBNP values are ambiguous. Risk scores: The PCP-HF equation predicts 10-year HF risk using traditional risk factors plus QRS duration. The AHA PREVENT score incorporates HF risk calculation and includes markers of kidney function (albuminuria, eGFR), though it may underestimate risk in men and Black adults. The CKM syndrome staging framework (Stages 0–4) provides a holistic approach to assessing systemic cardiovascular-kidney-metabolic risk. 4. What are the key nontraditional risk factors and cross-cutting themes in heart failure prevention? Genetics: Pathogenic cardiomyopathy variants exist in ~1 in 200 individuals in the general population. The HFSA and ACMG recommend cascade testing to identify at-risk family members. Polygenic risk scores for dilated cardiomyopathy show a 3.8-fold risk for DCM in the top 10th percentile compared with the median. Sex-specific considerations: Women have 2.8 times the odds of developing HFpEF, while men have similarly increased odds of HFrEF. A complete obstetric/gynecologic history is essential—preeclampsia is associated with a 4-fold increased risk of HF. Peripartum cardiomyopathy requires intentional screening in high-risk populations. Cardiotoxic exposures: Clinicians should be aware of medications that cause direct myocardial toxicity (e.g., anthracyclines, trastuzumab, tyrosine kinase inhibitors). A team-based approach with pharmacists can help optimize medication selection and risk factor modification. Social determinants of health: Environmental exposures (air pollution, arsenic, lead, cadmium), food insecurity, financial instability, and limited healthcare access contribute to HF risk and progression. Equity-focused, risk-based prevention strategies are needed. Psychological health: Depression is common in HF and independently associated with worse outcomes. Screening with brief questionnaires (e.g., PHQ-2) is recommended. Meditation, spirituality, and holistic wellness approaches remain underutilized. 5. What systems-level and policy changes are needed to move the needle on heart failure prevention? Multidisciplinary HF prevention clinics that bring together preventive cardiologists, HF specialists, endocrinologists, nephrologists, dietitians, pharmacists, exercise physiologists, and genetic counselors are advocated by the statement. EHR-embedded risk stratification could proactively flag patients on a trajectory toward HF—analogous to sepsis alerts or fall risk flags—enabling earlier intervention, particularly for patients who may not reach a cardiologist. Cardiac rehabilitation remains underutilized, particularly in HFrEF (Class 2b recommendation) and HFpEF (not yet covered by Medicare). The HF-ACTION trial showed quality-of-life benefits, and the REHAB-HF trial showed particular benefit in older patients with HFpEF. Policy priorities include expanding insurance coverage for preventive screening and novel therapies (SGLT2i, GLP-1 RAs, nsMRAs), reducing clinical inertia through team-based care models with closer follow-up intervals, and ensuring equitable access to evidence-based therapies across diverse populations. Digital health and AI hold promise for personalized risk prediction, remote monitoring (e.g., wearable devices, implantable PA pressure monitors), and virtual cardiac rehabilitation to overcome access barriers. Figure  Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013) References Key references are bolded. Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078 SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939 Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275(20):1557-1562. doi:10.1001/jama.1996.03530440037034 Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997. doi:10.1001/jama.288.23.2981 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145-153. doi:10.1056/NEJM200001203420301 Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720 Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038 Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286 Filippatos G, Anker SD, Agarwal R, et al. Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial. Circulation. 2022;145(6):437-447. doi:10.1161/CIRCULATIONAHA.121.057983 Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107 Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563 Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773-786. doi:10.1016/S0140-6736(24)01498-3  Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963 Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636-1664. doi:10.1161/CIR.0000000000001175 Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):430-449. doi:10.1161/CIRCULATIONAHA.123.067626 Khan SS, Ning H, Shah SJ, et al. 10-year risk equations for incident heart failure in the general population. J Am Coll Cardiol. 2019;73(19):2388-2397. doi:10.1016/j.jacc.2019.02.057 Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. J Am Coll Cardiol. 2021;77(11):1454-1469. doi:10.1016/j.jacc.2021.01.030 Packer M. Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation. 2018;137(15):1614-1631. doi:10.1161/CIRCULATIONAHA.117.032474 Lala A, Tayal U, Hamo CE, et al. Sex differences in heart failure. J Card Fail. 2022;28(3):477-498. doi:10.1016/j.cardfail.2021.10.006 Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure. Eur J Heart Fail. 2021;23(3):352-380. doi:10.1002/ejhf.2115 Hershberger RE, Givertz MM, Ho CY, et al. Genetic evaluation of cardiomyopathy—a Heart Failure Society of America practice guideline. J Card Fail. 2018;24(5):281-302. doi:10.1016/j.cardfail.2018.03.004 Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:10.1161/CIR.0000000000000947 Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-1400. doi:10.1016/S0140-6736(22)00369-5

This podcast is in German./ Dieser Podcast ist auf Deutsch. Kurzfristig hält die Unsicherheit an, da die Ölpreise weiterhin volatil sind und sich die Dynamik innerhalb des Technologiesektors verändert. Wir erwarten eine breitere Gewinnentwicklung, unterstützt durch die KI-Revolution. Präsentiert von David Schroeder, Head of Distribution AXA IM Select Germany, BNPP Asset Management und Achim Stranz, Kapitalmarktexperte und externer Berater. This podcast is intended for professional investors, and must not be shared with a non-professional audience. Not for Retail distribution: This marketing communication is intended exclusively for Professional, Institutional or Wholesale Clients / Investors only, as defined by applicable local laws and regulation. Circulation must be restricted accordingly. This marketing communication is for informational purposes only and does not constitute investment research or financial analysis relating to transactions in financial instruments as per MIF Directive (2014/65/EU), nor does it constitute on the part of BNP PARIBAS ASSET MANAGEMENT Europe or its affiliated companies an offer to buy or sell any investments, products or services, and should not be considered as solicitation or investment, legal or tax advice, a recommendation for an investment strategy or a personalized recommendation to buy or sell securities. Due to its simplification, this document is partial and opinions, estimates and forecasts herein are subjective and subject to change without notice. There is no guarantee forecasts made will come to pass. Data, figures, declarations, analysis, predictions and other information in this document is provided based on our state of knowledge at the time of creation of this document. Whilst every care is taken, no representation or warranty (including liability towards third parties), express or implied, is made as to the accuracy, reliability or completeness of the information contained herein. Reliance upon information in this material is at the sole discretion of the recipient. This material does not contain sufficient information to support an investment decision. Issued in the UK by AXA Investment Managers UK Limited, which is authorised and regulated by the Financial Conduct Authority in the UK. Registered in England and Wales, No: 01431068. Registered Office: 22 Bishopsgate, London, EC2N 4BQ.

Each week, join Editor-in-Chief Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week, join Brad on location at BCVS Scientific Sessions in Boston as he sits down with the new BCVS Council Chair, Sean Wu. Brad and Sean discuss the priorities for BCVS, the standards for high-quality and actionable science in the era of multi-omics, how cardiovascular science can adapt to growing emphasis on acquired determinants of disease, and finally, find ways to improve the clinical translational relevance of basic science. For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20260717.271223

For 22 years, I predicted death for life insurance companies. One pattern showed up in file after file: most "genetic" conditions have no gene behind them. Ask your doctor which gene causes your blood pressure, your autoimmune condition, or your ADHD, and most can't answer, because it doesn't exist. What actually runs in your family is a nutrient deficiency, not a disease, and once your body gets what it's missing, the disease often clears on its own. This isn't medical advice, so bring this to your own doctor before you assume anything is permanent. CLICK HERE TO BECOME GARYS VIP!: https://bit.ly/4ai0Xwg Thank you to our partners A-GAME: “ULTIMATE15” FOR 15% OFF: http://bit.ly/4kek1ij AION: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD AIRES: "ULTIMATE20 " FOR 20% OFF: https://bit.ly/4a3Duze BAJA GOLD: "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa BODYHEALTH: “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV COLD LIFE: THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp CYMBIOTIKA: "ULTIMATE20" FOR 20% OFF: https://bit.ly/4tjyluP  GENETIC METHYLATION TEST (UK ONLY): https://bit.ly/48QJJrk GENETIC TEST (USA ONLY): ⁠https://bit.ly/3Yg1Uk9 GOPUFF: GET YOUR FAVORITE SNACK!: https://bit.ly/4obIFDC H2TABS: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg HEALF: 10% OFF YOUR ORDER: https://bit.ly/41HJg6S PEPTUAL: “TUH10” FOR 10% OFF: https://bit.ly/4mKxgcn SNOOZE: LET'S GET TO SLEEP!: https://bit.ly/4pt1T6V WHOOP: JOIN & GET 1 FREE MONTH!: https://bit.ly/3VQ0nzW Watch  the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: https://bit.ly/3RPQYX8 Podcasts: https://bit.ly/3RQftU0 Connect with Gary Brecka Instagram: https://bit.ly/3RPpnFs TikTok: https://bit.ly/4coJ8foX: https://bit.ly/3Opc8tf Facebook: https://bit.ly/464VA1H LinkedIn: https://bit.ly/4hH7Ri2 Website: https://bit.ly/4eLDbdU Merch: https://bit.ly/4aBpOM1 Newsletter: https://bit.ly/47ejrws Ask Gary: https://bit.ly/3PEAJuG Timestamps 00:00 - Intro of Show 01:57 - 22 Years Predicting Mortality 03:00 - Medical Error and Misdiagnosis 07:40 - Idiopathic Hypertension Explained 09:59 - Autoimmune of Unknown Origin 11:00 - Presence of Oxygen, Two Promises 14:07 - The Methylation Pathways Map 16:00 - Attention Overload, Not Deficit 19:00 - MTHFR Gene and Folic Acid 22:00 - What Anxiety Actually Is 26:50 - COMT Gene and B12 Forms 29:00 - Serotonin and the SSRI Problem 33:00 - Dana White's Blood Pressure Story 37:00 - Circulation, Homocysteine, and TMG 43:00 - Blood Sugar and Insulin Resistance 57:15 - The Truth About LDL Cholesterol 59:00 - The Only Diet Rule That Matters 01:01:31 - Community and Faith as Medicine 01:04:00 - Molecular Hydrogen Explained 01:08:00 - Morning Routine: Sun and Breath 01:13:37 - Q&A: Thyroid and Selenium 01:18:51 - Q&A: Autoimmune and Heavy Metals 01:22:00 - Q&A: Neuropathy and Circulation  Disclaimer: This podcast is for informational purposes only and does not provide medical advice. It is not intended for diagnosing or treating any health condition. Always consult a licensed healthcare professional before making health or wellness decisions.  Gary Brecka is the owner of Ultimate Human, LLC which operates The Ultimate Human podcast and promotes certain third-party products used by Gary Brecka in his personal health and wellness protocols and daily life and for which Ultimate Human LLC and / or Gary Brecka directly or indirectly holds an economic interest or receives compensation.  Accordingly, statements made by Gary Brecka and others (including on The Ultimate Human podcast) may be considered promotional in nature. Learn more about your ad choices. Visit megaphone.fm/adchoices

James is Associate Professor of Religious Studies at Northwestern University. He is the author of five books, most recently "Materializing the Bible: Scripture, Sensation, Place." His current research focuses on the secondhand circulation of Christian material culture.I spoke with James about his path into studying material religion and why materiality is essential for understanding religious practice. We discussed the Bible as a powerful object, how creativity functions in the context of literal interpretations of Scripture, and the ways religious artifacts circulate, gaining new meanings and values. James shared insights on the remixing of objects, the journey of the Gauchi brothers' Holy Land model, and the ethics of collecting and selling Christian items. We also talked about how we can be surprised by  material culture, the role of intentionality, and how secondhand spaces reveal both the endurance and transformation of Christianity in everyday life, especially in relation to popular culture.

This podcast is in Italian./ Questo podcast è in italiano. La trasformazione tecnologica è stata finora quest'anno il principale motore dei mercati azionari. Al contempo, i titoli di Stato sono rimasti sotto pressione in un contesto di turbolenze geopolitiche. Analizziamo quali elementi gli investitori potrebbero prendere in considerazione in questo scenario. Presentato dal Alessandro Tentori, Chief Investment Officer e Giorgio Civalleri, Senior Relationship Manager. This podcast is intended for professional investors, and must not be shared with a non-professional audience. Not for Retail distribution: This marketing communication is intended exclusively for Professional, Institutional or Wholesale Clients / Investors only, as defined by applicable local laws and regulation. Circulation must be restricted accordingly. This marketing communication is for informational purposes only and does not constitute investment research or financial analysis relating to transactions in financial instruments as per MIF Directive (2014/65/EU), nor does it constitute on the part of BNP PARIBAS ASSET MANAGEMENT Europe or its affiliated companies an offer to buy or sell any investments, products or services, and should not be considered as solicitation or investment, legal or tax advice, a recommendation for an investment strategy or a personalized recommendation to buy or sell securities. Due to its simplification, this document is partial and opinions, estimates and forecasts herein are subjective and subject to change without notice. There is no guarantee forecasts made will come to pass. Data, figures, declarations, analysis, predictions and other information in this document is provided based on our state of knowledge at the time of creation of this document. Whilst every care is taken, no representation or warranty (including liability towards third parties), express or implied, is made as to the accuracy, reliability or completeness of the information contained herein. Reliance upon information in this material is at the sole discretion of the recipient. This material does not contain sufficient information to support an investment decision. Issued in the UK by AXA Investment Managers UK Limited, which is authorised and regulated by the Financial Conduct Authority in the UK. Registered in England and Wales, No: 01431068. Registered Office: 22 Bishopsgate, London, EC2N 4BQ.

On this week's episode of Circulation on the Run, join Editor-in-Chief Bradley Maron and Deputy Editor Mercedes Carnethon as they welcome Circulation's Executive Editor, Karen E. Joynt Maddox.  Karen discussed health services and health care policy, and what prospective authors should consider when submitting manuscripts to Circulation. Then, Brad and Mercedes welcome authors Marc Humbert and Jason Weatherald as they discuss their review article regarding pulmonary arterial hypertension in the July 14th issue of Circulation. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260713.392409

You have a wedding, a vacation, a babymoon, a reunion, or a big shoot in about two months, and you want to walk in glowing. In this episode I give you my full 8 week glow up protocol, the same one I build for my one on one clients, and it is all from the inside out. I break down what glow actually is on a physiological level: collagen, glycation, inflammation and puffiness, gut health, circulation and lymph, and body composition. Then I walk you through the labs to run, my three pillars of nutrition, lifestyle, and supplements, and the peptides I reach for when a client wants skin, hair, tan, and fat loss support. I close with budget tiers so you can start whether you have $100 or $5,000 a month. If you want me to build this protocol with you, work with me one on one for peptides, hormones, longevity, and a full lab review.   I TALK ABOUT: 00:00 Welcome and the 8 week glow up premise 04:16 What glow really is: collagen as your scaffolding 09:52 Glycation, AGEs, and how sugar ages your skin 11:11 Inflammation, puffiness, and what actually drives bloat 18:56 The gut skin axis 20:34 Circulation, lymph, and de-puffing 24:09 Muscle tone, body composition, and hormones 28:46 The labs to run first 35:45 Pillar 1: Nutrition (protein, collagen, electrolytes) 50:03 Pillar 2: Lifestyle and biohacks 58:39 Pillar 3: Supplements 1:02:25 Peptides for skin, hair, tan, and fat loss 1:17:32 Budget tiers from $100 to $5,000 and how to start   WORK WITH ME: 1:1 longevity and peptide consults for women My Peptide Source Guide Her Stack Planner Join The LongHer Life   WHAT I MENTIONED IN THIS EPISODE: Labs: Function Health, SiPhox Health (code BRITTANY20), and NiaHealth for Canada. Skincare, SPF, and gua sha: OneSkin, code BIOHACKINGBRITTANY. Protein: Vega Sport. Electrolytes and pre workout: Baja Gold Salt Company, Tidal, code BIOHACKINGBRITTANY. Movement: Booty by Bret. Sleep tracking: Oura Ring. Everything I use, with my codes, is in my shop.   LET'S CONNECT: Instagram: @biohackingbrittany TikTok: @biohacking Facebook: Biohacking Brittany Website: biohackingbrittany.com   This episode is for educational purposes only and is not medical advice.

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

Dragon Breathing Level 1 is one of the most important practices I've developed over the years, and it's become a foundational part of the Sexual Kung Fu system.This guided practice is designed to help you open the microcosmic orbit, cultivate earth energy through the feet, and learn how to circulate energy through the body in a way that builds vitality, pleasure, and deep relaxation.The goal isn't to force anything or visualize complicated energy pathways. It's to become more sensitive to your body, connect with the ground beneath you, and gradually train your nervous system to experience greater levels of energy and full-body awareness.In this guided session you'll learn:• How to practice Dragon Breathing Level 1• The role of foot breathing and earth energy• How to circulate energy through the body naturally• Why grounding is essential for sexual vitality• How this practice supports ejaculation control and full-body pleasure• Ways to integrate Dragon Breathing into qigong, meditation, and sexual cultivationI recommend practicing this regularly for at least a few weeks before moving on to more advanced methods.Consistency is the key.Let me know in the comments what you experience from this practice and how it unfolds for you over time.Get my FREE Ebook - 3 Techniques for Legendary Ejaculation Control:

Tu veux que je te raconte l'histoire du rond-point sans route? Alors attrape ta brosse à dents, ton dentifrice, et c'est parti!

Circulation on the Run welcomes Circulation's new Editor-in-Chief, Bradley A. Maron, MD. Join Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week join Brad, Mercedes and Jane as they first welcome Vice Chair Pamela B. Morris as she discusses the 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Then join author Hertzel Gerstein as he discusses his article "Cardiovascular Risk Reduction with GLP-1 RA Drugs." Besides gaining insight about leading science research, learn more about the scientific researchers in Circulation on the Run's newest feature, "Get to Know Our Guests." Don't miss this newly revamped podcast! For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260706.284480

We're delighted today to sit down with MDVIP Chief Medical Officer, Dr. Jeffrey Lin to talk about so building a sustainable practice, finding joy in the practice of medicine, and what's happening what the next chapter of Primary Care looks like. Dr. Jeffrey Lin is a board-certified cardiologist, internist, and the newly appointed Chief Medical Officer of MDVIP, the nation's leading network supporting physicians in personalized, preventive, and relationship-driven primary care. A Harvard Medical School graduate and Yale summa cum laude, Dr. Lin completed advanced fellowship training at Massachusetts General Hospital and Columbia University before building a distinguished career that spans academic medicine, elite sports cardiology as a consultant to the NFL Players Association, and executive leadership at Devoted Health, where he was the company's first physician hire and helped build a patient-centered care model serving over 400,000 members across 29 states. He joins MDVIP at a pivotal moment in the organization's growth, bringing with him a career-long conviction that prevention is a long game, that physician joy is inseparable from patient outcomes, and that the future of primary care depends on giving doctors the time and the tools to actually know their patients. --- MDVIP Appoints Jeffrey Lin, MD, FACC, as Chief Medical Officer     BOCA RATON, Fla. – April 22, 2026 – MDVIP, the national leader in supporting physicians to provide personalized, preventive, and primary care, today announced the appointment of Dr. Jeffrey Lin as Chief Medical Officer. A board-certified cardiologist and accomplished healthcare executive, Dr. Lin will lead MDVIP's clinical strategy and delivery as the company continues to expand its preventive and relationship-driven primary care model nationwide. Dr. Lin will also collaborate with the network's Medical Advisory Board on MDVIP's current and future offerings. The appointment reflects MDVIP's investment in physician leadership that deeply understands both the patient and provider experience, reinforcing the company's commitment to long-term health outcomes, proactive prevention, and a care model that gives doctors the time and tools to deliver truly personalized care. A cardiologist and internist by training, Dr. Lin has a longstanding commitment to prevention and optimizing health through data-driven, lifestyle-oriented approaches. He joins MDVIP from Devoted Health, where he served as National Medical Director and was the company's first physician hire, responsible for building its clinical care platform from the ground up. Since 2019, he helped lead the development and scaling of a comprehensive, patient-centered care model integrating preventive care, chronic disease management, and longitudinal wellness for primary care patients across the country, growing the clinical team to serve over 400,000 members across 29 states. As Chief Medical Officer, Dr. Lin will work closely with affiliated physicians and the MDVIP team to enhance the MDVIP experience for patients and providers alike. His priorities include strengthening MDVIP's preventive and wellness programs, supporting physicians transitioning into more manageable practice sizes, and expanding the MDVIP model to new physician segments and patient populations across different life stages. "MDVIP was built on the belief that primary care should be proactive, personal and sustainable for physicians," said Larry Kutscher, CEO and Board Chairman of MDVIP. "Dr. Lin has devoted his career to those same principles, designing care models that prioritize prevention, meaningful time with patients and better long-term health. He will be a powerful advocate for our physician community and a key partner in shaping the future of MDVIP." Dr. Lin's passion for MDVIP's mission is rooted in his early years in practice, when he saw firsthand how fragmented, specialist-heavy care consumed patients' lives and made it difficult to focus on prevention and long-term health. "As a cardiologist, I've always viewed health as a long game," said Dr. Jeffrey Lin, Chief Medical Officer of MDVIP. "The choices we make in our 40s and 60s shape the next 30 years of our lives. MDVIP has spent more than 25 years building a model that gives physicians the time and tools to focus on prevention and real relationships with patients. I'm excited to help bring that kind of care to more doctors and patients across the country." Dr. Lin also emphasized the importance of elevating the physician experience. "You can't deliver great long-term outcomes if the people providing care are burnt out," he added. "I'm looking forward to partnering with our affiliated clinicians to bring more joy back into their practice and help patients live longer, healthier lives." With the appointment of Dr. Lin, MDVIP is beginning a new chapter in its growth story, doubling down on personalized, relationship-centered care and expanding its influence among patients and physicians nationwide. About Dr. Jeffrey Lin Dr. Jeffrey Lin is a board-certified cardiologist, internist, and an accomplished physician executive dedicated to advancing personalized, preventive, and relationship-driven care. He previously served as National Medical Director at Devoted Health, a tech-enabled Medicare Advantage organization, where he's helped lead the development and scaling of a comprehensive, patient-centered care model nationwide since 2019. A cardiologist by training, Dr. Lin has a longstanding commitment to prevention and optimizing cardiovascular health through data-driven, lifestyle-oriented approaches. Earlier in his career, he served as Assistant Professor of Medicine at Mount Sinai Medical Center in Miami Beach and Co-Director of Cardiac Rehabilitation, where he built a thriving ambulatory cardiology practice and developed programs that enabled patients to achieve meaningful, sustained improvements in heart health. Dr. Lin's experience also includes caring for elite and professional athletes as a cardiology consultant to the National Football League Players Association, as well as leading clinical research on cardiovascular performance and endurance. His work has been published in leading medical journals, including the Journal of the American College of Cardiology and Circulation. He is also a Fellow of the American College of Cardiology. Dr. Lin earned his medical degree from Harvard Medical School and graduated summa cum laude from Yale University. He completed his residency in internal medicine at Columbia University Medical Center, followed by advanced fellowship training in cardiovascular medicine, sports cardiology, and cardiac imaging at Massachusetts General Hospital and Columbia University.

 CardioNerds (Drs. Apoorva Gangavelli, Rebecca Garber, and Tina Reddy discuss INOCA with Dr. Claire Raphael. Audio editing by CardioNerds Academy intern, student doctor Pacey Wetstein. This episode was produced as part of the CardioNerds Academy curriculum by House Einthoven under the guidance of House Chief, Dr. Apoorva Gangavelli, and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. Non-obstructive coronary artery disease (CAD) is more common than often recognized, particularly in women and individuals with risk factors like diabetes or hypertension. Conditions such as INOCA, ANOCA, and MINOCA can cause ischemia and chest pain despite “clean” angiograms, often due to microvascular dysfunction, coronary spasms, or subtle plaque. Diagnosing these conditions requires advanced imaging or invasive studies to assess blood flow and vessel function. Treatment focuses on reducing cardiovascular risk with aspirin, statins, ACE inhibitors, or ARBs, and managing symptoms with beta-blockers or calcium channel blockers. The key takeaway: A normal angiogram doesn't rule out disease, and these patients need a comprehensive, evidence-based approach to care. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls: When patients present with chest pain but do not have obstructive coronary artery disease, the story does not end there! Other pathologies that must be ruled out include spontaneous coronary artery disease (SCAD), coronary vasospasm, microvascular disease, Takotsubo, and cardiomyopathy. A TTE can help rule out other pathologies. Cardiac MRI can help identify myocardial fibrosis, scarring, or edema that may suggest prior events or alternative diagnoses.  About 60-70% of INOCA cases are in women. However, it is estimated that about half of the patients with so-called “normal” angiograms actually have positive stress tests. Patients with elevated troponins are more likely to have recurrent events. Patients with INOCA are more likely to come back to the ER multiple times before getting diagnosed. These patients have a 1.4x increased risk of adverse cardiovascular events (such as HFpEF, MI, and recurrent hospitalizations for cardiac chest pain).  INOCA is a complex condition with a variety of causes, primarily linked to microvascular disease. Within microvascular disease, there are different “endotypes” (types or subcategories) classified by specific characteristics. In centers that conduct microvascular testing, patients are categorized as endothelium-independent or endothelium-dependent, based on their responses to adenosine or acetylcholine during testing. Additionally, microvascular disease can be classified as either structural or functional, depending on the results of tests measuring microvascular resistance. The field is moving towards the term ANOCA, or angina with non-obstructive coronary arteries, to include patients with anginal symptoms without objective ischemia.  The field is moving toward using genotyping and hemodynamic testing to guide first-line therapies for microvascular disease, a heterogeneous condition. Current treatments mostly come from obstructive coronary artery disease, but specialized approaches—like the coronary sinus reducer—may offer unique benefits for microvascular disease. Treatment includes sublingual nitroglycerin, ACE inhibitors/ARBs, and beta-blockers. Remember to also treat any additional comorbidities, such as diabetes, hypertension, and hyperlipidemia. Unfortunately, many of these patients may still have refractory chest pain, so it is important to reassure them. These patients can still exercise, but they may be hesitant to do so for fear of having chest pain. Cardiac rehab may be helpful for these patients as it helps them build up their tolerance. References Lawton JS, Tamis-Holland JE, Bangalore S, et al; Writing Committee Members. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):e18-e114. doi:10.1161/CIR.0000000000001039 Hwang D, Park S, Koo B-K. Ischemia with nonobstructive coronary artery disease. JACC: Asia. 2023;3(2):169-180. doi:10.1016/j.jacasi.2023.01.004 Yukselen Z, Majmundar V, Dasari M, Kumar PA, Singh Y. Chest pain risk stratification in the emergency department: current perspectives. Open Access Emerg Med. 2024;16:29-43. doi:10.2147/OAEM.S419657

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

This week marks the final Circulation on the Run under Dr. Joseph Hill's tenure. For this episode, please join our current hosts along with former host Carolyn Lam, Executive Editor James de Lemos, and Editor-in-Chief Joseph Hill as they remember the legacy of the podcast started a decade ago, the important scientific research discussed, and fond memories after 520 episodes. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260629.459176

"Living in a physical world can be challenging. To experience the New Faith Currency in your daily life requires faith, inspired action... and a little Unicorn magic." — Thom and the Golden White Unicorns Inspired by a chapter from Jennifer Ruth Russell's book, Opulence Infusion: A New Faith Currency, this guided meditation invites you into a sacred partnership with the Golden White Unicorns. As you relax and receive their blessings, you'll awaken the circulation of Divine Supply, increase your capacity to receive, and open yourself to greater grace, generosity, synchronicity, and Opulence. If the Golden Unicorns speak to your heart, I warmly invite you to join me for Tea with Mother Mary, held on the first Wednesday of every month, where we explore the wisdom, love, and guidance of Mother Mary and her Heavenly Team. Sign up here: https://www.jenniferruthrussell.com/post/tea-with-mother-mary

Send us Fan MailMorning prayer: Christians coming together in the name of Jesus to pray and seek God's favor, God's forgiveness, and God's blessings for people in need. #prayer#Jesus#God#HolySpirit#heal#loveThank you for listening, our heart's prayer is for you and I to walk daily with Jesus, our joy and peaceaimingforjesus.comYouTube Channel https://www.youtube.com/@aimingforjesus5346Instagram https://www.instagram.com/aiming_for_jesus/Threads https://www.threads.com/@aiming_for_jesusX https://x.com/AimingForJesusTik Tok https://www.tiktok.com/@aiming.for.jesus

CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov.  The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.

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

In this episode, Dr. Brendan McCarthy breaks down one of the most misunderstood topics in hormone replacement therapy: estradiol. Not all estrogen is the same—and how estradiol is delivered can dramatically affect hormone balance, inflammation, clotting risk, testosterone levels, and overall health outcomes. Dr. McCarthy discusses: • Why route of administration matters (oral, patch, injectable, topical, vaginal, pellet) • How oral estradiol converts to estrone • The differences between estradiol (E2), estrone (E1), and estriol (E3) • Estrone's relationship to inflammation and metabolic health • Oral estrogen and clotting risk • Oral estrogen's effect on SHBG and free testosterone • The impact of oral estrogen on IGF-1 and growth hormone signaling • Why informed consent should be central to hormone therapy • Benefits and limitations of pellets, patches, creams, and injections • Estriol and emerging research in autoimmune conditions such as multiple sclerosis At Protea Medical Center, our philosophy is simple: patients deserve complete information so they can make empowered decisions about their health.

Not sure about you, but guaiacwood essential oil is one I'm so excited to pick back up again and put in my weekly rotation of oils to be using.  We discussed topics such as: Inflammation Joint Pain Circulation Support Male Wellness Join us for this conversation, cause I can promise you it's one you will want to send to all your friends. Men, take what is said here and try it out. We call it product testing.        Also..... Get this Book! Link for Essential Emotions book. You need it.  https://aromatools.com/collections/frontpage/products/essential-emotions-14th-edition   The Essential Life book here https://essentiallife.com/product/essential-life-10th-edition/   If this episode touched something in your heart, just know you don't have to walk through it alone. This is the kind of emotional healing work we support our clients through, and we'd be honored to walk alongside you when you're ready.   Book with Vicki: https://vickilebrilla.com/coaching   Book with Sarah: https://sarahsepos.com/coaching   Scoop of the Day Roller Bottle Recipe for Male Arousal 10 Guaiacwood 4 Sandalwood 4 Frankincense in a 5mL roller and top off with fractionated coconut oil   #GuaiacwoodEssentialOil #EssentialOilBenefits #NaturalPainRelief #InflammationSupport #JointHealth #CirculationSupport #LymphaticHealth #NaturalWellness #HolisticHealth #MenHealth #EssentialOils #HealthyAging #WellnessJourney #NaturalHealing #PlantBasedWellness   Welcome into our little essential oil world where we talk about the physical and emotional support of our essential oils.   Hi friends, don't forget to leave us a review, your feedback is always welcome, and helps this podcast reach more ears. Join us in our New Facebook Community! Connect on Instagram  Follow us on YouTube: https://www.youtube.com/@TheEssentialOilScoopPodcast   We upload a brand new episode every Tuesday and Thursday!   Want to learn more about us? theessentialoilscoop.com   Remember to like, share, and subscribe to our podcast so you will be notified every time we upload a brand new episode.  Leave us a review as well, your feedback is always welcome. Also opt-in to our newsletter at https://theessentialoilscoop.com/newsletter   If you have any questions or have subject ideas you would like us to cover please email us at theessentialoilscoop@gmail.com   Tag us on socials using #theessentialoilscoop #essentialoilpodcast #oilpodcast   Disclaimer:  Welcome to The Essential Oil Scoop Podcast. We want to remind our listeners that the information provided in this podcast is for educational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. The use of essential oils is a personal choice and should be done at your own risk. We are not medical professionals and cannot diagnose, treat, or prescribe any medical condition. Please consult with a qualified healthcare provider before using any essential oils or making changes to your healthcare routine. Any information or opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the views of any particular organization. Thank you for listening.  

I sit down with nutrition scientist Dr. Luke Bucci to explore the powerful connection between blood flow, nitric oxide, mitochondrial health, and healthy aging. We discuss why circulation impacts nearly every function in the body, what causes energy levels to decline with age, and how nutrition, exercise, and targeted supplementation may help support long-term vitality. Dr. Bucci also explains the science behind nitric oxide, blood sugar regulation, and the role mitochondria play in keeping us energized and resilient throughout life.Dr. Luke Bucci, PhD, CNS, CCN is the Chief Scientific Officer of Juvenon and a biomedical scientist with more than 40 years of experience in nutrition, dietary supplements, and clinical laboratory science. He earned his PhD in Biomedical Sciences from the University of Texas Health Science Center at Houston and has helped develop numerous patented nutritional products used worldwide. A recognized authority in healthy aging, sports nutrition, omega-3s, probiotics, and dietary supplement science, Dr. Bucci has authored scientific books, taught university-level courses, and received multiple industry awards for his contributions to nutrition and health innovation.Links mentioned during this episode:Juvenon: https://juvenon.com/Free Initial Consultation with Dr. Megan: https://p.bttr.to/3a9lfYkLyons' Share Instagram: www.instagram.com/thelyonsshareJoin Megan's newsletter: www.thelyonsshare.org/newsletter

This week, join Circulation's Disparities Editors Mercedes Carnethon, Karol Watson, and Guest Editor Eric J. Brandt as they host this week's Circulation on the Run episode. First, they speak with authors Rishi K. Wadhera and Prihatha R. Narasimmaraj as they discuss their article "The Cardiovascular Cost of Medicaid Cuts Under H.R. 1." Then Mercedes speaks with author Yi-Yun "Crystal" Chen as she discusses her original research article "Multidimensional Social Adversity and Mortality in People With HIV and Heart Failure: Insights From NYC Health + Hospitals HIV–Heart Failure Cohort." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260615.699938

Scientists have made a new scientific breakthrough in the study of the human body.Researchers in the United States have discovered something amazing: a third circulatory system within the human body.Alongside the previously known cardiovascular and lymphatic systems, this interstitium system (as it's being called) appears to allow the different organs of the human body to pass things along to one another.Which in-and-of-itself is an amazing discovery, but it's made even more exciting by the fact that this newly discovered system maps very well onto the model of the human body that's been used in traditional Eastern medicine for thousands of years (in practices like acupuncture, for instance).Meaning, this discovery might very well be the missing link between Western and Eastern medicine.Let's go through the details together.

Listener feedback, transcatheter tricuspid valve replacement, a new metabolic disease called CKM, the ARISE-FLUIDS Trial, the BIHCA trial, and temporal trends in ICD therapies are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback LOSE-AF Trial https://jamanetwork.com/journals/jama/fullarticle/2849335 ARREST-AF Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2840225 POP-AF Trial https://doi.org/10.1093/eurheartj/ehaf689 PRAGUE-25 Trial https://www.jacc.org/doi/10.1016/j.jacc.2025.04.042 II Transcatheter Tricuspid Valve Replacement TRISCEND Cost Study https://doi.org/10.1016/j.shj.2026.101049 TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 III More Disease Creation – the CKM Syndrome ACC/AHA Release First-Ever Guideline for CKM Syndrome https://www.medscape.com/viewarticle/acc-aha-release-first-ever-guideline-ckm-syndrome-2026a1000jbs CKM Guideline in Circulation https://www.ahajournals.org/doi/10.1161/CIR.0000000000001447 IV Two Trials That Teach Important EBM Lessons ARISE-FLUIDS Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2516225 Dr Josh Farkas Post on X https://x.com/PulmCrit/status/2065064796270022845?s=20   V  Bicarbonate for Inpatient Cardiac Arrest –The BIHCA trial BIHCA Trial https://jamanetwork.com/journals/jama/fullarticle/2850405 VI The Decline of VT in Heart Failure Trends and Outcomes in ICD Recipients: 15-Year Analysis https://doi.org/10.1093/europace/euag110 Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that's great for Family medicine or internal medicine, but how does that affect us in women's health? Well, it's complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

I'm joined by Dr. Jeffrey Sankoff to talk about three exercise “rules” you may be allowed to break: you don't always need to spread workouts across the week, intensity doesn't have to come from a formal interval session, and most short workouts don't require a complicated hydration or fueling plan.The Exercise Rules You're Allowed to BreakHave you ever skipped a workout because you couldn't do the “right” one? Maybe you didn't have time for the gym, a long hike, or a structured bike ride. Today, we revisit Voltaire's reminder that “the great is the enemy of the good” and apply it to exercise. The evidence is reassuring: weekend workouts count, short bursts of effort during the day count, and for most workouts under an hour, hydration hype may matter far less than we've been led to believe.Dr. Jeffrey Sankoff, an ER physician, Ironman triathlete, triathlon coach, and host of the evidence-focused TriDoc Podcast, joins me for this conversation. While Jeff works with endurance athletes, today's discussion is for anyone who wants to live long and well while still managing the realities of work, family, travel, and everyday life.First, we break the calendar rule. Many people assume exercise has to be spread evenly throughout the week, but a 2024 Circulation study on “weekend warrior” physical activity found that people who concentrated their moderate-to-vigorous exercise into one or two days still had lower risk for many diseases compared with inactive people, especially cardiometabolic conditions such as hypertension, diabetes, obesity, and sleep apnea. The study was observational, so it does not prove weekend-only exercise is ideal, and injury risk still matters. But the practical message is clear: if weekdays are impossible, weekends still count. Next, we break the formal-interval rule. High intensity does not always have to mean a structured HIIT class, a bike trainer, or a carefully timed workout. A 2026 European Heart Journal study found that a higher percentage of vigorous physical activity was associated with lower risk across several chronic diseases and mortality outcomes. Even a small proportion of vigorous activity may matter, meaning short real-life bursts—taking the stairs quickly, walking briskly uphill, carrying groceries with purpose, or chasing a child or grandchild—can become meaningful movement when they raise your breathing and effort level. This study was also observational, so it cannot prove cause and effect, and anyone with medical concerns should check with their clinician before adding vigorous bursts. Finally, we break the bottle rule. For endurance races, long workouts, or hot-weather exercise, hydration, electrolytes, and carbohydrates can matter. But for many 30- to 60-minute workouts in ordinary conditions, a formal hydration or fueling plan may not be necessary. The American College of Sports Medicine's position stand emphasizes fluid replacement to support hydration during physical activity, but the need depends on duration, sweat loss, heat, and intensity. A practical “N of 1” approach is to weigh yourself before and after a typical workout to see how much fluid you actually lose. We also discuss electrolytes and carbohydrates. Electrolytes are mostly salts, and they become more relevant with long, hot, sweaty, or repeated sessions. Carbohydrate-containing drinks can help with longer endurance performance, but for a 35-minute walk or a short gym session, sugar in your bottle is usually not the bottleneck. A systematic review on carbohydrates and exercise performance found benefits in longer exercise contexts, but that does not mean every short workout needs sports drinks or gels. TakeawaysDon't let the perfect workout plan keep you from the good-enough workout you can actually do.If weekdays are packed, a weekend warrior approach may still provide meaningful health benefits.Look for small bursts of vigorous effort in daily life, and for most workouts under an hour, water when thirsty is usually enough.Send us Fan MailSupport the show

The third episode of the Cities and Geopolitics series explores the spatial and operational logics of circulation, examining how the movement of goods, capital, data, and people is organised, accelerated, and contested across urban and regional space. Our guests discuss how circulation has become a central terrain of geopolitical strategy, focusing on a range of infrastructures, from economic corridors and port expansions to special economic zones, rail networks, and digital logistics platforms. The episode highlights how circulatory systems are not only designed to facilitate flows, but also to direct, channel, and control them, reconfiguring territories, reshaping urban hierarchies, and producing new forms of inclusion and exclusion. The conversation traces how the control of corridors and logistical infrastructures materialises geopolitical ambitions in highly uneven ways, often generating fragmentation, dispossession, and environmental transformation along their routes. Cities emerge here not simply as nodes within global networks, but as sites where the frictions of circulation are negotiated, where congestion, labour struggles, infrastructural bottlenecks, and regulatory regimes reveal the limits and contradictions of seamless flow. At the same time, the episode attends to the lived and situated dimensions of logistics, showing how everyday practices rework infrastructural spaces. This episode invites listeners to rethink geopolitics through the lens of movement and mobility, highlighting how the governance of flows has become central to the organisation of global power, and how urban space is continuously remade through the infrastructures, and frictions of circulation.

This is my personal favorite topic, but probably your least favorite: strength training.  Before you run away, hear me out! Because whether you’re bed-bound, housebound, or just convinced your body can’t handle it right now, this episode is for you. I’m breaking down exactly WHY resistance and strength training isn’t just helpful for vestibular disorders—it’s essential.  You Have to Move Your Body to Manage Your Dizziness From the dizzy-anxious-dizzy cycle to blood sugar regulation to better sleep to reduced inflammation, strength training touches virtually every struggle vestibular warriors face. I’m not letting anyone off the hook, but I am meeting you exactly where you are. Starting with 3 minutes? That counts.  Walking to the mailbox and back? That counts too.  Because the goal here is progress, not perfection. And you know I have the science to back every single word of it! In this episode, we'll dig into: Why strength training is non-negotiable for vestibular disorder management How exercise helps break the dizzy-anxious-dizzy cycle “In the moment” vs. “hangover” dizziness and how to adjust your approach Why EDS, HSD, or MCAS makes building muscle even more critical The truth about the fear of getting “bulky” How to start exercising when you’re bedbound or couch-bound What physical activity guidelines actually say, and where most people fall short How functional movements like the deadlift directly support vestibular patients How Vestibular Group Fit makes strength and resistance training accessible Whether you start with 3 minutes or 30, the most important thing is that you start. Because your vestibular system, your mood, your balance, and your future self are all counting on it. Links Mentioned: Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit Free Resources: ⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n ⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd ⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership ⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit ⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor Work with Dr. Madison: For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com Otherwise, I'll see ya in Vestibular Group Fit! Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/ Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit Citations: Adriano Oliveira, Andressa Fidalgo, Paulo Farinatti, Walace Monteiro,Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis,Archives of Gerontology and Geriatrics,Volume 124,2024,105451,ISSN 0167-4943,https://doi.org/10.1016/j.archger.2024.105451.(https://www.sciencedirect.com/science/article/pii/S0167494324001274) Yu Y, Wang J, Xu J. Optimal dose and type of exercise to improve cognitive function in patients with mild cognitive impairment: a systematic review and network meta-analysis of RCTs. Front Psychiatry. 2024 Sep 12;15:1436499. doi: 10.3389/fpsyt.2024.1436499. PMID: 39328348; PMCID: PMC11424528. Zhang Y, Zhou M, Yin Z, Zhuang W, Wang Y. Relationship between physical activities and mental health in older people: a bibliometric analysis. Front Psychiatry. 2024 Oct 21;15:1424745. doi: 10.3389/fpsyt.2024.1424745. PMID: 39497901; PMCID: PMC11532734. Garcia Meneguci, C. A., Meneguci, J., Sasaki, J. E., Tribess, S., & Júnior, J. S. V. (2021). Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PloS one, 16(1), e0246275. https://doi.org/10.1371/journal.pone.0246275 Mennitti C, Farina G, Imperatore A, De Fonzo G, Gentile A, La Civita E, Carbone G, De Simone RR, Di Iorio MR, Tinto N, Frisso G, D’Argenio V, Lombardo B, Terracciano D, Crescioli C, Scudiero O. How Does Physical Activity Modulate Hormone Responses? Biomolecules. 2024 Nov 7;14(11):1418. doi: 10.3390/biom14111418. PMID: 39595594; PMCID: PMC11591795. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010 Jun 3;411(11-12):785-93. doi: 10.1016/j.cca.2010.02.069. Epub 2010 Feb 25. PMID: 20188719; PMCID: PMC3629815.  Chastin, S.F.M., Abaraogu, U., Bourgois, J.G. et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Med 51, 1673–1686 (2021). https://doi.org/10.1007/s40279-021-01466-1 Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022 Jan;70(1):49-59. doi: 10.1111/jgs.17477. Epub 2021 Sep 24. PMID: 34536288. Rey-Lopez JP, Rimm EB, Tabung FK, Giovannucci EL. Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults. Circulation. 2022 Aug 16;146(7):523-534. doi: 10.1161/CIRCULATIONAHA.121.058162. Epub 2022 Jul 25. PMID: 35876019; PMCID: PMC9378548. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(19):1262-7. doi: 10.1136/bjsports-2014-094306. Epub 2015 Aug 3. PMID: 26238869. Chandrasekaran B, Ganesan TB. Sedentarism and chronic disease risk in COVID 19 lockdown – a scoping review. Scott Med J. 2021 Feb;66(1):3-10. doi: 10.1177/0036933020946336. Epub 2020 Jul 27. PMID: 32718266; PMCID: PMC8685753. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824-853. doi: 10.1007/s12603-021-1665-8. PMID: 34409961; PMCID: PMC12369211. Bunnell E, Stratton MT. The Impact of Functional Training on Balance and Vestibular Function: A Narrative Review. J Funct Morphol Kinesiol. 2024 Dec 3;9(4):251. doi: 10.3390/jfmk9040251. PMID: 39728235; PMCID: PMC11679947. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-31. PMID: 3920711; PMCID: PMC1424733. Warner A, Vanicek N, Benson A, Myers T, Abt G. Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression. PLoS One. 2022 Nov 3;17(11):e0277031. doi: 10.1371/journal.pone.0277031. PMID: 36327341; PMCID: PMC9632890. “Metabolic Equivalent (MET): Pick the Best Exercise for Longevity.” Whyiexercise.com, www.whyiexercise.com/metabolic-equivalent.html. Love what you heard?Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you! This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— strength and resistance training, exercises for vestibular disorders, living with vestibular migraine, guidelines of physical activity, anxiety and depression, chronic dizziness, couch bound, bed bound, dizzy-anxious-dizzy cycle, physical therapist

A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case.Hosts:·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical CenterLearning objectives:-       Recognize the clinical presentation and pathophysiology of phlegmasia cerulea dolens-       Describe how pregnancy affects decision making in patients with phlegmasia and venous thromboembolic disease-       Discuss the goals of treatment for patients with DVT's and identify when operative intervention is indicated-       Describe the sequelae of DVT's and how this relates to post thrombotic syndrome-       Review the indications, risks, and limitations of anticoagulation, catheter-directed thrombolysis, thrombectomy, and fasciotomy in the management of DVT and phlegmasia.-       Explain the role of IVUS in managing venous thromboembolic disease and May Thurner syndromeReferences:-       Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., … Kearon, C. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. New England Journal of Medicine, 377(23), 2240–2252. https://doi.org/10.1056/NEJMoa1615066-       Gomes, M. S., Guimarães, M., & Montenegro, N. (2019). Thrombolysis in pregnancy: A literature review. Journal of Maternal-Fetal & Neonatal Medicine, 32(14), 2418–2428. https://doi.org/10.1080/14767058.2018.1438402-       Mangla, A., & Hamad, H. (2023). May-Thurner syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554377/-       Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., et al. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Advances, 2(22), 3317–3359. https://doi.org/10.1182/bloodadvances.2018024802-       Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., et al. (2014). The postthrombotic syndrome: Evidence-based prevention, diagnosis, and treatment strategies. Circulation, 130(18), 1636–1661. https://doi.org/10.1161/CIR.0000000000000130 https://pubmed.ncbi.nlm.nih.gov/25246013/Sponsor URL: https://www.goremedical.com/If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, the we welcome back guest host, Dr. Neelou Weeker, and ED nurse, Leigh Clary, to discuss the critical intersection of language barriers, patient equity, and emergency care. Through two powerful clinical scenarios, the team explores the “gold standards” of medical translation, the challenges of resource-limited community settings, and how TeamSTEPPS tools—specifically closed-loop communication and situational monitoring—can be leveraged to ensure true informed consent and patient safety. The Gold Standard vs. Clinical Reality Providing equitable care means ensuring every patient, regardless of language or culture, fully understands their medical team. While academic centers are often highly resourced, executing communication seamlessly remains a universal challenge. 1. Translation Tools and Hierarchy The Gold Standard: Video- or audio-based professional interpretation tablets allow face-to-face or direct vocal translation. The Secondary Backup: In-house dual-handset “blue phones” connect directly to professional phone lines when tablets experience connectivity issues. The Tertiary Backup: Multilingual staff members can help act as a bridge. Many institutions feature language fluencies on staff ID badges. Note: Staff members should only be used to establish initial rapport or identify the required dialect, not as official medical interpreters. The Danger of Family Interpreters: While family members bring invaluable cultural context and an understanding of the patient’s baseline, studies show they only correctly interpret medical dialogue 19% of the time. The Bottom Line: Always utilize the official route first. When technology fails, do your absolute best—never settle for “good enough” when better communication is possible. 2. Academic vs. Community and Rural Settings Emergency medicine requires extreme adaptability. In resource-limited community or rural hospitals, finding an interpreter for less commonly spoken languages can take upwards of 30 minutes. Physicians must sometimes physically carry translation phones from room to room while managing other patients just to maintain an open line with a rare-dialect interpreter. Applying TeamSTEPPS to Patient Communication We routinely use TeamSTEPPS tools to communicate with our fellow clinicians, but we must remember that the patient is the most important member of the healthcare team. 1. Closed-Loop Communication & The Teach-Back Method To confirm true patient understanding, avoid simple “yes or no” questions, nods, or smiles. Instead, utilize the Teach-Back Method, requiring the patient to repeat the instructions or choices back to you in their own words. How to Phrase It (Taking Responsibility): “I want to make sure that I have been clear in what I’ve said to you. To help me feel reassured that I communicated everything correctly, could you tell me what you understand is going on?” Clinical Value: This is particularly vital for high-stakes decisions and ED discharge instructions. Multimodal Approach: In high-stakes moments, combine professional translation, family context, and teach-back to minimize errors. 2. Situational Monitoring Resuscitative environments are chaotic, and the primary physician trying to run a cod or secure an airway has immense cognitive load. The Team Safety Net: Other team members (nurses, techs, scribes) can help monitor the situation and catch critical communication errors. Reconciling Clinical Urgency with Informed Consent How do you balance the immediate need to save a life with the time-consuming process of formal translation? The ABC Priority: First and foremost, secure Airway, Breathing, and Circulation. If a patient presents to the ED in extremis and cannot communicate, clinicians must operate under the assumption that the patient wants life-saving measures performed. Task Delegation: While the medical team manages the immediate ABCs, immediately task support staff (such as social workers) with finding an official interpreter, locating family members, and gathering background information. Next Steps: Once the ABCs are stable, the team has the time and space to pause, establish formal translation, and dive deeper into informed consent for further procedures. Key Takeaways Acknowledge the Bias of Urgency: Time pressure can tempt us to bypass official translation channels. Guard against this by maintaining an equity-first mindset. Close the Loop with Patients: Ensure they can paraphrase their care plan or consent choices. Protect the Team via Shared Roles: Trust your teammates to monitor the big picture and catch subtle communication gaps during high-stress resuscitations. Do you use TeamSTEPPS or a similar model in your ED? We'd love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Host: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN. TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality EM Pulse: TeamSTEPPS, September 17, 2021  *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services. Disclaimer: The opinions expressed on this podcast are those of the hosts or guests and do not necessarily reflect the views of UC Davis Department of Emergency Medicine, UC Davis Health, or their parent organizations.  

This week, please join authors Rasha K. Al-Lamee and Fiyyaz Ahmed-Jushuf as well as Associate Editor Emmanouil Brilakis as they discuss the article "Determining the Physiological Threshold for Angina (ORBITA-FIRE): A Double-Blind, Randomized, Placebo-Controlled Study." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260608.559074

In this episode, we review key updates from the 2026 ACC-AHA Guidelines on the Management of Dyslipidemia. Key Concepts The PREVENT ASCVD equation is now recommended to calculate ASCVD risk, with thresholds at 3%, 5%, and 10%. The previous 7.5% threshold for statin treatment is now 5%. In addition to the 10-year ASCVD estimate, clinicians should consider the use of Lp(a), "risk enhancers", and coronary artery calcium (CAC) scans as a "tie breaker" with shared decision-making when the decision to treat is not clear. In addition to LDL goals of < 100, < 70, or < 55 (depending on risk), the new guidelines also suggest non-HDL-C and apoB goals once LDL cholesterol is at goal. Many patients will require non-statin therapies to achieve lipid goals. The recommended non-statin therapies include ezetimibe, PCSK9 mAb, PCSK9-interfering RNA, and bempedoic acid. References Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/CIR.0000000000001423 Wiggins BS, Barac A, Benziger CP, et al. 2026 Dyslipidemia Guideline-at-a-Glance. J Am Coll Cardiol. 2026;87(19):2617-2623. doi:10.1016/j.jacc.2026.02.4872 Superko H, Garrett B. Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with 'Normal' LDL-C Levels. Biomedicines. 2022;10(4):829. Published 2022 Apr 1. doi:10.3390/biomedicines10040829

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

This week, please join author Sreekanth Vemulapalli as he discusses the article "Adaptive AI for Cardiovascular Event Adjudication: Cardiovascular Event Adjudication Across Different Definitions in the ODYSSEY OUTCOMES and EUCLID Trials." For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20260601.995930

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

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

Join CardioNerds EP Council Chair Dr. Naima Maqsood and Episode Lead Dr. Sukriti Banthiya as they discuss the results of the International Collaborative LBBAP Study (I-CLAS) with expert faculty Dr. Theofanie Mela and Dr. Pugazhendhi Vijayraman. Audio editing by CardioNerds academy intern, Grace Qiu. The International Collaborative LBBAP Study (I-CLAS) evaluated clinical outcomes between biventricular pacing (BVP) and left bundle branch area pacing (LBBAP) in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing cardiac resynchronization therapy. Between January 2018 and June 2023, 2,579 patients were enrolled across 18 centers. The primary composite outcome was defined as all-cause mortality or heart failure hospitalization. LBBAP demonstrated a shorter paced QRS duration and was associated with a lower risk of primary composite outcome and heart failure hospitalization. No significant difference was observed in all-cause mortality. Additionally, procedural complications were lower with LBBAP. This episode was planned in collaboration with  Heart Rhythm TV with mentorship from Dr. Daniel Alyesh and Dr. Mehak Dhande.  Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Journal Club PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

In this episode, CardioNerds Dr. Colin Blumenthal, Dr. Kelly Arps, and Dr. Yong Hao Yeo are joined by electrophysiology expert Dr. Bradley Knight to discuss atrial fibrillation (AF) management in challenging clinical scenarios. We explore arrhythmias in patients with pre-excitation syndromes, particularly Wolff-Parkinson-White (WPW) syndrome, and strategies for rhythm control. We also discuss AF management in pregnancy, adult congenital heart disease, and patients with tachycardia-bradycardia (tach-brady) syndrome. This episode provides essential insights into nuanced decision-making for the care of patients with complex arrhythmia profiles. Audio editing by CardioNerds academy intern, Grace Qiu. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! PEARLS AF in WPW is a true emergency—AV nodal blocking agents can be deadly. In patients with WPW syndrome, AF can rapidly conduct through the accessory pathway, risking ventricular fibrillation and sudden death. Avoid AV nodal blockers like beta-blockers and calcium channel blockers. Catheter ablation is the first-line rhythm control strategy in WPW. Catheter ablation carries a Class I recommendation and offers >90% success. If antiarrhythmic drugs are needed, sodium channel blockers like flecainide or propafenone are preferred in patients without structural heart disease. In pregnancy, protecting the mother is protecting the fetus. An unstable mother means an unstable fetus. Rate control is the first step in AF with rapid ventricular responses and electrical cardioversion is safe when needed. Multidisciplinary care is essential. AF in congenital heart disease is often outside the pulmonary veins. Surgical scars and chamber remodeling in ACHD patients often lead to AF from non-pulmonary vein foci. Electrogram-based mapping and targeted ablation strategies are essential to increase success rate of durable rhythm control. Tachy-brady syndrome may require pacing to unlock therapy. AF may cause atrial myopathy and sinus node dysfunction. These patients often require permanent pacing to allow safe use of rate-controlling medications like beta-blockers and to prevent syncope or chronotropic incompetence. Notes: Notes drafted by Dr. Yong Hao Yeo Why is atrial tachycardia in patients with WPW syndrome dangerous? Patients with WPW commonly present with supraventricular tachycardia (SVT) due to atrioventricular reentrant circuits, either orthodromic or antidromic. This SVT can degenerate into AF. In the absence of AV nodal as the governor between the atrium and ventricles, the accessory pathway may conduct impulses rapidly and frequently. This can lead to dangerously high ventricular rates, predisposing patients to ventricular fibrillation and sudden cardiac arrest. What are some strategies for rhythm control in patients with WPW and atrial tachycardia? Catheter ablation is the first-line therapy (Class I recommendation), with a success rate of over 90%. Ablation reduces the risk of sudden cardiac arrest, though some patients may remain prone to AF. If ablation is not feasible/ contraindicated, sodium channel blockers such as flecainide and propafenone are good options in patients without ischemia or structural heart disease (Class IIa recommendation). Amiodarone should be avoided because it has a long half-life, can accumulate in the system, and may delay definitive treatment with catheter ablation. AV nodal blocking agents like beta blockers and calcium channel blockers should be avoided, as they are less effective at controlling ventricular rate in WPW and can increase conduction over the accessory pathway. These agents can also exacerbate the risk of rapid ventricular rates during AF and worsen left ventricular function. What are some special considerations in managing AF in pregnant patients? The primary goal in managing cardiovascular disease during pregnancy is to protect the mother, as fetal outcomes depend on maternal well-being. Therefore, while caution is necessary, we should avoid undertreating pregnant patients with AF. In cases of AF with rapid ventricular response (RVR), rate control is usually the first-line strategy, with beta blockers preferred over digoxin or non-dihydropyridine calcium channel blockers. It is then reasonable to initially observe for spontaneous conversion in stable patients. Antiarrhythmic drugs (AADs) are generally avoided during the first trimester, but clinical judgment on a case-by-case basis is essential. Evidence for the safety of AADs in pregnancy is limited, often derived from their use in other conditions such as fetal SVT. Flecainide and sotalol are reasonable options for rhythm control (Class IIa recommendation). Electrical cardioversion is considered safe in pregnancy and should be utilized when indicated (Do not forget!). There is no pregnancy-specific thromboembolic risk stratification tool. CHA₂DS₂-VASc scoring and the presence of risk factors like mitral stenosis can help guide anticoagulation decisions, though the magnitude of thromboembolic risk during pregnancy remains unclear. Rate control agents are typically continued during delivery due to the increased physiologic stress of labor and delivery. Multidisciplinary care is crucial and should involve obstetrics, maternal-fetal medicine, cardiology, and electrophysiology specialists. What are some key considerations for AF management in patients with adult congenital heart disease (ACHD)? Patients with repaired congenital heart disease are at increased risk for arrhythmias due to two main factors: surgical scars that create arrhythmogenic foci and mechanical remodeling of the atria or ventricles resulting from the underlying disease. In these patients with structural heart disease, sodium channel blockers may not be ideal antiarrhythmic options. When selecting an antiarrhythmic drug, clinicians must consider the nature of structural or surgical impairments, such as right bundle branch block or prolonged QT interval. It is also essential to assess renal and hepatic function (often impaired in patients with ACHD) to ensure appropriate metabolism and clearance of antiarrhythmic medications. Electrogram-based ablation strategies (those leveraging artificial intelligence are developing!) may help identify effective ablation targets, which are often outside the pulmonary veins in patients with ACHD. These individualized approaches can improve ablation success rates in this complex patient population. What makes tachycardia-bradycardia (tach-brady) syndrome a unique challenge in arrhythmia management? Patients who present with both AF and bradycardia, especially with syncope, require a thoughtful diagnostic approach to identify the underlying rhythm disturbance. Extended cardiac monitoring, including event monitors or implantable loop recorders, can help capture intermittent arrhythmias and correlate them with symptoms. AF may lead to atrial myopathy, and since the sinus node resides within the atrium, this can result in sinus node dysfunction—a hallmark of tachy-brady syndrome. Following spontaneous conversion from AF to sinus rhythm, sinus node dysfunction may persist, leading to prolonged pauses or chronotropic incompetence. Management becomes more complex when beta-blockers are needed for AF with RVR, as they can exacerbate bradycardia. Permanent pacemaker implantation is often the next step to consider. Permanent pacemaker implantation is often considered to facilitate safe rate control in these cases. In younger patients, aggressive AF burden reduction may prevent atrial remodeling and the development of true atrial myopathy, potentially avoiding pacemaker implantation. References Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;149(1). doi:https://doi.org/10.1161/CIR.0000000000001193 ‌ Van IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024;45(36). doi:https://doi.org/10.1093/eurheartj/ehae176 ‌ Joglar JA, Kapa S, Saarel EV, et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. Published online May 1, 2023. doi:https://doi.org/10.1016/j.hrthm.2023.05.017 ‌ Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary. Journal of the American College of Cardiology. 2019;73(12):1494-1563. doi:https://doi.org/10.1016/j.jacc.2018.08.1028 ‌

Nick Norwitz has an MD, a PhD, and a cholesterol level that should have killed him — at least according to the standard model of cardiovascular disease. For seven years, his total cholesterol held above 700. His LDL sat in the high 500s. Every clinical algorithm flagged him as a cardiac emergency. He took none of the prescribed medications.His just-published case report shows zero coronary plaque. Not reduced. Not minimal. Zero.This episode isn't a victory lap. It's a serious conversation about what that result means — for how medicine measures risk, how it handles outliers, and why the incentive structures that shape clinical decisions may be more dangerous than any single cholesterol number. Dr. Philip Ovadia and Nick Norwitz also go deep on a fraudulent case report published in Circulation, why statins suppress GLP-1 levels and almost no cardiologist knows it, and what happens when the patient who refuses to follow the algorithm turns out to be right.#metabolichealth #cholesterol #ketodiet #heartdisease #LDLcholesterol #evidencebasedmedicine #lowcarb #preventivecardiologyBIG IDEAA patient with seven years of astronomically high cholesterol and zero coronary plaque is not an outlier to dismiss — he is a question medicine is obligated to answer.Nick Norwitz Contact InfoNewsletter: staycuriousmetabolism.com (Top 2 Best-Selling in Science, Globally)YouTube: https://www.youtube.com/@nicknorwitzMDPhD (>1M Subscribers)Twitter: https://x.com/nicknorwitzInstagram: https://www.instagram.com/nicknorwitz/LinkedIn: https://www.linkedin.com/in/nicknorwitz/Threads: https://www.threads.net/@nicknorwitzFacebook: https://www.facebook.com/nicknorwitzNick's Case Report:Seven Years of 700 Cholesterol Without CoronaryAtherosclerosis: A Lean Mass Hyper-Responder Case ReportSend Dr. Ovadia a Text Message. (If you want a response, you must include your contact information.) Dr. Ovadia cannot respond here. To contact his team, please send an email to team@ifixhearts.com Order at Amazon: Stay Off My Kitchen Table  Like what you hear? Head over to IFixHearts.com/book to grab a copy of my book, Stay Off My Operating Table. Ready to go deeper? Talk to someone from my team at IFixHearts.com/talk.Ready to take control of your health?  Grab Dr. Ovadia's brand new book Stay Off My Kitchen Table now! This isn't just another diet book; it reveals why it's not just what you eat, but what your body actually absorbs that determines your health.If you're struggling with low energy, stubborn weight, or feeling like “healthy eating” isn't working… this book shows you exactly how to fix it.Learn how to reset your gutEliminate hidden foods sabotaging your progressUnlock real energy, metabolism, and longevityDon't wait until it's too late. Take action today. Get your copy of Stay Off My Kitchen Table now.Learn More:Take Dr. Ovadia's metabolic health quiz: iFixHearts Dr. Ovadia's website: Ovadia Heart HealthTheme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey (c) 2016 Mercury Retro RecordingsAny use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

On this vintage episode of Vitality Radio, Jared takes a hard look at the cholesterol hypothesis and why it has failed to deliver true solutions for heart health. Instead of focusing on lowering cholesterol—a vital compound for hormones, brain function, and cellular integrity—he highlights the often-overlooked root cause: stiff, aging arteries. You'll learn how the blood vessels lose flexibility with age, stress, toxins, poor diet, and inactivity, and why this breakdown leads to high blood pressure and drives cardiovascular risk far more than cholesterol numbers alone. Jared explains the role of nitric oxide in reversing arterial aging and how natural boosters like beets, leafy greens, and amino acids support healthy nitric oxide production. This episode is about shifting the conversation: instead of suppressing what the body needs, learn how to encourage its own built-in repair and resilience mechanisms.Products:N.O. Cardio BoostVital D3/K2Ultimate Vitality MultiNutraBio Beet Root PowderSolaray Beet Root CapsulesNutraBio L-Citrulline PowderBlack Market Labs L-Citrulline PowderJust Ingredients Pre-Workout Visit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

10. Medical Symbolism in Vermeer's The Lacemaker Guest: Andrew Graham Dixon Andrew Graham Dixonprovides a speculative interpretation of The Lacemaker, arguing the painting contains coded references to blood circulation and placental science that were being discovered by medical scholars during that era. 101900 LA

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