Podcasts about preventive cardiology

Episode 124!Joining us in the studio today is Dr. John Osborne. Dr. Osborne is a Harvard-trained, world-renowned cardiologist with a Ph.D. in cardiovascular physiology.  He is a preventive heart health pioneer with over 30 years at the forefront of cutting edge heart disease prevention as a life-saver, disruptor and visionary on a mission to eradicate preventable heart disease by 2040. Dr. Osborne is currently Chief Medical Officer of ClearCardio LLC, a company leading the AI revolution in Preventive Cardiology by merging AI-driven diagnostics with science-backed, personalized medicine.Tune in to hear Dr. Osborne share how his team is changing the narrative to one where we all believe “Heart Attacks Don't Have to Happen”.  Enjoy!  ===========================================================================Follow Dr. Osborne here: Website: https://clearcardio.com/Thanks for listening! Eric Sardina Executive Life Coaching As a business and life coach, I help individuals work towards authentic lives of meaning and purpose. I also work with organizations to optimize their teams and individual contributors. Interested in working with me or learning more? Connect with me below: Website: https://www.ericsardina.com - book a free, 15-minute strategy session. https://calendly.com/ericsardina/8-session-authentically-you-discovery-call-website-linkFollow me on: Instagram: @theericsardina Facebook: Eric SardinaLinkedIn: https://www.linkedin.com/in/ericsardina/ YouTube: https://www.youtube.com/@EricSardina Affiliate: LMNT hydration drink mix: get a free sample pack with your first order by using this link: http://elementallabs.refr.cc/ericsardina

In this profound episode of Parallax, Dr Ankur Kalra welcomes Dr Pam Taub, Professor of Medicine and Director of Preventive Cardiology at UC San Diego, for an enlightening conversation about integrating spirituality, purpose, and scientific curiosity in cardiovascular practice. Dr Taub shares her unique philosophical foundation, shaped by exposure to diverse religions in South India. This experience fostered her belief that all faiths fundamentally center on being a good person and serving others. She explores how this spiritual perspective transforms medicine from a profession into a sacred calling, where patient interactions become profound privileges that fuel her desire to make meaningful impact beyond individual achievements. The episode highlights Dr Taub's groundbreaking work with POTS (Postural Orthostatic Tachycardia Syndrome), demonstrating how scientific curiosity serves as a spiritual path. Her research journey—from recognizing misdiagnosed conditions to conducting the first clinical trial for ivabradine in POTS—exemplifies how deeper questioning and evidence-based inquiry can transform patient lives on a broader scale. The episode also explores Dr Taub's research on time-restricted eating, connecting modern scientific evidence to fasting practices across many faiths. Questions and comments can be sent to "podcast@radcliffe-group.com" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In our May episode, we marked Hypertension Awareness Month with Dr. Robert Ostfeld, a cardiologist at Montefiore Medical Center. Dr. Ostfeld shared how his patients naturally lowered their blood pressure by adopting a plant-based diet and offered tips for eating more plant-based foods. In this month's Key Note, he explains how getting proper sleep can reduce stress hormones that contribute to high blood pressure. The Takeaway We want to hear from you! Please complete our survey: org/member-feedback. Drop us a line at our social media channels: Facebook// Instagram // YouTube. Get started on your health journey by making an appointment with your primary care physician to know your numbers. Get to know your numbers at 1199SEIUBenefits.org/healthyhearts. Find healthy recipes and meal-prep tips at 1199SEIUBenefits.org/food-as-medicine. Visit the Healthy Living Resource Center for wellness tips, information and resources; 1199SEIUBenefits.org/healthyliving. Get inspired by fellow members through our Members' Voices series: 1199SEIUBenefits.org/healthyliving/membervoices. Stop by our Benefits Channel to join webinars on building healthy meals, managing stress and more: 1199SEIUBenefits.org/videos. Visit our YouTube channel to view a wide collection of healthy living videos: youtube.com/@1199SEIUBenefitFunds/playlists. Sample our wellness classes to exercise body and mind: 1199SEIUBenefits.org/wellnessevents. Robert Ostfeld, MD, MSc, FACC, is the Director of Preventive Cardiology at Montefiore Health System and a Professor of Medicine at the Albert Einstein College of Medicine. Dr. Ostfeld treats patients with adult cardiovascular disease, including coronary artery disease, hypertension, hyperlipidemia and erectile dysfunction with a focus on prevention and treatment through lifestyle change. He works closely with his patients to help them adopt a plant-based diet. Dr. Ostfeld received his Bachelor of Arts in the Biologic Basis of Behavior from the University of Pennsylvania, graduating Summa Cum Laude and Phi Beta Kappa and his Doctor of Medicine from Yale University School of Medicine. He then did his medical internship and residency at the Massachusetts General Hospital and his Cardiology Fellowship and Research Fellowship in Preventive Medicine at Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. During his Cardiology Fellowship, he earned a Master's of Science in Epidemiology from the Harvard School of Public Health. Dr. Ostfeld's research focus is on cardiovascular disease prevention and reversal through lifestyle modification. Ongoing topics he investigates include the impact of plant-based nutrition on erectile function, coronary artery disease, angina and heart failure. His work has been published in peer-reviewed journals, books, articles, and clinical statements and has been presented nationally. Dr. Ostfeld is board certified in Cardiovascular Disease and Echocardiography, and he is a member of numerous professional societies, including the Physician's Committee for Responsible Medicine and the American College of Cardiology.

In this conversation, Dr. Jennie Berkovich and Dr. Alan Rozanski explore the intricate relationship between stress, optimism, and cardiac health. They discuss the impact of chronic stress on cardiovascular disease, the importance of resilience, and how positive mindsets can promote longevity. The dialogue emphasizes the need for a holistic approach to health that includes behavioral management, mindfulness, and exercise. Dr. Rozanski shares insights on how to effectively communicate these concepts to patients, highlighting the significance of time management in maintaining health. The conversation concludes with a look towards the future of cardiology and patient education.Dr. Alan Rozanski is Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Chief Academic Officer, Executive Director of Cardiac Education and Fellowship Training Programs, and Director of Nuclear Cardiology for the Department of Cardiology at Mount Sinai St. Lukes.A graduate of Yale University and the Tufts University School of Medicine, Dr. Rozanski completed his Internal Medicine and Cardiology Fellowship training at Mount Sinai Hospital and a fellowship in Nuclear Medicine at Cedars-Sinai Medical Center in Los Angeles.While at Cedars-Sinai Medical Center, Dr. Rozanski founded a large multi-disciplinary program in Preventive and Rehabilitative Cardiology and initiated research which helped lead to the creation of a new field of Behavioral Cardiology. This led to a prestigious Sabbatical Fellowship from the MacArthur Foundation to study the determinants of health-promoting and health-damaging behaviors alongside many leading behavioral clinicians across the nation.In 1990, Dr. Rozanski joined the cardiology staff of St. Lukes/Roosevelt Hospital (now Mount Sinai St. Lukes and Mount Sinai West Hospitals) where he eventually served as Chief of Cardiology before assuming his current positions.Dr. Rozanski is noted for his unique clinical and academic focus and novel research that uniquely integrates the fields of Preventive Cardiology with Health Psychology and Behavioral Medicine.In addition, Dr. Rozanski is a leading expert in applying Cardiac Imaging for optimal Risk Assessment and Clinical Decision Making among patients who are candidates for cardiac testing due to risk factors or symptoms which are suggesting of heart disease.Dr. Rozanski is the co-author of over 270 peer-reviewed medical articles, book chapters and medical editorials, many of which are considered seminal contributions to the fields of Cardiology and/or Health Psychology._________________________________________________Sponsor the JOWMA Podcast! Email digitalcontent@jowma.orgBecome a JOWMA Member! www.jowma.orgFollow us on Instagram! www.instagram.com/JOWMA_orgFollow us on Twitter!www.twitter.com/JOWMA_medFollow us on Facebook! https://www.facebook.com/JOWMAorgStay up-to-date with JOWMA news! Sign up for the JOWMA newsletter! https://jowma.us6.list-manage.com/subscribe?u=9b4e9beb287874f9dc7f80289&id=ea3ef44644&mc_cid=dfb442d2a7&mc_eid=e9eee6e41e

In this episode of the Smarter Not Harder Podcast, Dr. Abid Husain joins Dr. Scott Sherr for a masterclass on cardiovascular health — from cholesterol myths to mitochondrial truth. They explore what truly drives inflammation, plaque formation, and cardiovascular risk, while dismantling the outdated “cholesterol = heart disease” narrative. Whether you're a clinician or simply someone trying to make smarter choices for your heart, this episode offers insight into testing, interventions, and personalized strategies that go beyond basic lipid panels. Join us as we delve into: + Why LDL alone doesn't tell the full story of cardiovascular risk + How mitochondria, hormones, and inflammation intersect with lipid metabolism + The real role of CCTA scans, plaque imaging, and particle size analysis + Advanced medications and peptides that support vascular and metabolic health This episode is for you if: - You've been told to fear cholesterol but want the full picture - You're a practitioner looking to personalize cardiovascular treatment plans - You've heard of statins and PCSK9s but don't know when or why to use them - You're curious about GLP-1s, NO precursors, and other precision tools for heart health You can also find this episode on… YouTube: https://youtu.be/npYvJS2cpGc Find more from Dr. Abid Husain: Boulder Longevity: https://boulderlongevity.com LinkedIn: https://www.linkedin.com/in/abid-husain-md-facc-abaarm-00874419/ Find more from Smarter Not Harder: Website: https://troscriptions.com/blogs/podcast | https://homehope.org Instagram: @troscriptions | @homehopeorg Get 10% Off your purchase of the Metabolomics Module by using PODCAST10 at https://www.homehope.org Get 10% Off your Troscriptions purchase by using POD10 at https://www.troscriptions.com Get daily content from the hosts of Smarter Not Harder by following @troscriptions on Instagram.

Participating in religious activities appears to benefit cardiovascular health among Black Americans. It's something we explored in an episode on this podcast a few years back. Health systems, professional societies and researchers are increasingly recognizing that “faith-based organizations are trusted institutions within underserved communities and that people not only seek spiritual refuge and salvation in these places of worship, but they are also wonderful, trusted vessels to  distribute reliable health information,” says Dr. LaPrincess Brewer, a faculty member in the division of  Preventive Cardiology, department of Cardiovascular Medicine at Mayo Clinic. “Participating in religious activities from church services to private prayer, as well as holding deep spiritual beliefs are  linked to better cardiovascular health among Black Americans," according to researchers of a 2022 study published in the Journal of the American Heart Association. The researchers go on to suggest that recognition by health professionals and researchers of the centrality and influence of religiosity and spirituality in the lives of African American adults may serve as a means to address cardiovascular health disparities. In an episode that was first published in 2023, Movement Is Life's Dr. Mary O'Connor spoke with Dr. Brewer, whose primary research focus is reducing cardiovascular disease health disparities in racial and ethnic minority populations  and in underserved communities, and Clarence Jones, a community engagement specialist and former director of community engagement at a federally qualified health center in Minneapolis who has extensive experience in  collaborating with community and faith-based partners in promoting community wellness and access to health services.  Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.  

For Hypertension Awareness Month, we are fortunate to have Dr. Robert Ostfeld, a cardiologist at Montefiore Medical Center, join us to talk about lifestyle approaches for treating – and preventing – high blood pressure. In this episode, Dr. Ostfeld explains the numbers, the symptoms – or lack of symptoms – and the associated risks. A self-confessed “reformed cardiologist,” he talks about how he saw his patients who adopted a plant-based diet significantly lower their blood pressure. Not ready to go totally plant-based? Dr. Ostfeld says simply adding more fruits, vegetables and whole grains to your diet can help lower not only your blood pressure but also your risk for heart disease, stroke and dozens of other conditions.   The Takeaway We want to hear from you! Please complete our survey: org/member-feedback. Drop us a line at our social media channels: Facebook// Instagram // YouTube. Get started on your health journey by making an appointment with your primary care physician to know your numbers. Get to know your numbers at 1199SEIUBenefits.org/healthyhearts. Find healthy recipes and meal-prep tips at 1199SEIUBenefits.org/food-as-medicine. Visit the Healthy Living Resource Center for wellness tips, information and resources; 1199SEIUBenefits.org/healthyliving. Get inspired by fellow members through our Members' Voices series: 1199SEIUBenefits.org/healthyliving/membervoices. Stop by our Benefits Channel to join webinars on building healthy meals, managing stress and more: 1199SEIUBenefits.org/videos. Visit our YouTube channel to view a wide collection of healthy living videos: youtube.com/@1199SEIUBenefitFunds/playlists. Sample our wellness classes to exercise body and mind: 1199SEIUBenefits.org/wellnessevents. Robert Ostfeld, MD, MSc, FACC, is the Director of Preventive Cardiology at Montefiore Health System and a Professor of Medicine at the Albert Einstein College of Medicine. Dr. Ostfeld treats patients with adult cardiovascular disease, including coronary artery disease, hypertension, hyperlipidemia and erectile dysfunction with a focus on prevention and treatment through lifestyle change. He works closely with his patients to help them adopt a plant-based diet. Dr. Ostfeld received his Bachelor of Arts in the Biologic Basis of Behavior from the University of Pennsylvania, graduating Summa Cum Laude and Phi Beta Kappa and his Doctor of Medicine from Yale University School of Medicine. He then did his medical internship and residency at the Massachusetts General Hospital and his Cardiology Fellowship and Research Fellowship in Preventive Medicine at Brigham and Women's Hospital, both teaching hospitals of Harvard Medical School. During his Cardiology Fellowship, he earned a Master's of Science in Epidemiology from the Harvard School of Public Health. Dr. Ostfeld's research focus is on cardiovascular disease prevention and reversal through lifestyle modification. Ongoing topics he investigates include the impact of plant-based nutrition on erectile function, coronary artery disease, angina and heart failure. His work has been published in peer-reviewed journals, books, articles, and clinical statements and has been presented nationally. Dr. Ostfeld is board certified in Cardiovascular Disease and Echocardiography, and he is a member of numerous professional societies, including the Physician's Committee for Responsible Medicine and the American College of Cardiology.

Quand on parle d'alcool et de grossesse, le message est clair : les femmes doivent éviter toute consommation pendant cette période. Mais un aspect encore méconnu du grand public mérite davantage d'attention — celui du rôle de l'homme avant la conception. De plus en plus d'études scientifiques montrent que les habitudes de vie du futur père, notamment la consommation d'alcool, peuvent avoir un impact direct sur la santé du bébé à naître.Une méta-analyse chinoise de 2020, publiée dans la revue European Journal of Preventive Cardiology, a compilé les données de plusieurs études portant sur les habitudes de consommation d'alcool chez les hommes avant la conception. Les résultats sont sans appel : la consommation paternelle d'alcool est associée à un risque significativement plus élevé de malformations congénitales, notamment des malformations cardiaques. Selon cette analyse, si le père consomme de l'alcool dans les trois mois précédant la conception, le risque de certaines anomalies augmente de manière notable.Mais comment expliquer ce phénomène ? Contrairement à une idée reçue, le rôle du père ne se limite pas à la fécondation. La qualité du sperme — et donc de l'ADN qu'il transmet — peut être altérée par des facteurs environnementaux, dont l'alcool. L'éthanol et ses métabolites peuvent endommager l'ADN du spermatozoïde, générer du stress oxydatif, perturber l'expression génétique ou même modifier l'épigénome. Autrement dit, même avant la fécondation, les effets de l'alcool peuvent déjà avoir laissé leur empreinte, avec des conséquences pour le futur développement de l'embryon.Des recherches sur les modèles animaux ont également montré que la consommation d'alcool chez le père pouvait entraîner des troubles du développement neurologique chez les descendants, incluant des déficits cognitifs, de l'hyperactivité ou des comportements anxieux. Ces effets sont de plus en plus étudiés dans le cadre de ce que les chercheurs appellent le syndrome d'alcoolisation fœtale d'origine paternelle — un concept encore en cours d'exploration mais qui tend à s'imposer. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Oltre 3.500 donne lombarde coinvolte e un messaggio che non lascia spazio a dubbi: la consapevolezza femminile sui rischi cardiovascolari è ancora troppo bassa. Più del 64% delle partecipanti non sa che le malattie cardiovascolari sono la prima causa di morte tra le donne. Una disinformazione silenziosa che può avere conseguenze drammatiche. Lo rivelano i risultati dell’indagine “A Call for Women”, appena pubblicata sullo European Journal of Preventive Cardiology e coordinata dalla dottoressa Serenella Castelvecchio, responsabile del Programma di Prevenzione Cardiovascolare e Medicina di Genere dell’IRCCS Policlinico San Donato, ospite di Obiettivo Salute.

Save 20% on all Nuzest Products WORLDWIDE with the code MIKKIPEDIA at www.nuzest.co.nz, www.nuzest.com.au or www.nuzest.comThis week on the podcast, Mikki speaks to Dr. Matt Budoff – a world-renowned cardiologist and researcher who has spent decades at the forefront of cardiovascular imaging and prevention. Known for his pioneering work in coronary artery calcium (CAC) scoring and computed tomography angiography (CCTA), Dr. Budoff has helped transform how we detect and assess heart disease risk.In this conversation, we explore what first sparked his interest in cardiovascular imaging and how his views on lipids, plaque, and heart disease risk have evolved over time. We dig into his recent research on lifestyle interventions—particularly low-carbohydrate and ketogenic diets—and how they affect LDL cholesterol, atherosclerosis, and overall coronary health.We also discuss the implications of his KETO study, which found no direct correlation between elevated LDL-C and plaque burden in lean, metabolically healthy individuals following a ketogenic diet.Dr. Matthew J. Budoff is a distinguished cardiologist and professor of medicine at the David Geffen School of Medicine at UCLA. He holds the Endowed Chair of Preventive Cardiology at Harbor-UCLA Medical Center and serves as the Program Director and Director of Cardiac CT in the Division of Cardiology Renowned for his pioneering work in non-invasive cardiovascular imaging, Dr. Budoff has significantly advanced the use of coronary artery calcium (CAC) scoring and computed tomography angiography (CCTA) to detect and monitor coronary artery disease. His research focuses on early detection methods for cardiac disease, aiming to identify high-risk patients and implement preventive strategies Dr. Budoff has authored or co-authored over 50 books and book chapters and more than 2,000 articles and abstracts. His contributions have been recognised with numerous awards, including the Gold Medal Award from the Society of Cardiovascular Computed Tomography and designation as a Master of the Society Matt Budoff https://profiles.ucla.edu/matthew.budoffLMHR https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109  Curranz Supplement: Use code MIKKIPEDIA to get 20% off your first order - go to www.curranz.co.nz  or www.curranz.co.uk to order yours Contact Mikki:https://mikkiwilliden.com/https://www.facebook.com/mikkiwillidennutritionhttps://www.instagram.com/mikkiwilliden/https://linktr.ee/mikkiwilliden

Un reciente informe de la Escuela de Medicina de Harvard destaca que caminar nada más 21 minutos diarios, lo que equivale a 2 horas y media semanales, puede disminuir el riesgo de padecer enfermedades cardíacas en un 30%. Hallazgo similares se publicaron en la revista European Journal of Preventive Cardiology. EPP, caminar 2.337 pasos al día contribuye a reducir el riesgo de muerte por enfermedades del corazón y de los vasos sanguíneos.

In today's episode of The Root Cause Medicine Podcast, Dr. Kate Kresge sits down with Dr. Eve Henry to explore the often-misunderstood world of cholesterol, lipids, and heart disease risk. You'll hear them discuss: 1. Why cholesterol matters for longevity and heart health 2. Advanced lipid testing beyond standard panels 3. How to interpret ApoB, LP(a), and triglyceride levels 4. Understanding medications, supplements, and lifestyle approaches for heart health Dr. Eve Henry is board certified in Internal and Integrative Medicine. With extensive experience in personalized medicine and longevity science, she is dedicated to providing innovative care that optimizes healthspan and lifespan. She was previously Medical Director at Early Medical and is now founder of her own clinic, Eve Henry MD. She also serves as Medical Advisor to multiple start ups and enjoys her work educating leadership teams and consumers on ways to enhance their own health.

Preventive Cardiology

Preventive Cardiology

 While a certain level of stress can serve as a motivator, chronic and excessive stress can take a toll on both our physical and mental well-being. It's essential to recognize the detrimental effects stress can have on our bodies, particularly its role in triggering an increase in stress hormones and inflammatory chemicals. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

One of the team members to consider on your menopause journey is a preventive cardiologist. While your GP or internist may be ordering annual labs for you, they are not experts in lipidology. Most women will see their cholesterol increase steadily during the menopause transition and not have the proper labs taken to assess their cardiovascular disease risk, which is the leading cause of death among women (and men). That risk increases significantly after menopause. This phase of life brings not only physical and hormonal changes but also heightened vulnerability to heart disease. In this episode, we explore how menopause influences heart health and why it's essential for women to be proactive about their cardiovascular wellness. We discuss the hormonal shifts that affect everything from blood pressure to cholesterol. We will also discuss the impact of family history, and genetics and what labs and tests are crucial for assessing your risk. We discuss the ongoing debate over using estrogen as a tool for heart disease prevention versus statins. Dr. Martha Gulati, MD is a preventive cardiologist with a long, impressive list of accolades. To name a few, she is the Past President of the American Society for Preventive Cardiology, professor of cardiology at the Smidt Heart Institute at Cedars Sinai in Los Angeles, and the associate director of the Barbra Streisand Women's Heart Center. She holds the Anita Dann Friedman Endowed Chair in Women's Cardiovascular Medicine and Research. She is the author of the best-seller, “Saving Women's Hearts”. Her exceptional commitment to studying women and cardiac diseases has won her numerous awards and distinctions, including being named by Crain's Chicago Business as one of Chicago's Top 40 under 40. She was a co-investigator in the Women's Health Initiative (WHI). She has published articles in peer-reviewed publications, including The New England Journal of Medicine, Circulation, and Journal of the American Medical Association (JAMA). If I continue going on about Dr. Gulati our time will be up! Let's dig in.Medical Disclaimer:By listening to this podcast, you agree not to use this podcast as medical advice or to make any lifestyle changes to treat any medical condition in yourself or others. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any of my guests on my podcast.Podcast Resources:IG: @drmarthagulatiWebsite: https://drmarthagulati.com/To locate a preventive cardiologist: https://www.aspconline.org/Stay connected to JFW:Watch on my YouTube channel: https://www.youtube.com/@jillfooswellness/videosFollow me on Instagram: https://www.instagram.com/jillfooswellness/Follow me on Facebook: https://www.facebook.com/jillfooswellnessGrab discounts on my favorite biohacking products: https://www.jillfooswellness.com/health-productsEnjoy 20% savings and free shipping at Fullscript for your favorite supplements by leading brands:https://us.fullscript.com/welcome/jillfooswellnessSubscribe to the JFW newsletter at www.jillfooswellness.com and receive your FREE Guide on How To Increase Your Protein in 5 Easy Steps and your free Protein Powder Recipe Ebook. Schedule your complimentary 30-minute Zoom consultation here:https://calendly.com/jillfooswellness/30-minute-zoom-consultations

Did you know that there's a way to detect if you're at risk for the leading cause of death in America? Tune in for Katherine Wilemon is the founder and CEO of the Family Heart Foundation & Laurence S. Sperling, M.D., Chief Medical Officer for the Family Heart Foundation on Cardiovascular Disease.Moments with Marianne airs in the Southern California area on KMET1490AM & 98.1 FM ABC Talk News Radio affiliate!  Katherine Wilemon is the founder and CEO of the Family Heart Foundation (formerly the FH Foundation), a leading research and advocacy non-profit dedicated to reducing heart disease and stroke by advancing the understanding and care of familial hypercholesterolemia (FH) and elevated Lipoprotein(a) [Lp(a)].  https://familyheart.orgLaurence S. Sperling, M.D., FACC, FAHA, FACP, MASPC serves as the Chief Medical Officer for the Family Heart Foundation, a non-profit organization focused on timely identification and improved care of people living with familial hypercholesterolemia and elevated Lp(a) through research, advocacy, and education. He is the Founder and was the Director of The Heart Disease Prevention Center at Emory (1997-2019).  He is currently the Katz Professor in Preventive Cardiology at the Emory University School of Medicine, and Professor of Global Health in the Rollins School of Public Health. https://familyheart.orgFor more show information visit: www.MariannePestana.com

Heart disease is the leading cause of death and disability worldwide. Dr. Shapiro joins us to discuss the increase in cardiovascular disease mortality, the primary causes and risk factors associated with CVD, common treatment approaches, and advances in screenings for risk and new treatments. Read more about Dr. Shapiro at https://school.wakehealth.edu/faculty/s/michael-d-shapiro

Alcohol – it's a ubiquitous part of social gatherings, celebrations, and even daily routines for many. Yet, amidst the conviviality, it's crucial to understand the delicate balance between indulgence and moderation when it comes to alcohol consumption. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

Cardiovascular disease is the biggest killer of Australians and elevated cholesterol is a key risk factor. Host Amelia Phillips and Prof. Karam Kostner discuss the latest strategies to lower cholesterol, including diet protocols, exercise and key supplements. They discuss medications and why it's important that some people get and stay on medications whereas others can manage through lifestyle. They touch on many other elements such as familial hypercholesterolemia, longevity hacks such as lipoprotein(a) test, Omega index and the CAC score.  If you are interested in longevity, already healthy but want to optimise consider these novel tests: Lipoprotein A, omega-3 index, coronary calcium scan. Reach out to Amelia if you would like to organise any of these tests.  Dutch Lipid Score Calculator (to estimate FH risk): https://www.athero.org.au/fh/calculator/  About the guest: Dr Karam Kostner is an Associate Professor of Medicine at the University of Queensland and Director of Cardiology at Mater public and private Hospitals in Brisbane. He is a cardiologist and one of the most experienced lipidologists in Australia. He is in charge of both a large public and private lipid clinic.  Dr Kostner is an associate editor of Atherosclerosis and the Journal of Preventive Cardiology and associate editor and cardiovascular section editor of the European Journal Clinical Investigation and a regular reviewer for many journals, as well as being a NHMRC Grant Reviewer https://cholesterolcare.com.au/our-team/professor-dr-karam-kostner/  About the host: Amelia Phillips is a registered exercise scientist and nutritionist with a career spanning 26 years in health. She's a registered exercise scientist, nutritionist and researcher (with a Masters of Human Nutrition). She was the co-founder of health tech company 12WBT which grew from start-up and more recently Inner Vitality, an 8 week online program using biomarkers and personalised health that she runs with an Integrative GP.  Amelia also consults to health companies, presents and appears in the media, most recently on the Ch9 show Do You Want to Live Forever. Amelia had four kids in five years and is dedicated to empowering women to build a life after kids on the foundation of health (mental and physical), connection and purpose.  If you have a question for Amelia, reach out via Insta @_amelia_phillips, email ap@ameliaphillips.com.au  Find out more at www.ameliaphillips.com.au Find out more about Inner Vitality, a new approach to your health: https://innervitality.ameliaphillips.com.au/pages/  CREDITSHost: Amelia Phillips                                                                                                        Guest: Dr Karam Kostner                                                                                                      Audio Producer: Darren RothMusic: Matt Nicholich                                                                                                      Production Partner: Nova Entertainment Pty Ltd Healthy Her acknowledges the Traditional Owners of the Land we have recorded this podcast on, the Gadigal people of the Eora Nation. We pay our respects to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander cultures. See omnystudio.com/listener for privacy informationSee omnystudio.com/listener for privacy information.

In today's fast-paced world, where stress levels are soaring and lifestyles are increasingly sedentary, the importance of regular exercise cannot be overstated. Incorporating exercise into your daily routine is not just about achieving a certain physique; it's about nurturing your body, mind, and overall well-being. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

A client had a complex surgical procedure on her heart two weeks prior, but it was conducted by way of a catheter threaded up her femoral artery and aorta. Now, she wants to receive massage again. A quick Google search suggests that it would be OK. Her MT is skeptical and wants to be more conservative. Who is right? Listen on for information about transcatheter aortic valve replacement (TAVR) surgery, using AI to make clinical decisions, and how to get to “yes” for people who have recently had surgery. Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.                    Resources:    Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app   Braun, L.A. et al. (2012) ‘Massage therapy for cardiac surgery patients--a randomized trial', The Journal of Thoracic and Cardiovascular Surgery, 144(6), pp. 1453–1459, 1459.e1. Available at: https://doi.org/10.1016/j.jtcvs.2012.04.027.   Grafton-Clarke, C. et al. (2019) ‘Can postoperative massage therapy reduce pain and anxiety in cardiac surgery patients?', Interactive Cardiovascular and Thoracic Surgery, 28(5), pp. 716–721. Available at: https://doi.org/10.1093/icvts/ivy310.   Patients Who Stay in Hospital Less Than 3 Days After TAVR Fare Better (no date) American College of Cardiology. Available at: https://www.acc.org/about-acc/press-releases/2019/03/04/13/53/http%3a%2f%2fwww.acc.org%2fabout-acc%2fpress-releases%2f2019%2f03%2f04%2f13%2f53%2fpatients-who-stay-in-hospital-less-than-3-days-after-tavr-fare-better (Accessed: 26 September 2024).   Pressler, A. et al. (2018) ‘Long-term effect of exercise training in patients after transcatheter aortic valve implantation: Follow-up of the SPORT:TAVI randomised pilot study', European Journal of Preventive Cardiology, 25(8), pp. 794–801. Available at: https://doi.org/10.1177/2047487318765233.   Transcatheter Aortic Valve Replacement (TAVR) (no date). Available at: https://my.clevelandclinic.org/health/treatments/17570-transcatheter-aortic-valve-replacement-tavr (Accessed: 25 September 2024).   Wang, A.T. et al. (2010) ‘Massage therapy after cardiac surgery', Seminars in Thoracic and Cardiovascular Surgery, 22(3), pp. 225–229. Available at: https://doi.org/10.1053/j.semtcvs.2010.10.005.   What recovery looks like 6 months after an aortic valve replacement (2023). Available at: https://www.medicalnewstoday.com/articles/6-months-after-aortic-valve-replacements (Accessed: 25 September 2024).   Sponsors:   Anatomy Trains: www.anatomytrains.com    Elements Massage: www.elementsmassage.com/abmp   MassageBook: www.massagebook.com   Books of Discovery: www.booksofdiscovery.com   The American Massage Conference: www.massagetherapymedia.com/conferences    

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland. DOI: 10.1161/CIRCULATIONAHA.122.063281

In a world where dietary choices abound, understanding what constitutes a truly healthy diet can be challenging. However, several well-researched dietary patterns have emerged as effective frameworks for promoting overall health and well-being. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

Dr. Alan Rozanski is Professor of Medicine at the Icahn School of Medicine at Mount Sinai, and Chief Academic Officer, Executive Director of Cardiac Education and Fellowship Training Programs, and Director of Nuclear Cardiology for the Department of Cardiology at Mount Sinai St. Lukes.  A graduate of Yale University and the Tufts University School of Medicine, Dr. Rozanski completed his Internal Medicine and Cardiology Fellowship training at Mount Sinai Hospital and a fellowship in Nuclear Medicine at Cedars-Sinai Medical Center in Los Angeles. While at Cedars-Sinai Medical Center, Dr. Rozanski founded a large multi-disciplinary program in Preventive and Rehabilitative Cardiology and initiated research which helped lead to the creation of a new field of Behavioral Cardiology. This led to a prestigious Sabbatical Fellowship from the MacArthur Foundation to study the determinants of health-promoting and health-damaging behaviors alongside many leading behavioral clinicians across the nation. In 1990, Dr. Rozanski joined the cardiology staff of St. Lukes/Roosevelt Hospital (now Mount Sinai St. Lukes and Mount Sinai West Hospitals) where he eventually served as Chief of Cardiology before assuming his current positions.     Dr. Rozanski is noted for his unique clinical and academic focus and novel research that uniquely integrates the fields of Preventive Cardiology with Health Psychology and Behavioral Medicine.  In addition, Dr. Rozanski is a leading expert in applying Cardiac Imaging for optimal Risk Assessment and Clinical Decision Making among patients who are candidates for cardiac testing due to risk factors or symptoms which are suggesting of heart disease.    Dr. Rozanski is the co-author of over 270 peer-reviewed medical articles, book chapters and medical editorials, many of which are considered seminal contributions to the fields of Cardiology and/or Health Psychology.

In this episode of AGE BETTER with Barbara Hannah Grufferman, I dive into a groundbreaking conversation about heart health with one of the world's leading experts on cholesterol and heart disease prevention, Dr. Ann Marie Navar. Dr. Navar is an Associate Professor of Medicine and preventive cardiologist at the University of Texas Southwestern Medical Center, with a research focus on preventing heart disease through cholesterol management. She also serves on the Executive Committee of the American Society of Preventive Cardiology.    KEY TAKEAWAYS:    Understanding ApoB: Dr. Navar explains what ApoB is and why it's a more accurate marker for assessing heart disease risk than traditional cholesterol measurements like LDL-C.    Why ApoB Testing Matters: Learn why measuring ApoB can provide a clearer picture of your heart disease risk, especially if you have metabolic risk factors like obesity, diabetes, or high triglycerides, or even if you appear metabolically healthy.    Current Guidelines and Future Recommendations: Dr. Navar discusses the limitations of the current guidelines that focus primarily on LDL-C and the need to revise these guidelines to include routine ApoB testing for a more comprehensive assessment of heart health.    The Role of Coronary Artery Calcium Score: Discover the importance of the coronary artery calcium score test in evaluating plaque buildup in the arteries and how it can complement ApoB testing for a more thorough evaluation of cardiovascular risk.    Join us for this essential discussion to learn how to take proactive steps in managing your heart health with the latest insights from cutting-edge research.    KEY LINKS:  Learn more about Dr. Ann Marie Navar here.   Read more about Dr. Navar's research on ApoB here.    Get more insights in the Coronary Artery Calcium Score Test here.   More information about lipoprotein (a) here.     Don't forget to subscribe to AGE BETTER with Barbara Hannah Grufferman for more expert advice on how to age better!  Learn more about your ad choices. Visit megaphone.fm/adchoices

In today's fast-paced world, where convenience often takes precedence over health, maintaining an optimal weight can sometimes feel like an uphill battle. However, understanding the importance of weight management as a crucial component of a healthy lifestyle is paramount. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

The widespread use of tobacco products, including traditional smoking and vaping, continues to take a heavy toll on public health. Despite concerted efforts to raise awareness of the associated risks, smoking-related illnesses remain a leading cause of preventable death worldwide. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

Pradeep is a brilliant geneticist and Director of Preventive Cardiology, holds the Paul & Phyllis Fireman Endowed Chair in Vascular Medicine at Mass General Hospital and on faculty at Harvard Medical School and the Broad Institute. His prolific research has been illuminating for the field of improving our approach to reduce the risk of heart disease. That's especially important because heart disease is the global (and US) #1 killer and is on the increase. We didn't get into lifestyle factors here since there was so much ground to cover on new tests. drugs, and strategies.A video snippet of our conversation on ApoB. Full videos of all Ground Truths podcasts can be seen on YouTube here. The audios are also available on Apple and Spotify.Transcript with links to key publications and audioEric Topol (00:06):Well, welcome to Ground Truths. I'm Eric Topol and with me is Pradeep Natarajan from Harvard. He's Director of Preventative Cardiology at the Mass General Brigham Health System and he has been lighting it up on the field of cardiovascular. We're going to get to lots of different parts of that story and so, Pradeep welcome.Pradeep Natarajan (00:31):Thanks Eric, really delighted and honored to be with you and have this discussion.Eric Topol (00:36):Well, for years I've been admiring your work and it's just accelerating and so there's so many things to get to. I thought maybe what we'd start off with is you recently wrote a New England Journal piece about two trials, two different drugs that could change the landscape of cardiovascular prevention in the future. I mean, that's one of the themes we're going to get to today is all these different markers and drugs that will change cardiology as we know it now. So maybe you could just give us a skinny on that New England Journal piece.Two New Lipid Targets With RNA DrugsPradeep Natarajan (01:16):Yeah, yeah, so these two agents, the trials were published at the same time. These phase two clinical trials for plozasiran, which is an siRNA against APOC3 and zodasiran, which is an siRNA against ANGPTL3. The reason why we have medicines against those targets are based on human genetics observations, that individuals with loss of function mutations and either of those genes have reduced lipids. For APOC3, it's reduced triglycerides for ANGPTL3 reduced LDL cholesterol and reduced triglycerides and also individuals that have those loss of function mutations also have lower risk for coronary artery disease. Now that's a very similar parallel to PCSK9. We have successful medicines that treat that target because people have found that carriers of loss of function mutations in PCSK9 lead to lower LDL cholesterol and lower coronary artery disease.(02:11):Now that suggests that therapeutic manipulation without significant side effects from the agents themselves for APOC3 and ANGPTL3 would be anticipated to also lower coronary artery disease risk potentially in complementary pathways to PCSK9. The interesting thing with those observations is that they all came from rare loss of function mutations that are enriched in populations of individuals. However, at least for PCSK9, has been demonstrated to have efficacy in large groups of individuals across different communities. So the theme of that piece was really just the need to study diverse populations because those insights are not always predictable about which communities are going to have those loss of function mutations and when you find them, they often have profound insights across much larger groups of individuals.Eric Topol (03:02):Well, there's a lot there that we can unpack a bit of it. One of them is the use of small interfering RNAs (siRNA) as drugs. We saw in the field of PCSK9, as you mentioned. First there were monoclonal antibodies directed against this target and then more recently, there's inclisiran which isn't an RNA play if you will, where you only have to take it twice a year and supposedly it's less expensive and I'm still having trouble in my practice getting patients covered on their insurance even though it's cheaper and much more convenient. But nonetheless, now we're seeing these RNA drugs and maybe you could comment about that part and then also the surprise that perhaps is unexplained is the glucose elevation.Pradeep Natarajan (03:53):Yeah, so for medicines and targets that have been discovered through human genetics, those I think are attractive for genetic-based therapies and longer interval dosing for the therapies, which is what siRNAs allow you to do because the individuals that have these perturbations, basically the naturally occurring loss of function mutations, they have these lifelong, so basically have had a one-time therapy and have lived, and so far, at least for these targets, have not had untoward side effects or untoward phenotypic consequences and only reduce lipids and reduce coronary artery disease. And so, instead of taking a pill daily, if we have conviction that that long amount of suppression may be beneficial, then longer interval dosing and not worrying about the pill burden is very attractive specifically for those specific therapeutics. And as you know, people continue to innovate on further prolonging as it relates to PCSK9.(04:57):Separately, some folks are also developing pills because many people do feel that there's still a market and comfort for daily pills. Now interestingly for the siRNA for zodasiran at the highest dose, actually for both of them at the highest doses, but particularly for zodasiran, there was an increase in insulin resistance parameters actually as it relates to hyperglycemia and less so as it relates to insulin resistance, that is not predicted based on the human genetics. Individuals with loss of function mutations do not have increased risks in hyperglycemia or type 2 diabetes, so that isolates it related to that specific platform or that specific technology. Now inclisiran, as you'd mentioned, Eric is out there. That's an siRNA against PCSK9 that's made by a different manufacturer. So far, the clinical trials have not shown hyperglycemia or type 2 diabetes as it relates inclisiran, so it may be related to the specific siRNAs that are used for those targets. That does merit further consideration. Now, the doses that the manufacturers do plan to use in the phase three clinical trials are at lower doses where there was not an increase in hyperglycemia, but that does merit further investigation to really understand why that's the case. Is that an expected generalized effect for siRNAs? Is it related to siRNAs for this specific target or is it just related to the platform used for these two agents which are made by the same manufacturer?Eric Topol (06:27):Right, and I think the fact that it's a mystery is intriguing at the least, and it may not come up at the doses that are used in the trials, but the fact that it did crop up at high doses is unexpected. Now that is part of a much bigger story is that up until now our armamentarium has been statins and ezetimibe to treat lipids, but it's rapidly expanding Lp(a), which for decades as a cardiologist we had nothing to offer. There may even be drugs to be able to lower people who are at high risk with high Lp(a). Maybe you could discuss that.What About Lp(a)?Pradeep Natarajan (07:13):Yeah, I mean, Eric, as you know, Lp(a) has been described as a cardiovascular disease risk factors for quite so many years and there are assays to detect lipoprotein(a) elevation and have been in widespread clinical practice increasing widespread clinical practice, but we don't yet have approved therapies. However, there is an abundance of literature preclinical data that suggests that it likely is a causal factor, meaning that if you lower lipoprotein(a) when elevated, you would reduce the risk related to lipoprotein(a). And a lot of this comes from similar human genetic studies. The major challenge of just relating a biomarker to an outcome is there are many different reasons why a biomarker might be elevated, and so if you detect a signal that correlates a biomarker, a concentration to a clinical outcome, it could be related to that biomarker, but it could be to the other reasons that the biomarker is elevated and sometimes it relates to the outcome itself.(08:10):Now human genetics is very attractive because if you find alleles that strongly relate to that exposure, you can test those alleles themselves with the clinical outcome. Now the allele assignment is established at birth. No other factor is going to change that assignment after conception, and so that provides a robust, strong causal test for that potential exposure in clinical outcome. Now, lipoprotein(a) is unique in that it is highly heritable and so there are lots of different alleles that relate to lipoprotein(a) and so in a well powered analysis can actually test the lipoprotein(a) SNPs with the clinical outcomes and similar to how there is a biomarker association with incident myocardial infarction and incident stroke, the SNPs related to lipoprotein(a) show the same. That is among the evidence that strongly supports that this might be causal. Now, fast forward to many years later, we have at least three phase three randomized clinical trials testing agents that have been shown to be very potent at lowering lipoprotein(a) that in the coming years we will know if that hypothesis is true. Importantly, we will have to understand what are the potential side effects of these medicines. There are antisense oligonucleotides and siRNAs that are primarily in investigation. Again, this is an example where there's a strong genetic observation, and so these genetic based longer interval dosing therapies may be attractive, but side effects will be a key thing as well too. Those things hard to anticipate really can anticipate based on the human genetics for off target effects, for example.(09:52):It's clearly a risk signal and hopefully in the near future we're going to have specific therapies.Eric Topol (09:57):Yeah, you did a great job of explaining Mendelian randomization and the fact the power of genetics, which we're going to get into deeper shortly, but the other point is that do you expect now that there's these multiple drugs that lower Lp(a) efficiently, would that be enough to get approval or will it have to be trials to demonstrate improved cardiovascular outcomes?Pradeep Natarajan (10:24):There is a great regulatory path at FDA for approval just for LDL cholesterol lowering and inclisiran is on the market and the phase three outcomes data has not yet been reported because there is a wide appreciation that LDL cholesterol lowering is a pretty good surrogate for cardiovascular disease risk lowering. The label will be restricted to LDL cholesterol lowering and then if demonstrated to have clinical outcomes, the label could be expanded. For other biomarkers including lipoprotein(a), even though we have strong conviction that it is likely a causal factor there hasn't met the bar yet to get approval just based on lipoprotein(a) lowering, and so we would need to see the outcomes effects and then we would also need to understand side effects. There is a body of literature of side effects for other therapies that have targeted using antisense oligonucleotides. We talked about potential side effects from some siRNA platforms and sometimes those effects could overtake potential benefits, so that really needs to be assessed and there is a literature and other examples.(11:31):The other thing I do want to note related to lipoprotein(a) is that the human genetics are modeled based on lifelong perturbations, really hard to understand what the effects are, how great of an effect there might be in different contexts, particularly when introduced in middle age. There's a lot of discussion about how high lipoprotein(a) should be to deliver these therapies because the conventional teaching is that one in five individuals has high lipoprotein(a), and that's basically greater than 75 nanomoles per liter. However, some studies some human genetic studies to say if you want to get an effect that is similar to the LDL cholesterol lowering medicines on the market, you need to start with actually higher lipoprotein(a) because you need larger amounts of lipoprotein(a) lowering. Those are studies and approaches that haven't been well validated. We don't know if that's a valid approach because that's modeling based on this sort of lifelong effect. So I'm very curious to see what the overall effect will be because to get approval, I think you need to demonstrate safety and efficacy, but most importantly, these manufacturers and we as clinicians are trying to find viable therapies in the market that it won't be hard for us to get approval because hopefully the clinical trial will have said this is the context where it works. It works really well and it works really well on top of the existing therapies, so there are multiple hurdles to actually getting it directly to our patients.How Low Do You Go with LDL Cholesterol?Eric Topol (13:02):Yeah, no question about that. I'm glad you've emphasized that. Just as you've emphasized the incredible lessons from the genetics of people that have helped guide this renaissance to better drugs to prevent cardiovascular disease. LDL, which is perhaps the most impressive surrogate in medicine, a lab test that you already touched on, one of the biggest questions is how low do you go? That is Eugene Braunwald, who we all know and love. They're in Boston. The last time I got together with him, he was getting his LDL down to close to zero with various tactics that might be extreme. But before we leave these markers, you're running preventive cardiology at man's greatest hospital. Could you tell us what is your recipe for how aggressive do you go with LDL?Pradeep Natarajan (14:04):Yeah, so when I talk to patients where we're newly getting lipid lowering therapies on, especially because many people don't have a readout of abnormal LDL cholesterol when we're prescribing these medicines, it's just giving them a sense of what we think an optimal LDL cholesterol might be. And a lot of this is based on just empirical observations. So one, the average LDL cholesterol in the modern human is about 100 to 110 mg/dL. However, if you look at contemporary hunter gatherers and non-human primates, their average LDL is about 40 to 50 and newborn babies have an LDL cholesterol of about 30. And the reason why people keep making LDL cholesterol lowering medicines because as you stack on therapies, cardiovascular disease events continue to reduce including down to these very low LDL cholesterol values. So the population mean for LDL cholesterol is high and everybody likely has hypercholesterolemia, and that's because over the last 10,000 years how we live our lives is so dramatically different and there has not been substantial evolution over that time to change many of these features related to metabolism.(15:16):And so, to achieve those really low LDL cholesterol values in today's society is almost impossible without pharmacotherapies. You could say, okay, maybe everybody should be on pharmacotherapies, and I think if you did that, you probably would reduce a lot of events. You'll also be treating a lot of individuals who likely would not get events. Cardiovascular disease is the leading killer, but there are many things that people suffer from and most of the times it still is not cardiovascular disease. So our practice is still rooted in better identifying the individuals who are at risk for cardiovascular disease. And so, far we target our therapies primarily in those who have already developed cardiovascular disease. Maybe we'll talk about better identifying those at risk, but for those individuals it makes lots of sense to get it as low as possible. And the field has continued to move to lower targets.(16:07):One, because we've all recognized, at least based on these empirical observations that lower is better. But now increasingly we have a lot of therapies to actually get there, and my hope is that with more and more options and the market forces that influence that the cost perspective will make sense as we continue to develop more. As an aside, related aside is if you look at the last cholesterol guidelines, this is 2018 in the US this is the first time PCSK9 inhibitors were introduced in the guidelines and all throughout that there was discussions of cost. There are a lot of concerns from the field that PCSK9 inhibitors would bankrupt the system because so many people were on statins. And you look at the prior one that was in 2013 and cost was mentioned once it's just the cost effectiveness of statins. So I think the field has that overall concern.(17:01):However, over time we've gotten comfortable with lower targets, there are more medicines and I think some of this competition hopefully will drive down some of the costs, but also the overall appreciation of the science related to LDL. So long-winded way of saying this is kind of the things that we discussed just to give reassurance that we can go to low LDL cholesterol values and that it's safe and then we think also very effective. Nobody knows what the lower limit is, whether zero is appropriate or not. We know that glucose can get too low. We know that blood pressure can be too low. We don't know yet that limit for LDL cholesterol. I mean increasingly with these trials we'll see it going down really low and then we'll better appreciate and understand, so we'll see 40 is probably the right range.Eric Topol (17:49):40, you said? Yeah, okay, I'll buy that. Of course, the other thing that we do know is that if you push to the highest dose statins to get there, you might in some people start to see the hyperglycemia issue, which is still not fully understood and whether that is, I mean it's not desirable, but whether or not it is an issue, I guess it's still out there dangling. Now the other thing that since we're on LDL, we covered Lp(a), PCSK9, the siRNA, is ApoB. Do you measure ApoB in all your patients? Should that be the norm?Measuring ApoBPradeep Natarajan (18:32):Yeah, so ApoB is another blood test. In the standard lipid panel, you get four things. What's measured is cholesterol and triglycerides, they're the lipids insoluble in blood to get to the different tissues that get packaged in lipoprotein molecules which will have the cholesterol, triglycerides and some other lipids and proteins. And so, they all have different names as you know, right? Low density lipoprotein, high density lipoprotein and some others. But also in the lipid panel you get the HDL cholesterol, the amount of cholesterol in an HDL particle, and then most labs will calculate LDL cholesterol and LDL cholesterol has a nice relationship with cardiovascular disease. You lower it with statins and others. Lower risk for cardiovascular disease, turns out a unifying feature of all of these atherogenic lipoproteins, all these lipoproteins that are measured and unmeasured that relate to cardiovascular disease, including lipoprotein(a), they all have an additional protein called ApoB. And ApoB, at least as it relates to LDL is a pretty good surrogate of the number of LDL particles.(19:37):Turns out that that is a bit better at the population level at predicting cardiovascular disease beyond LDL cholesterol itself. And where it can be particularly helpful is that there are some patients out there that have an unexpected ratio between ApoB and LDL. In general, the ratio between LDL cholesterol and ApoB is about 1.1 and most people will have that rough ratio. I verify that that is the expected, and then if that is the expected, then really there is no role to follow ApoB. However, primarily the patients that have features related to insulin resistance have obesity. They may often have adequate looking LDL cholesterols, but their ApoB is higher. They have more circulating LDL particles relative to the total amount of LDL cholesterol, so smaller particles themselves. However, the total number of particles may actually be too high for them.(20:34):And so, even if the LDL cholesterol is at target, if the ApoB is higher, then you need to reduce. So usually the times that I just kind of verify that I'm at appropriate target is I check the LDL cholesterol, if that looks good, verify with the ApoB because of this ratio, the ApoB target should be about 10% lower. So if we're aiming for about 40, that's like 36, so relatively similar, and if it's there, I'm good. If it's not and it's higher, then obviously increase the LDL cholesterol lowering medicines because lower the ApoB and then follow the ApoB with the lipids going forward. The European Society of Cardiology has more emphasis on measuring ApoB, that is not as strong in the US guidelines, but there are many folks in the field, preventive cardiologists and others that are advocating for the increasing use of ApoB because I think there are many folks that are not getting to the appropriate targets because we are not measuring ApoB.Why Aren't We Measuring and Treating Inflammation?Eric Topol (21:37):Yeah, I think you reviewed it so well. The problem here is it could be part of the standard lipid panel, it would make this easy, but what you've done is a prudent way of selecting out people who it becomes more important to measure and moderate subsequently. Now this gets us to the fact that we're lipid centric and we don't pay homage to inflammation. So I wrote a recent Substack on the big miss on inflammation, and here you get into things like the monoclonal antibody to interleukin-6, the trial that CANTOS that showed significant reduction in cardiovascular events and fatal cancers by the way. And then you get into these colchicine trials two pretty good size randomized trials, and here the entry was coronary disease with a high C-reactive protein. Now somehow or other we abandon measuring CRP or other inflammatory markers, and both of us have had patients who have low LDLs but have heart attacks or significant coronary disease. So why don't we embrace inflammation? Why don't we measure it? Why don't we have better markers? Why is this just sitting there where we could do so much better? Even agents that are basically cost pennies like colchicine at low doses, not having to use a proprietary version could be helpful. What are your thoughts about us upgrading our prevention with inflammation markers?Pradeep Natarajan (23:22):Yeah, I mean, Eric, there is an urgent need to address these other pathways. I say urgent need because heart disease has the dubious distinction of being the leading killer in the US and then over the last 20 years, the leading killer in the world as it takes over non-communicable diseases. And really since the early 1900s, there has been a focus on developing pharmacotherapies and approaches to address the traditional modifiable cardiovascular disease risk factors. That has done tremendous good, but still the curves are largely flattening out. But in the US and in many parts of the world, the deaths attributable to cardiovascular disease are starting to tick up, and that means there are many additional pathways, many of them that we have well recognized including inflammation. More recently, Lp(a) that are likely important for cardiovascular disease, for inflammation, as you have highlighted, has been validated in randomized controlled trials.(24:18):Really the key trial that has been more most specific is one on Canakinumab in the CANTOS trial IL-1β monoclonal antibody secondary prevention, so cardiovascular disease plus high C-reactive protein, about a 15% reduction in cardiovascular disease and also improvement in cancer related outcomes. Major issues, a couple of issues. One was increased risk for severe infections, and the other one is almost pragmatic or practical is that that medicine was on the market at a very high price point for rare autoinflammatory conditions. It still is. And so, to have for a broader indication like cardiovascular disease prevention would not make sense at that price point. And the manufacturer tried to go to the FDA and focus on the group that only had C-reactive protein lowering, but that's obviously like a backwards endpoint. How would you know that before you release the medicine? So that never made it to a broader indication.(25:14):However, that stuck a flag in the broader validation of that specific pathway in cardiovascular disease. That pathway has direct relevance to C-reactive protein. C-reactive protein is kind of a readout of that pathway that starts from the NLRP3 inflammasome, which then activates IL-1β and IL-6. C-reactive protein we think is just a non causal readout, but is a reliable test of many of these features and that's debatable. There may be other things like measuring IL-6, for example. So given that there is actually substantial ongoing drug development in that pathway, there are a handful of companies with NLRP3 inflammasome inhibitors, but small molecules that you can take as pills. There is a monoclonal antibody against IL-6 that's in development ziltivekimab that's directed at patients with chronic kidney disease who have lots of cardiovascular disease events despite addressing modifiable risk factors where inflammatory markers are through the roof.(26:16):But then you would also highlighted one anti-inflammatory that's out there that's pennies on the dollar, that's colchicine. Colchicine is believed to influence cardiovascular disease by inhibiting NLRP3, I say believed to. It does a lot of things. It is an old medicine, but empirically has been shown in at least two randomized controlled trials patients with coronary artery disease, actually they didn't measure C-reactive protein in the inclusion for these, but in those populations we did reduce major adverse cardiovascular disease events. The one thing that does give me pause with colchicine is that there is this odd signal for increased non-cardiovascular death. Nobody understands if that's real, if that's a fluke. The FDA just approved last year low dose colchicine, colchicine at 0.5 milligrams for secondary prevention given the overwhelming efficacy. Hasn't yet made it into prevention guidelines, but I think that's one part that does give me a little bit pause. I do really think about it particularly for patients who have had recurrent events. The people who market the medicine and do research do remind us that C-reactive protein was not required in the inclusion, but nobody has done that secondary assessment to see if measuring C-reactive protein would be helpful in identifying the beneficial patients. But I think there still could be more work done on better identifying who would benefit from colchicine because it's an available and cheap medicine. But I'm excited that there is a lot of development in this inflammation area.Eric Topol (27:48):Yeah, well, the development sounds great. It's probably some years away. Do you use colchicine in your practice?Pradeep Natarajan (27:56):I do. Again, for those folks who have had recurrent events, even though C-reactive protein isn't there, it does make me feel like I'm treating inflammation. If C-reactive protein is elevated and then I use it for those patients, if it's not elevated, it's a much harder sell from my standpoint, from the patient standpoint. At the lower dose for colchicine, people generally are okay as far as side effects. The manufacturer has it at 0.5 milligrams, which is technically not pennies on the dollar. That's not generic. The 0.6 milligrams is generic and they claim that there is less side effects at the 0.5 milligrams. So technically 0.6 milligrams is off label. So it is what it is.CHIP and Defining High Risk People for CV DiseaseEric Topol (28:40):It's a lot more practical, that's for sure. Now, before I leave that, I just want to mention when I reviewed the IL-1β trial, you mentioned the CANTOS trial and also the colchicine data. The numbers of absolute increases for infection with the antibody or the cancers with the colchicine are really small. So I mean the benefit was overriding, but I certainly agree with your concern that there's some things we don't understand there that need to be probed more. Now, one of the other themes, well before one other marker that before we get to polygenic risk scores, which is center stage here, defining high risk people. We've talked a lot about the conventional things and some of the newer ways, but you've been one of the leaders of study of clonal hematopoiesis of indeterminate potential known as CHIP. CHIP, not the chips set in your computer, but CHIP. And basically this is stem cell mutations that increase in people as we age and become exceptionally common with different mutations that account in these clones. So maybe you can tell us about CHIP and what I don't understand is that it has tremendous correlation association with cardiovascular outcomes adverse as well as other system outcomes, and we don't measure it and we could measure it. So please take us through what the hell is wrong there.Pradeep Natarajan (30:14):Yeah, I mean this is really exciting. I mean I'm a little bit biased, but this is observations that have been made only really over the last decade, but accelerating research. And this has been enabled by advances in genomic technologies. So about 10 years or plus ago, really getting into the early days of population-based next generation sequencing, primarily whole exome sequencing. And most of the DNA that we collect to do these population-based analyses come from the blood, red blood cells are anucleate, so they're coming from white blood cells. And so, at that time, primarily interrogating what is the germline genetic basis for coronary artery disease and early onset myocardial infarction. At the same time, colleagues at the Broad Institute were noticing that there are many additional features that you can get from the blood-based DNA that was being processed by the whole exome data. And there were actually three different groups that converged on that all in Boston that converged on the same observation that many well-established cancer causing mutations.(31:19):So mutations that are observed in cancers that have been described to drive the cancers themselves were being observed in these large population-based data sets that we were all generating to understand the relationship between loss of function mutations in cardiovascular disease. That's basically the intention of those data sets for being generated for other things. Strong correlation with age, but it was very common among individuals greater than 70; 10% of them would have these mutations and is very common because blood cancer is extremely, it's still pretty rare in the population. So to say 10% of people had cancer causing driver mutations but didn't have cancer, was much higher than anyone would've otherwise expected. In 2014, there were basically three main papers that described that, and they also observed that there is a greater risk of death. You'd say, okay, this is a precancerous lesion, so they're probably dying of cancer.(32:17):But as I said, the absolute incidence rate for blood cancer is really low and there's a relative increase for about tenfold, but pretty small as it relates to what could be related to death. And in one of the studies we did some exploratory analysis that suggested maybe it's actually the most common cause of death and that was cardiovascular disease. And so, a few years later we published a study that really in depth really looked at a bunch of different data sets that were ascertained to really understand the relationship between these mutations, these cancer causing mutations in cardiovascular disease, so observed it in enrichment and older individuals that had these mutations, CHIP mutations, younger individuals who had early onset MI as well too, and then also look prospectively and showed that it related to incident coronary artery disease. Now the major challenge for this kind of analysis as it relates to the germline genetic analysis is prevalence changes over time.(33:15):There are many things that could influence the presence of clonal hematopoiesis. Age is a key enriching factor and age is the best predictor for cardiovascular disease. So really important. So then we modeled it in mice. It was actually a parallel effort at Boston University (BU) that was doing the same thing really based on the 2014 studies. And so, at the same time we also observed when you modeled this in mice, you basically perturb introduce loss of function mutations in the bone marrow for these mice to recapitulate these driver mutations and those mice also have a greater burden of atherosclerosis. And Eric, you highlighted inflammation because basically the phenotype of these cells are hyper inflamed cells. Interestingly, C-reactive protein is only modestly elevated. So C-reactive protein is not fully capturing this, but many of the cytokines IL-1β, IL-6, they're all upregulated in mice and in humans when measured as well.(34:11):Now there've been a few key studies that have been really exciting about using anti-inflammatories in this pathway to address CHIP associated cardiovascular disease. So one that effort that I said in BU because they saw these cytokines increased, we already know that these cytokines have relationship with atherosclerosis. So they gave an NLRP3 inflammasome inhibitor to the mice and they showed that the mice with or without CHIP had a reduction in atherosclerosis, but there was a substantial delta among the mice that are modeled as having CHIP. Now, the investigators in CANTOS, the manufacturers, they actually went back and they survey where they had DNA in the CANTOS trial. They measured CHIP and particularly TET2 CHIP, which is the one that has the strongest signal for atherosclerosis. As I said, overall about 15% reduction in the primary outcome in CANTOS. Among the individuals who had TET2 CHIP, it was a 64% reduction in event.(35:08):I mean you don't see those in atherosclerosis related trials. Now this has the caveat of it being secondary post hoc exploratory, the two levels of evidence. And so, then we took a Mendelian randomization approach. Serendipitously, just so happens there is a coding mutation in the IL-6 receptor, a missense mutation that in 2012 was described that if you had this mutation, about 40% of people have it, you have a 5%, but statistically significant reduction in coronary artery disease. So we very simply said, if the pathway of this NLRP3 inflammasome, which includes IL-6, if you have decreased signaling in that pathway, might you have an even greater benefit from having that mutation if you had CHIP versus those who didn't have CHIP. So we looked in the UK Biobank, those who didn't have CHIP 5% reduction, who had that IL-6 receptor mutation, and then those who did have CHIP, if they had that mutation, it was about a 60% reduction in cardiovascular disease.(36:12):Again, three different lines of evidence that really show that this pathway has relevance in the general population, but the people who actually might benefit the most are those with CHIP. And I think as we get more and more data sets, we find that not all of the CHIP mutations are the same as it relates to cardiovascular disease risk. It does hone in on these key subsets like TET2 and JAK2, but this is pretty cool as a preventive cardiologist, new potential modifiable risk factor, but now it's almost like an oncologic paradigm that is being applied to coronary artery disease where we have specific driver mutations and then we're tailoring our therapies to those specific biological drivers for coronary artery disease. Hopefully, I did that justice. There's a lot there.Why Don't We Measure CHIP?Eric Topol (36:57):Well, actually, it's phenomenal how you've explained that, but I do want to review for our listeners or readers that prior to this point in our conversation, we were talking about germline mutations, the ones you're born with. With CHIP, we're talking about acquired somatic mutations, and these are our blood stem cells. And what is befuddling to me is that with all the data that you and others, you especially have been publishing and how easy it would be to measure this. I mean, we've seen that you can get it from sequencing no less other means. Why we don't measure this? I mean, why are we turning a blind eye to CHIP? I just don't get it. And we keep calling it of indeterminate potential, not indeterminate. It's definite potential.Pradeep Natarajan (37:51):Yeah, no, I think these are just overly cautious terms from the scientists. Lots of people have CHIP, a lot of people don't have clinical outcomes. And so, I think from the lens of a practicing hematologists that provide some reassurance on the spectrum for acquired mutation all the way over to leukemia, that is where it comes from. I don't love the acronym as well because every subfield in biomedicine has its own CHIP, so there's obviously lots of confusion there. CH or clinical hematopoiesis is often what I go, but I think continuing to be specific on these mutations. Now the question is why measure? Why aren't we measuring it? So there are some clinical assays out there. Now when patients get evaluated for cytopenias [low cell counts], there are next generation sequencing tests that look for these mutations in the process for evaluation. Now, technically by definition, CHIP means the presence of these driver mutations that have expanded because it's detectable by these assays, not a one-off cell because it can only be detected if it's in a number of cells.(38:55):So there has been some expansion, but there are no CBC abnormalities. Now, if there's a CBC abnormality and you see a CHIP mutation that's technically considered CCUS or clonal cytopenia of unknown significance, sometimes what is detected is myelodysplastic syndrome. In those scenarios still there is a cardiovascular disease signal, and so many of our patients who are seen in the cancer center who are being evaluated for these CBC abnormalities will be detected to have these mutations. They will have undergone some risk stratification to see what the malignancy potential is. Still pretty low for many of those individuals. And so, the major driver of health outcomes for this finding may be cardiovascular. So those patients then get referred to our program. Dana-Farber also has a similar program, and then my colleague Peter Libby at the Brigham often sees those patients as well. Now for prospective screening, so far, an insurance basically is who's going to pay for it.(39:51):So an insurance provider is not deemed that appropriate yet. You do need the prospective clinical trials because the medicines that we're talking about may have side effects as well too. And what is the yield? What is the diagnostic yield? Will there actually be a large effect estimate? But there has been more and more innovation, at least on the assay and the cost part of the assay because these initial studies, we've been using whole exome sequencing, which is continuing to come down, but is not a widely routine clinical test yet. And also because as you highlighted, these are acquired mutations. A single test is not necessarily one and done. This may be something that does require surveillance for particular high risk individuals. And we've described some risk factors for the prevalence of CHIP. So surveillance may be required, but because there are about 10 genes that are primarily implicated in CHIP, that can substantially decrease the cost of it. The cost for DNA extraction is going down, and so there are research tests that are kind of in the $10 to $20 range right now for CHIP. And if flipped over to the clinical side will also be reasonably low cost. And so, for the paradigm for clinical implementation, that cost part is necessary.Eric Topol (41:10):I don't know the $10 or $20 ones. Are there any I could order on patients that I'm worried about?Pradeep Natarajan (41:17):Not yet clinical. However, there is a company that makes the reagents for at least the cores that are developing this. They are commercializing that test so that many other cores, research cores can develop it. I think it's in short order that clinical labs will adopt it as well too.Eric Topol (41:36):That's great.Pradeep Natarajan (41:37):I will keep you apprised.What About Polygenic Risk Scores?Eric Topol (41:39):I think that's really good news because like I said, we're so darn lipid centric and we have to start to respect the body of data, the knowledge that you and others have built about CHIP. Now speaking of another one that drives me nuts is polygenic risk score (PRS) for about a decade, I've been saying we have coronary disease for most people is a polygenic trait. It's not just a familial hypercholesterolemia. And we progressively have gotten better and better of the hundreds of single variants that collectively without a parental history will be and independently predict who is at double, triple or whatever risk of getting heart disease, whereby you could then guide your statins at higher aggressive or pick a statin, use one or even go beyond that as we've been talking about. But we don't use that in practice, which is just incredible because it's can be done cheap.(42:45):You can get it through whether it's 23andMe or now many other entities. We have an app, MyGeneRank where we can process that Scripss does for free. And only recently, Mass General was the first to implement that in your patient population, and I'm sure you were a driver of that. What is the reluctance about using this as an orthogonal, if you will, separate way to assess a person's risk for heart disease? And we know validated very solidly about being aggressive about lipid lowering when you know this person's in the highest 5% polygenic risk score. Are we just deadheads in this field or what?Pradeep Natarajan (43:30):Yeah, I mean Eric, as you know, lots of inertia in medicine, but this one I think has a potential to make a large impact. Like CHIP mutations, I said news is about 10% in individuals greater than 70. The prospect here is to identify the risk much earlier in life because I think there is a very good argument that we're undertreating high risk individuals early on because we don't know how to identify them. As you highlighted, Dr. Braunwald about LDL cholesterol. The other part of that paradigm is LDL cholesterol lowering and the duration. And as we said, everybody would benefit from really low LDL cholesterol, but again, you might overtreat that if you just give that to everybody. But if you can better identify the folks very early in life, there is a low cost, low risk therapy, at least related to statins that you could have a profound benefit from the ones who have a greater conviction will have future risk for cardiovascular disease.(44:21):You highlighted the family history, and the family history has given the field of clues that genetics play a role. But as the genome-wide association studies have gotten larger, the polygenic risk scores have gotten better. We know that family history is imperfect. There are many reasons why a family member who is at risk may or may not have developed cardiovascular disease. A polygenic risk score will give a single number that will estimate the contribution of genetics to cardiovascular disease. And the thing that is really fascinating to me, which is I think some of a clinical implementation challenge is that the alleles for an individual are fixed. The genotyping is very cheap. That continues to be extremely cheap to do this test. But the weights and the interpretation of what the effects should be for each of the SNPs are continually being refined over time.(45:18):And so, given the exact same SNPs in the population, the ability to better predict cardiovascular diseases getting better. And so, you have things that get reported in the literature, but literally three years later that gets outdated and those hypotheses need to be reassessed. Today, I'll say we have a great relative to other things, but we have a great polygenic risk score was just reported last year that if you compare it to familial hypercholesterolemia, which has a diagnostic yield of about 1 in 300 individuals, but readily detectable by severe hypercholesterolemia that has about threefold risk for cardiovascular disease. By polygenic risk score, you can find 1 in 5 individuals with that same risk. Obviously you go higher than that, it'll be even higher risk related to that. And that is noble information very early in life. And most people develop risk factors later in life. It is happening earlier, but generally not in the 30s, 40s where there's an opportunity to make a substantial impact on the curve related to cardiovascular disease.(46:25):But there is a lot of momentum there. Lots of interest from NIH and others. The major challenge is though the US healthcare system is really not well set up to prevention, as you know, we practice healthcare after patient's developed disease and prevent the complications related to progression. The stakeholder incentives beyond the patient themselves are less well aligned. We've talked a lot here today about payers, but we don't have a single payer healthcare system. And patients at different times of their lives will have different insurers. They'll start early in life with their parents, their first employer, they'll move on to the next job and then ultimately Medicare. There's no entity beyond yourself that really cares about your longevity basically from the beginning and your overall wellness. That tension has been a major challenge in just driving the incentives and the push towards polygenic risk scores. But there are some innovative approaches like MassMutual Life Insurance actually did a pilot on polygenic risk scoring.(47:33):They're in the business of better understanding longevity. They get that this is important data. Major challenges, there are federal protections against non-discrimination in the workplace, health insurance, not necessarily life insurance. So I think that there are lots of things that have to be worked out. Everybody recognizes that this is important, but we really have to have all the incentives aligned for this to happen at a system-wide level in the US. So there's actually lots of investment in countries that have more nationalized healthcare systems, lots of development in clinical trials in the UK, for example. So it's possible that we in the US will not be the lead in that kind of evidence generation, but maybe we'll get there.The GLP-1 DrugsEric Topol (48:16):Yeah, it's frustrating though, Pradeep, because this has been incubating for some time and now we have multi ancestry, polygenic risk scores, particularly for heart disease and we're not using it, and it's not in my view, in the patient's best interest just because of these obstacles that you're mentioning, particularly here in the US. Well, the other thing I want to just get at with you today is the drugs that we were using for diabetes now blossoming for lots of other indications, particularly the glucagon-like peptide 1 (GLP-1) drugs. This has come onto the scene in recent years, not just obviously for obesity, but it's anti-inflammatory effects as we're learning, mediated not just through the brain but also T cells and having extraordinary impact in heart disease for people with obesity and also with those who have heart failure, about half of heart failure for preserved ejection fraction. So recently you and your colleagues recently published a paper with this signal of optic neuropathy. It was almost seven eightfold increase in a population. First, I wanted to get your sense about GLP-1. We're also going to get into the SGLT2 for a moment as well, but how do you use GLP-1? What's your prognosis for this drug class going forward?Pradeep Natarajan (49:55):As it relates to the paper, I can't claim credit as one of my former students who is now Mass Eye and Ear resident who participated, but we can talk about that. There's obviously some challenges for mining real world data, but this was related to anecdotes that they were observing at Mass Eye and Ear and then studied and observed an enrichment. In general though, I feel like every week I'm reading a new clinical trial about a new clinical outcome benefit as it relates to GLP-1 receptor agonists. This is kind of one thing that stands out that could be interrogated in these other clinical trials. So I would have that caveat before being cautious about ocular complications. But the data has been overwhelmingly beneficial, I think, because at minimum, obesity and inflammation are relayed to myriad of consequences, and I'm really excited that we have therapies that can address obesity that are safe.(50:52):There's a legacy of unsafe medicines for obesity, especially related to cardiovascular disease. So the fact that we have medicines that are safe and effective for lowering weight that also have real strong effects on clinical outcomes is tremendous. We in cardiology are increasingly using a range of diabetes medicines, including GLP-1 receptor agonists and SGLT2 inhibitors. I think that is also the secular changes of what influences cardiovascular disease over time. I talked about over the last 10 years or so with this increase in deaths attributable to cardiovascular disease. If you look at the influences of traditional clinical risk factors today, many of them have decreased in importance because when abnormal, we recognize them, in general we modify them when recognized. And so, many of the things that are unaddressed, especially the features related to insulin resistance, obesity, they start rising in importance. And so, there is a dramatic potential for these kinds of therapies in reducing the residual risks that we see related to cardiovascular disease. So I'm enthusiastic and excited. I think a lot more biology that needs to be understood of how much of this is being influenced specifically through this pathway versus a very effective weight loss medicine. But also interesting to see the insights on how the effect centrally on appetite suppression has profound influences on weight loss as well too. And hopefully that will lead to more innovations in weight management.The SGLT-2 DrugsEric Topol (52:25):And likewise, perhaps not getting near as much play, but when it came on the cardiovascular scene that an anti-diabetic drug SGLT2 was improving survival, that was big, and we still don't know why. I mean, there's some ideas that it might be a senolytic drug unknowingly, but this has become a big part of practice of cardiology in patients with diabetes or with preserved ejection fraction heart failure. Is that a fair summary for that drug?Pradeep Natarajan (53:00):Yeah, I totally agree. I mean, as there has been increased recognition for heart failure preserved ejection fraction, it has been almost disheartening over the last several years that we have not had very specific effective therapies to treat that condition. Now, it is a tremendous boon that we do have medicines interestingly focused on metabolism that are very helpful in that condition for heart failure with preserved ejection fraction. But there is still much more to be understood as far as that condition. I mean, the major challenge with heart failure, as you know, especially with heart failure preserved ejection fraction, it likely is a mix of a wide variety of different etiologies. So in parallel with developing effective therapies that get at some aspect is really understanding what are the individual drivers and then targeting those specific individual drivers. That requires a lot of unbiased discovery work and further profiling to be done. So lot more innovation, but relative to heart failure itself, it is not had widespread recognition as heart failure reduced ejection fraction. So much more to innovate on, for sure.Eric Topol (54:07):Right, right. Yeah, I am stunned by the recent progress in cardiovascular medicine. You have been center stage with a lot of it, and we've had a chance to review so much. And speaking of genetics, I wanted to just get a little insight because I recently came across the fact that your mother here at the City of Hope in Southern California is another famous researcher. And is that, I don't know what chromosome that is on regarding parental transmission of leading research. Maybe you can tell me about that.Pradeep Natarajan (54:41):Yeah, I mean, I guess it is a heritable trait when a parent has one profession that there is a higher likelihood that the offspring will have something similar. So both of my parents are PhDs, nonphysicians. There is a diabetes department at the City of Hope, so she's the chair of that department. So very active. We do overlap in some circles because she does investigate both vascular complications and renal complications. And then sometimes will ask my advice on some visualization. But she herself has just had a science translational medicine paper, for example, just a couple of months ago. So it's fun to talk about these things. To be honest, because my parents are researchers, I was not totally sure that I would be a researcher and kind of wanted to do something different in medicine. But many of my early observations and just how common cardiovascular disease is around me and in my community and wanting to do something useful is what got me specifically into cardiology.(55:45):But obviously there are numerous outstanding, important questions. And as I went through my career, really focused on more basic investigations of atherosclerosis and lipids. What got me excited sort of after my clinical training was the ability to ask many of these questions now in human populations with many new biological data sets, at least first centered on genetics. And the capabilities continue to expand, so now I teach first year Harvard medical students in their genetics curriculum. And when I talk to them just about my career arc, I do remind them they're all doing millions of things and they're exploring lots of things, but when they get to my shoes, the capabilities will be tremendously different. And so, I really advise them to take the different experiences, mainly in an exercise for asking questions, thoughtfully addressing questions, connecting it back to important clinical problems. And then once they start to understand that with a few different approaches, then they'll totally take off with what the opportunities are down the road.Eric Topol (56:51):No, it's great. I mean, how lucky somebody could be in the first year of med school with you as their teacher and model. Wow. Pradeep, we've really gone deep on this and it's been fun. I mean, if there's one person I'm going to talk to you about cardiovascular risk factors and the things that we've been into today, you would be the one. So thank you for taking the time and running through a lot of material here today, and all your work with great interest.Pradeep Natarajan (57:24):Thanks, Eric. I really appreciate it. It's tremendous honor. I'm a big fan, so I would be glad to talk about any of these things and more anytime.***************Thanks for listening, reading or watching!The Ground Truths newsletters and podcasts are all free, open-access, without ads.Please share this post/podcast with your friends and network if you found it informative!Voluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff for audio and video support at Scripps Research.Note: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe

A recent study published in the European Journal of Preventive Cardiology presents some recommendations in support of heart patients. Canadian researchers played a key role in carrying out the study. The goal is to improve heart health for those diagnosed with a condition. Summer host Khalil Akhtar spoke to Dr. Christopher Labos.

A recent study published in the European Journal of Preventive Cardiology presents some recommendations in support of heart patients. Canadian researchers played a key role in carrying out the study. The goal is to improve heart health for those diagnosed with a condition. Summer host Khalil Akhtar spoke to Dr. Christopher Labos.

A recent study published in the European Journal of Preventive Cardiology presents some recommendations in support of heart patients. Canadian researchers played a key role in carrying out the study. The goal is to improve heart health for those diagnosed with a condition. Summer host Khalil Akhtar spoke to Dr. Christopher Labos.

DCS 1403: Imaging

DCS 1403: Antithrombotics

Regular exercise is one of the most effective methods to keep the heart healthy and efficient. In rare cases, however, there are reports of athletes collapsing mid-game due to cardiac arrest. And while exercise is generally also a key part of the rehabilitation process for those who've experienced cardiac events, caution should still be taken. This is where physician input is important, and where testing and regular monitoring can be implemented to reduce the risk of further events. Today, we're joined by experts in the fields of sports cardiology and exercise physiology, as well as an athlete with firsthand experience in the matter, to draw attention to the topic of cardiac health and how it pertains to sports medicine. In this episode, host Myra Cocker, Assistant Professor of Cardiology at Houston Methodist Hospital and Global Director of Clinical Science for Cardiovascular Ultrasound at Siemens Healthineers, welcomes Dr. Jonathan Kim, Associate Professor and Founding Director at Emory University Sports Cardiology and Team Cardiologist for Georgia Tech, the Atlanta Falcons, Hawks, and Braves; as well as Dr. Dominique Hansen, Professor of Rehabilitation and Exercise Physiology in Cardiometabolic Diseases at Universiteit Hasselt in Belgium and Secretary of the European Association of Preventive Cardiology; and retired professional soccer player and cardiology patient Daniel Engelbrecht. What you'll learn in this episode:How cardiac risk can affect older and younger elite athletes differentlyCardiac events can stem from myocarditis, caused by an infectious disease.Red flag symptoms when it comes to cardiac events while exercising, including intense chest pressure or loss of consciousnessThe use of Automated External Defibrillators is a critical first response strategy in the event of cardiac arrest.Implementation of an exercise program can be essential when treating a patient who has experienced, or is at risk for, cardiovascular disease.For patients who have suffered from major cardiac events, their timeline for return to sports or intense physical activity is heavily dependent on a number of individual factors.Connect with Myra CockerLinkedInConnect with Jonathan KimLinkedInConnect with Dominique HansenLinkedInConnect with Daniel EngelbrechtLinkedIn Hosted on Acast. See acast.com/privacy for more information.

In a world inundated with conflicting health messages and sedentary lifestyles, the concept of living a healthy life can seem elusive. Yet, amidst the chaos, lies a simple truth: the choices we make each day profoundly shape our well-being and longevity. Dr Alain Bouchard, MD discusses with Dr. Martha Gulati, Director of Prevention & Associate Director of the Barbra Streisand Women's Heart Center, and the President-Elect of the American Society for Preventive Cardiology.

In this special episode on Residual Risk: A Focus on Triglycerides, our host, Dr. Neil Skolnik will discuss Metabolic Syndrome: A Focus on Triglycerides with Dr. Peter Toth.  Dr. Toth is Director of Preventive Cardiology, CGH Medical Center, and an adjunct professor of medicine at Johns Hopkins Medical School. This special episode is supported by an independent educational grant from Amarin. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Peter Toth, M.D.,PhD,   Director of Preventive Cardiology, CGH Medical Center, Adjunct Professor of Medicine, Johns Hopkins Medical School.  Selected references  in the Podcast: Icosapent Ethyl: REDUCE-IT - N Engl J Med 2019; 380:11-22 Omega-3 Fatty Acids: STRENGTH trial - JAMA. 2020;324(22):2268-2280 Pemafibrate: PROMINENT - N Engl J Med 2022; 387:1923-1934 Icosapent Ethyl: JELIS - Lancet. 2007;369(9567):1090-1098 Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study.BMJMED 2024;3:e000451

Preventive cardiology is undergoing a revolution, with advanced biomarkers and imaging techniques offering unparalleled insights into cardiovascular risk. Traditional risk factors like cholesterol and blood pressure remain important. Still, cutting-edge tools such as Apolipoprotein B (ApoB), Lipoprotein(a) [Lp(a)], high-sensitivity C-reactive protein (hs-CRP), myeloperoxidase (MPO), Lipoprotein-Associated Phospholipase A2 (Lp-PLA2), Carotid Intima-Media Thickness (CIMT), Coronary Calcium Score (CAC), and Coronary Computed Tomography Angiography (CCTA) with Cleerly enable more precise risk assessment and targeted preventive strategies. #hearthealth #hearthealthmatters #cardiologist #prevention #integrativecardiologist #hearthealthtips #hearthealthylifestyle #preventivecardiologist #holistichealth #apob #Lp(a) #cleerly #cimt #MPO

Alors que la saison des courses populaires, dont la plupart accueillent une catégorie "marche" ou "nordic walking", est lancée, le Point J revient sur ce fameux objectif des 10'000 pas par jour. En août 2023, ce nombre a été remis en question par une étude publiée dans l'European Journal of Preventive Cardiology. Combien faut-il en faire réellement? Cette dose idéale existe-t-elle? On en discute avec Jérôme Barral, maître d'enseignement et de recherche au Centre interdisciplinaire de recherche sur le sport de l'UNIL. Journaliste: Julie Kummer Réalisation: Brian Lanni/Antoine Weissenbach Nous contacter: 079 134 34 70 (WhatsApp) ou pointj@rts.ch

In this episode of Run with Fitpage, we have one of the best Sports Cardiologists in the world - Dr. Sanjay Sharma. Dr. Sharma talks about heart health, cardiac screening, a number of medical tests for runners and alot more with our host, Vikas Singh. Dr. Sanjay Sharma is a highly esteemed Professor of Cardiology and Head of Research at St George's University of London, where he leads a renowned clinical and academic group. With a focus on sudden cardiac death in the young and heart muscle diseases, Dr. Sharma boasts an international reputation, backed by over 250 PubMed citations. He serves as the director of the largest sports cardiology unit in the UK, providing essential care for athletes from prestigious organizations like the British Premier Soccer and Rugby League. As the medical director of the Virgin London Marathon and lead cardiologist for the 2012 London Olympics, Dr. Sharma has been recognized for his exceptional contributions to endurance event medical services worldwide. He is also actively involved with charity work, notably leading the largest cardiac screening program in the UK with Cardiac Risk in the Young (CRY), screening over 20,000 individuals annually and advocating for preventative measures against young sudden death.In addition to his clinical and research endeavors, Dr. Sharma is dedicated to education, having authored several educational books, including the widely acclaimed Rapid Review of Medicine. With a passion for teaching and a commitment to saving lives, Dr. Sanjay Sharma continues to make significant strides in the fields of cardiology and sports medicine, leaving an indelible mark on both his students and the broader medical community.About Vikas Singh:Vikas Singh, an MBA from Chicago Booth, worked at Goldman Sachs, Morgan Stanley, APGlobale, and Reliance before coming up with the idea of democratizing fitness knowledge and helping beginners get on a fitness journey. Vikas is an avid long-distance runner, building fitpage to help people learn, train, and move better.For more information on Vikas, or to leave any feedback and requests, you can reach out to him via the channels below:Instagram: @vikas_singhhLinkedIn: Vikas SinghTwitter: @vikashsingh101Subscribe To Our Newsletter For Weekly Nuggets of Knowledge!

Female Patterned Heart Disease   Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat63   Target Audience             This activity is targeted toward primary care providers and advanced providers.   Statement of Need  This podcast will discuss female-patterned heart disease. Cardiovascular disease continues to be one of the leading causes of mortality for women. Research indicates that there continues to be disparities in the diagnosis and treatment of cardiovascular disease for women, resulting in greater mortality rate. (American Journal of Preventive Cardiology). The goal of this program is to highlight risks, symptoms and diagnostic characteristics specific to female patients with the goal of earlier intervention and improved patient outcomes.   Objectives At the conclusion of this offering, the participant will be able to: Define female-patterned heart disease and presenting symptoms unique to females. Discuss the latest diagnostic guidelines for female-patterned heart disease. Describe female specific risk factors of cardiovascular disease.    Moderator Mona Lisa Tailor, M.D. Internal Medicine Norton Community Medical Associates - Barrett Louisville, Kentucky   Speaker Li Zhou, M.D., Ph.D. Medical Director Norton Heart and Vascular Institute Norton Healthcare Louisville, Kentucky   Moderator, Speaker and Planner Disclosures   The planners, moderator and speaker of this activity do not have any relevant financial relationships to disclose.    Commercial Support   There was no commercial support for this activity.    Physician Credits Accreditation  Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.     Designation  Norton Healthcare designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Nursing Credits Norton Healthcare Institute for Education and Development is approved with distinction as a provider of nursing continuing professional development by the South Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. This continuing professional development activity has been approved for .75 contact hours. In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance.     For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org.   Resources Cardiovascular disease in women https://pubmed.ncbi.nlm.nih.gov/17569469/   Beyond equality, women require extra care in cardiovascular imaging https://pubmed.ncbi.nlm.nih.gov/35962143/     Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. Five Louisville hospitals provide inpatient and outpatient general care as well as specialty care including heart, neuroscience, cancer, orthopedic, women's and pediatric services. A strong research program provides access to clinical trials in a multitude of areas. More information about Norton Healthcare is available at NortonHealthcare.com.     Date of Original Release | Feb 2024; Information is current as of the time of recording.  Course Termination Date | Feb 2027 Contact Information | Center for Continuing Medical, Provider and Nursing Education; (502) 446-5955 or cme@nortonhealthcare.org      

Heart attack is the leading cause of death in the United States. Death due to stroke ranks number five. Both are worst-case scenarios for someone with cardiovascular (or heart) disease, which is commonly caused by plaque buildup in the arteries, or atherosclerosis. The purpose of having our cholesterol tested is to gauge our atherosclerosis risk because certain cholesterol-carrying particles—like LDL, or ‘bad cholesterol'—lead to plaque formation. But does the standard test of our LDL level give us a full picture of our heart disease risk? What about the danger posed by its related particles that can also cause plaques to form? On Vital Signs with Brendon Fallon, cardiologist Dr. Seth Baum reveals a more reliable measure of cholesterol-related heart disease risk. He also highlights the cholesterol-carrying particle that is dangerously high in twenty percent or more of the population, yet commonly goes unchecked. Dr. Baum is one of a handful of heart doctors in America who are board certified in clinical lipidology, which deals specifically with lipids like cholesterol and their effect on the body. He joins Vital Signs to paint the broader picture of lipid-related heart disease risk and to highlight the advanced blood-filtering method he oversees in his practice in Boca Raton, Florida to manage that risk. Dr. Baum is a clinical affiliate professor of medicine at Florida Atlantic University College of Medicine. He is also president of the American Society for Preventive Cardiology. ⭕️ Watch in-depth videos based on Truth & Tradition at Epoch TV

This episode kicks off the New Year with something we seem to all be so interested in, right behind belly fat, and that's longevity. Is it just me or is it even 30-somethings now trying to reverse aging? Unpacking all that this is and isn't could be a philosophical episode all on its own. Instead, I'd thought we'd take a look at 4 ways testing your longevity is possible, at home. Now, these tests are not fool-proof. And if you have an old injury or condition, you won't be able to do one or more. Yet, say some of the researchers, that's the reason to pay attention – close attention – to the things you can control! So, knowing is good.  But also.. Please… don't let this discourage you. It's not too late.  An article in Inc. magazine got my attention the other day.  Apparently a 60-year-old startup founder is 3x as likely to found a successful startup as a 30-year-old startup founder and 1.7 times more likely to have it wind up in the top 0.1 percent of all companies.  You can't do that – or anything meaningful – sick, old, tired or with stale ideas.  So whether you're one of our healthpreneurs or not, you're at an advantage if you're truly healthy.  Can you do 20 push ups? Sit and stand (barefoot on the floor unassisted)? Walk between at a minimum of 3.3 mph? and hang from a pull up bar for at least 30 seconds?  You're not only going to live longer but you can run your business (or family, home and organizations you volunteer for) like a boss. The first quarter of 2024 the Flipping 50 Membership is going to focus on benchmarking, improving and retesting. In addition to testing those progress chart tracking we always encourage (measurements, body composition and objective ratings of our daily health) we're targeting these.   Here's how you can start this at home! (or inside our membership? Do this with us the weekend of the 13th and 14th!  Community Member Question: Intermittent Fasting and Exercise Molly asked, “Debra  I have been wanting to incorporate fasting into my health regime.  However with your current recommendations of working out in a fed state I have found it is very difficult to get enough protein and to maintain the fasted state. I read the book Feast Fast Repeat and it goes against a lot of the information you recommend. It's difficult for me to fast for 18 to 20 hours and feel good. Just wondering what your thoughts are on fasting?”  Start earlier. That makes it simple! You don't have “dinner” at dinner time.. You have a last high protein meal at 3 or 4pm.  Fasting has a purpose. Getting off a plateau. You can kickstart with an 18 or 20 hour fast but there is NO reason if you're an active person to do this regularly. Rotate.., 12, 14, 15, 18 ….  Rotating the amount of carbs you have also becomes important. Overall, lower than you've probably had before in your life (remember when you'd have two bagels at a sitting?) But you might toggle between 50 and 100 grams a day. If you always go long fasting, if you also restrict calories when you are in an eating window, and if you never vary carbs and always go low, you will have no metabolic flexibility. For the majority of humans that just won't work. Your body is getting stressed by each of those things and never rewarded and replenished. Just where is that energy to do work and fun stuff going to come from?  If this was your first book? Keep reading. It's good but there are dozens of ways to fast. They include just going lower calorie for 5 days (with higher fat and lower protein), and using bone broth or doing smoothies twice daily. There are so many ways to start. But for intermittent fasting to be the goal then starting to extend your overnight fast is the beginning. Hit 12 hours. Try 13 and 14. See how you do. But don't always do it.  Your week should NOT ever look the same every day or you lose metabolic flexibility. If your goal is to stay active and gain muscle and bone density … tell me in a 20 hour fast how you manage to get micronutrients in. What we all have to do is prioritize. It's not intermittent fasting and exercise. It's intermittent fasting OR exercise. Which do you need most right now and why?  Also relevant: do you have any emotional eating tendencies or a history of eating disorder or diet and binge? If yes, this is a slippery slope for you. (see resources) Testing Your Longevity with 4 Tests PUSHUPS  Can you do 20 pushups? For females this is the goal as estimated based on the male-only study finding 40 pushups for men significantly decreased risk of cardiovascular risk. Further, it was a better indicator than sub-maximal treadmill tests. While VO2 capacity is associated with longevity, assessing VO2 max is limited to those first with access to a lab and those highly motivated to endure the discomfort a true test requires.  Pros: The push up is a test of multiple things including upper body strength as well as core. Overall, it's a functional use of the body. If you can do it horizontally, good form and posture vertically is far more likely.  Cons:  If you're at all compromised, as many are, with ability to stabilize the scapular (shoulder blades) or with shoulder rotator cuff issues, and can't maintain good form head to toe the push up can be injurious at worst or increase poor mechanics at best.  Flip:  I'd much rather that we all could do at least a few pull ups.  WALKING PACE Can you walk a pace between 3-4 mph? It's actually 3.3 that supports bone density, while slower paces don't. So, there's that too.  If you're over 60, the effect of slow vs fast walk (at least 3-4 mph) is even more pronounced in reducing all-cause mortality. Like 53% less. Map out a mile of relatively flat surface. Warm up, test your speed. When returning to retest be sure you do the exact same course.  Pros:  This is directly related to our independence later in life. Being able to walk at a respectable pace (I wouldn't designate this as fast) is a factor of weight and mobility, muscle and joint and metabolic health. Inability to perform this one already indicates a need to buff other areas to compensate.  Cons:  If you're compromised due to a previous injury or a condition in feet, ankles, knees, hips or significantly overweight there is already a limited ability to walk, this test is not a possibility.  Next up for testing your longevity is a challenging one!! So I hope you're warmed up!  SIT RISE TEST  A study in the European Journal of Preventive Cardiology found how well you do the stand to sit to stand test indicates your risk of mortality.  Stand barefoot, cross one leg over the other and lower yourself to a sitting position. Then try to stand back up.  Attempt to do so without touching the floor with your hand, knees, elbows, forearms or sides of your legs.  You begin with 10 points. Subtract half a point each time you use a body part to shift to one side before levering up. Also subtract half a point if you lose balance.  In the study those that scored less than 8 points were twice as likely to die within the following six years. Those that scored less than 5 were three times as likely to die within the following six years.   An increase in your score of any kind reduces your mortality rate by 21%.  Pros:  This requires flexibility, balance, mobility and muscle strength. Any lack of balance, flexibility, strength or being overweight make the test harder. Each of these components is correlated to risk of mortality.  Cons:  Compromise in a joint that limits the performance of this test may not reveal that some level of these functional components are present in other joints and are evidenced in other activities.  You need a tool for testing your longevity with this next test. They aren't costly and some gyms likely also have them.  GRIP STRENGTH  In 2018 the grip strength test was determined to correlate to overall body strength and muscle mass.  Low overall muscle strength (as correlated with grip strength) is a health hazard to all health outcomes except for colon cancer, prostate cancer and lung cancer.  You can buy a dynamometer to test grip or for an easier at home or gym option, hang from a pull up bar. For men 60, and for women 30 seconds is a good target, suggest some researchers. Yet, it's an increase or decrease that you want to watch. A six-pound decrease (as tested on with the hand grip tool – but that may correlate to any reduced time hanging) correlates with 16 percent higher risk of dying from any cause.  To improve grip strength, you don't want to just work on grip strength however. Don't go around the house squeezing tennis balls. That's not really the value of the test. Improve your overall skeletal muscle strength. Other ways to assess total body strength are a one-rep max or estimated 1-rep max by doing a 10-rep max. Grip strength is far less intimidating and less injurious. But make no mistake your bench press, row or pull up, or leg press weight should also be improving.  Are You Built to Last (and Love It?) This small battery of tests are simple ways to assess your function. Every test has limitations. You may not be able to do one or more of them. The best use of them is in addition to outcomes like body fat percent (30% is obese), waist girth (for women, 35 inches significantly increases health risk), amount of muscle mass (in pounds or kilograms) primarily to know if you're gaining, losing or at very least preserving are additional objective measures. You may already be using these without knowing the significance of them.  Flipping 50 Members have access to a Progress tracking both objective and subjective measures of progress. If you're not inside the members area yet with a course, membership, or downloadable freebie, you can start here. https://www.flippingfifty.com/login The point in measuring and interpreting these is realizing the habits you've had to this point got you the results you have at this point. If you wish to change the outcome, you change the habits related to them. An injury or condition may have limited your ability to perform a certain test. This awareness can still be an asset if it highlights the need to strengthen other areas of your health span longevity.  Need support? Join us for a masterclass Jan 10, 2024 https://www.flippingfifty.com/olderandstronger Resources:  Masterclass: https://www.flippingfifty.com/olderandstronger  Membership: https://www.flippingfifty.com/cafe  Smart Scale: https://www.flippingfifty.com/givescale Handgrip:  Power Plate: https://www.flippingfifty.com/powerplate – use code flipping50 for 25% off and free massage gun with purchase References: Araújo CGS, Castro CLB, Franca JFC, Araújo DS. Sitting–rising test: Sex- and age-reference scores derived from 6141 adults. European Journal of Preventive Cardiology. 2020;27(8):888-890. doi:10.1177/2047487319847004 Celis-Morales C A, Welsh P, Lyall D M, Steell L, Petermann F, Anderson J et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants  BMJ  2018;  361 :k1651 doi:10.1136/bmj.k1651 de Brito LBB, Ricardo DR, de Araújo DSMS, Ramos PS, Myers J, de Araújo CGS. Ability to sit and rise from the floor as a predictor of all-cause mortality. European Journal of Preventive Cardiology. 2014;21(7):892-898. doi:10.1177/2047487312471759 Stamatakis E, Kelly P, Strain T, et al Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts British Journal of Sports Medicine 2018;52:761-768. Yang J, Christophi CA, Farioli A, et al. Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men. JAMA Netw Open. 2019;2(2):e188341. doi:10.1001/jamanetworkopen.2018.8341  

Calling all those with a passion for cardiovascular prevention! In this episode of the CardioNerds Cardiovascular Prevention Series, we take a deep dive into the world of glucagon-like peptide-1 (GLP-1) receptor agonists. Along the way, you'll hear about the biology of the GLP-1 molecule and its related peptides, learn more about how GLP-1 agonists promote glycemic control, weight loss, and cardiometabolic health, and explore the current body of literature supporting the individualized application of these medications to patients with diabetes, obesity, and/or ASCVD. Join Dr. Christian Faaborg-Andersen (CardioNerds Academy Fellow and Internal Medicine Resident at MGH), Dr. Gurleen Kaur (Director of the CardioNerds Internship, Chief of House Einthoven, and Internal Medicine resident at BWH), and Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at JHH) for a wide-ranging discussion on GLP-1 and GIP agonists with Dr. Dennis Bruemmer (Cardiologist and Director of the Center for Cardiometabolic Health in the section of Preventive Cardiology at the Cleveland Clinic). Show notes were drafted by Dr. Christian Faaborg-Andersen. Audio editing was performed by CardioNerds Academy Intern, student Dr. Tina Reddy. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. 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 and Quotes - GLP-1 Agonists: Mechanisms to Applications The selection and dosing of GLP-1 and GIP agonists (GLP-1s and GIPs) depends on their intended use as an anti-glycemic or anti-obesity agent. The cardiovascular benefits of GLP-1s and GIPs may be independent of improvements in glycemic control, and in part be driven by reduction in inflammation, a key driver of arterial plaque formation. In patients with comorbid coronary artery disease, obesity, and diabetes, GLP-1 agonists and SGLT-2 inhibitors should be used as first-line agents, over metformin. Tirzepatide is a dual agonist that activates GIP and GLP-1 receptors. GIP is highly expressed in the brain, which may mediate satiety, promote energy expenditure, and enhance peripheral glucose metabolism. Caution should be used with GLP-1 agonists in patients with long-standing diabetes complicated by gastroparesis, as well as incompletely treated diabetic retinopathy. GI upset is not uncommon with GLP-1/GIP agonists, and switching to a different agonist is unlikely to help.  Show notes - GLP-1 Agonists: Mechanisms to Applications What are the mechanisms of action by which GLP-1 and GIP controls blood sugar and body weight? Glucagon-like peptide-1 (GLP-1) is an endogenous hormone that is secreted in response to an oral glucose load. It promotes insulin release, inhibits glucagon secretion, and slows gastric emptying via the brain-intestine axis, leading to satiety. GLP-1 agonists are medications that mimic the effect of this hormone and, on average, lower hemoglobin A1C by 0.8% to 1.5%. These medications include semaglutide, liraglutide, and dulaglutide. Glucose-dependent insulinotropic polypeptide (GIP) is also an endogenous hormone, similarly secreted by the body in response to an oral glucose load such as a meal. GIP is highly expressed in the arcuate nucleus and hypothalamus, which may mediate satiety, promote energy expenditure, and enhance peripheral glucose metabolism. Tirzepatide is a dual GLP-1/GIP agonist. What is the role of GLP-1/GIP agonists in patients with overweight/obesity and/or type 2 diabetes? How does the dosing of GLP-1/GIP medications change with their intended disease target?

Dr Andrew Tran visits the studio as we explore pediatric preventive cardiology. Heart disease is the leading cause of death in U.S. adults, but the process that leads to heart attacks and strokes begins in childhood. By identifying high-risk children, addressing their risks, and encouraging healthy lifestyles, we can decrease cardiovascular disease down the road. We hope you can join us!

Dr. Barry Franklin is Director of Preventive Cardiology and Cardiac Rehabilitation at Corewell Health. He is a prolific author and speaker, and has written 547 papers, 100 book chapters, and 27 books. He has also given over 1,000 presentations, both within and outside the medical profession. Barry's latest book is “GPS for Success: Skills, Strategies, and Secrets of Superachievers.”

Peter Allison and Peter Bowes – school friends 50 years ago, now contemplating the next chapter in life - return with another conversation about the latest science that could help us achieve a longer healthspan.In this episode·      A study in the British Journal of Sports Medicine found that wall squats and planks are best at lowering blood pressure, with isometric exercises providing greater benefits than aerobic exercise. ·      Walking just 3867 steps a day can reduce the risk of dying from any cause, according to research published in the European Journal of Preventive Cardiology.·      A study suggests that a 10-minute MRI scan could be better at screening for prostate cancer than the traditional PSA test.·      A nematode worm that survived 46,000 years in permafrost but could the episode highlight broader concerns that the melting permafrost could release potentially harmful organisms and viruses.References, transcript and additional show notes are available at the LLAMA podcast website-Affiliation disclosure: This podcast receives a small commission when you use the code LLAMA for purchases from companies below which support our mission.   It helps to cover production costs and ensures that our interviews, sharing information about human longevity, remain free for all to listen. -Time-line Mitopure (a highly pure form of Urolithin A) boosts the health of our mitochondria – the battery packs of our cells – and improves muscle strength. Time-line is offering LLAMA listeners a 10% discount on its range of products – Mitopure powders, softgels & skin creams. Use the code LLAMA at checkout- DoNotAgeDoNotAge.org is offering listeners to LLAMA a 10% discount on its range of products – NAD boosters, Sirtuin activators, senolytics and more. Any health queries can be answered by emailing the team at hello@donotage.orgUse the code LLAMA at checkout. -Support the showThe Live Long and Master Aging (LLAMA) podcast, a HealthSpan Media LLC production, shares ideas but does not offer medical advice. If you have health concerns of any kind, or you are considering adopting a new diet or exercise regime, you should consult your doctor.

What if there were a simple way to fix your diet (without dieting) and become healthier with every bite?  Today's guest, science communicator and nutrition expert Dr. Sarah Ballantyne, says there is.  Even for those of us who really care about what we eat, there's still a lot of confusion and a huge barrier to good information about basic nutrition concepts. Do you really know what different nutrients do? Or which foods have them? Or how to eat enough of them? If not, you're not alone. In fact, half of the US population is deficient in 10 nutrients!  I'm really excited to share this new podcast episode with you. Dr. Sarah Ballantyne created a whole new system to help us all understand what it means to eat for health. Join us for a fascinating discussion about nutrition, the body, and what it means to increase your nutrient intake. I'll tell you right now, some of this information might completely change your mind about things you thought you knew. I, for one, am excited to integrate new information into my philosophies… and add a couple of foods back into my diet!  Full show notes: jjvirgin.com/nutrivore Learn how foods cause leaky gut in The Virgin Diet: https://store.jjvirgin.com/products/the-virgin-diet-paperback Read my book, The Sugar Impact Diet: https://store.jjvirgin.com/collections/books/products/sugar-impact-diet-paperback-book Learn more about Dr. Sarah Ballantyne: https://nutrivore.com Subscribe to my podcast: http://subscribetojj.com Study: European Journal of Preventive Cardiology:https://pubmed.ncbi.nlm.nih.gov/30971126/ Study: Nutrition Journal: https://pubmed.ncbi.nlm.nih.gov/33888143/ Study: Food Technology and Biotechnology: https://pubmed.ncbi.nlm.nih.gov/28867958 Study: Journal of Functional Foods: https://www.sciencedirect.com/science/article/abs/pii/S1756464617300749 Study: Journal of Nutrition: https://academic.oup.com/jn/article/141/4/595/4743372?login=false Living Ratio Cacao Calm: https://livingratio.com/?sca_ref=2747593.vgty26M7uP&utm_source=2747593&utm_medium=jj-virgin&utm_campaign=45338 Healthy Eating Index: https://www.fns.usda.gov/CNPP/healthy-eating-index-hei My Plate: https://www.myplate.gov The Paleo Diet by Dr. Loren Cordain: https://amzn.to/44GZBXT Himalayan Tartary Buckwheat: https://amzn.to/3JVQk6q Get Dr. Sarah's Get 5 FREE Nutrivore Guides: https://nutrivore.com/thankyou

HEALTH NEWS   ·         Fermented red clover extract stops menopausal hot flushes and symptoms ·         Resveratrol, quercetin could provide new options for cancer therapy ·         World's largest study shows the more you walk, the lower your risk of death, even if you walk fewer than 5,000 steps ·         Brains of overweight people 'ten years older' than lean counterparts at middle-age ·         Soy protein found to deplete testosterone in men ·         Study shows endometriosis is linked to higher risk of depression, anxiety, eating disorders   Fermented red clover extract stops menopausal hot flushes and symptoms Aarhus University (Denmark), July 24, 2023 The vast majority of women in the menopause are familiar with the status of Red Clover as an herbal medicine that soothes hot flush symptoms and hormonal fluctuations. This holds true, new research shows, if the red clover is taken in a fermented form. Fermented Red Clover extract is demonstrated to decrease significantly both the number and severity of daily hot flushes. The study also found that the extract prevents the normally accelerated menopausal bone loss affecting one in three women over the age of 50 (e.g. results showed treatment blunted bone loss in the spine completely). These findings are very promising as the benefits take place without any of the side effects of traditionally proscribed hormone therapies that increase the risk of cancers and cardiovascular diseases. "It is the fermentation process of the Red Clover extract that makes the difference, as the lactic acid fermentation increases the bioavailability of the bioactive estrogen-like compounds (known as isoflavones or phytoestrogens) that Red Clover has in abundance," explains Max Norman Tandrup Lambert. "The challenge with isoflavones is that they can be difficult to digest as they naturally occur in the plant bound to sugar molecules which prevent absorption. Hence, a large proportion of the isoflavones that are consumed (e.g. as a pill or capsule) can pass through the intestine without entering circulation. This problem is bypassed when the Red Clover extract undergoes a fermentation process. To be technical the process separates the sugar molecules from the isoflavones, thereby increasing bioavailability," explains Max Norman Tandup Lambert. A studyrecruited 130 women with menopause symptoms, of which 60 were selected based on criteria of at least five severe hot flushes per day and blood tests (including FSH, that indicates the "stage" of menopause). "The women were separated into two groups of 30, so 30 drank 150ml Red Clover extract per day for 12 weeks, whilst the other 30 drank a masked placebo product. After 12 weeks we tested again and were speechless about the data. There was a much greater effect than we had hoped for." Says Max Norman Tandrup Lambert.   Resveratrol, quercetin could provide new options for cancer therapy Oregon State University, July 16, 2023 Resveratrol and quercetin, two polyphenols that have been widely studied for their health properties, may soon become the basis of an important new advance in cancer treatment, primarily by improving the efficacy and potential use of an existing chemotherapeutic cancer drug. In laboratory experiments, researchers at Oregon State University have developed a system to increase the bioavailability of these compounds in the body by using "copolymers" that make them water soluble and allow their injection into the blood stream, creating levels that are far higher than could ever be obtained by diet or oral intake. The resveratrol and quercetin then appear to reduce the cardiac toxicity of a very widely used cancer drug, Adriamycin. Although highly effective in the treatment of lymphomas, breast, ovarian and other cancers, Adriamycin can only be used for a limited time in humans because of its cardiotoxicity. The co-administration of these polyphenols might allow much more extensive use of this drug, while at the same time improving its efficacy and demonstrating the polyphenols' own anti-cancer properties, scientists said. Findings on this research have been published in the Journal of Controlled Release, by scientists from the College of Pharmacy at Oregon State University and the School of Pharmacy at Pacific University. Both institutions supported the research. "The co-administration of high levels of resveratrol and quercetin, in both in vitro and in vivo studies, shows that it significantly reduces the cardiac toxicity of Adriamycin," Alani said. "And these compounds have a synergistic effect that enhances the efficacy of the cancer drug, by sensitizing the cancer cells to the effects of the drug." It's possible, Alani said, that after further research it could be demonstrated that use of these compounds can completely eliminate the cardiotoxicity of Adriamycin, as they scavenge the toxic free radicals produced by use of this drug. It's also possible, he said, that administration of these natural polyphenols could have value in cancer therapy by themselves, or in combination with a wider range of other chemotherapeutic drugs.   World's largest study shows the more you walk, the lower your risk of death, even if you walk fewer than 5,000 steps Medical University of Lodz (Poland) & Johns Hopkins University School of Medicine, August 8, 2023 The number of steps you should walk every day to start seeing benefits to your health is lower than previously thought, according to the largest analysis to investigate this. The study, published in the European Journal of Preventive Cardiology, found that walking at least 3967 steps a day started to reduce the risk of dying from any cause, and 2337 steps a day reduced the risk of dying from diseases of the heart and blood vessels (cardiovascular disease). However, the new analysis of 226,889 people from 17 different studies around the world has shown that the more you walk, the greater the health benefits. The risk of dying from any cause or from cardiovascular disease decreases significantly with every 500 to 1000 extra steps you walk. An increase of 1000 steps a day was associated with a 15% reduction in the risk of dying from any cause, and an increase of 500 steps a day was associated with a 7% reduction in dying from cardiovascular disease. The researchers, led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, found that even if people walked as many as 20,000 steps a day, the health benefits continued to increase. They have not found an upper limit yet. "Our study confirms that the more you walk, the better," says Prof. Banach. "We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates. In addition, our analysis indicates that as little as 4,000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from cardiovascular disease." There is strong evidence that a sedentary lifestyle may contribute to an increase in cardiovascular disease and a shorter life. Studies have shown that insufficient physical activity affects more than a quarter of the world's population. More women than men (32% versus 23%), and people in higher income countries compared to low-income countries (37% versus 16%) do not undertake a sufficient amount of physical activity. The studies analyzed by the researchers followed up participants for a median (average) of seven years. The mean (average) age was 64, and 49% of participants were female. In people aged 60 years or older, the size of the reduction in risk of death was smaller than that seen in people aged younger than 60 years. In the older adults, there was a 42% reduction in risk seen in those who walked between 6,000 and 10,000 steps a day, while there was a 49% reduction in risk in younger adults who walked between 7,000 and 13,000 steps a day.   Brains of overweight people 'ten years older' than lean counterparts at middle-age University of Cambridge, August 4, 2023 From middle-age, the brains of obese individuals display differences in white matter similar to those in lean individuals ten years their senior, according to new research led by the University of Cambridge. White matter is the tissue that connects areas of the brain and allows for information to be communicated between regions.   Our brains naturally shrink with age, but scientists are increasingly recognising that obesity - already linked to conditions such as diabetes, cancer and heart disease - may also affect the onset and progression of brain ageing; however, direct studies to support this link are lacking.   The team studied data from 473 individuals between the ages of 20 and 87, recruited by the Cambridge Centre for Aging and Neuroscience.  The researchers divided the data into two categories based on weight: lean and overweight. They found striking differences in the volume of white matter in the brains of overweight individuals compared with those of their leaner counterparts. Overweight individuals had a widespread reduction in white matter compared to lean people.   They discovered that an overweight person at, say, 50 years old had a comparable white matter volume to a lean person aged 60 years, implying a difference in brain age of 10 years. Strikingly, however, the researchers only observed these differences from middle-age onwards, suggesting that our brains may be particularly vulnerable during this period of ageing.   "As our brains age, they naturally shrink in size, but it isn't clear why people who are overweight have a greater reduction in the amount of white matter," says first author Dr Lisa Ronan from the Department of Psychiatry at the University of Cambridge, "We can only speculate on whether obesity might in some way cause these changes or whether obesity is a consequence of brain changes."       Soy protein found to deplete testosterone in men University of Connecticut, July 27, 2023  The health detriments of soy consumption are reiterated in a new study out of the University of Connecticut that highlights the importance of avoiding soy at all costs. Researchers from the school found that men who consume soy protein rather than whey protein for muscle recovery and growth experience considerable reductions in their testosterone levels, as well as marked increases in levels of the stress hormone cortisol. Published in the Journal of the American College of Nutrition (JACN), the randomized, placebo-controlled crossover study looked at how soy supplementation affects testosterone, cortisol and sex hormone-binding globulin (SHBG) levels in men who engage in resistance exercises and training. They compared these effects to those brought about in men who supplement with whey. For the research, 10 resistance-trained men in their early 20s had their hormones evaluated in conjunction with an assigned supplemental diet. The men were divided into three groups: one receiving whey protein isolate, one receiving soy protein isolate and the last receiving a maltodextrin-based placebo control. The men were not allowed to take any other supplements, and vegetarians, vegans and individuals who were consuming high-protein diets were excluded. For two weeks, the men were told to ingest 20 grams of their assigned supplement every morning at the same time. The participants were then instructed to perform six sets of heavy resistance squats at 10 reps each, exerting 80 percent of their maximum lifting weight. At the end of the 14-day period, the researchers collected hormone profiles from each of the men and made comparisons. They found that, compared to the men who supplemented with whey, those taking soy did not necessarily produce more estrogen. They did, however, experience decreased testosterone levels and elevated cortisol levels, a deadly combination that can leave men at risk of disease and weight gain. Lowered testosterone levels and elevated cortisol levels are also generally attributed to the feminization phenomenon occurring in men that sometimes leads to disorders like nipple discharge, breast enlargement and hot flashes. It can also lead to inhibited thyroid function, bone loss, sleeping disorders, decreased sex function and reproductive problems.     Study shows endometriosis is linked to higher risk of depression, anxiety, eating disorders Yale University, August 7, 2023 Endometriosis is not just a condition that affects the pelvis, but a systemic disease that involves the entire body. Now, the largest epidemiological study to date on the psychiatric factors that can accompany endometriosis has demonstrated that depression, anxiety, and eating disorders are not only a result of the chronic pain endometriosis generates, but also have their own underlying genetic mechanisms. The team published its findings in JAMA Network Open. "The relationship between endometriosis and mental health is more complicated than we expected," says Renato Polimanti, Ph.D., associate professor of psychiatry and the study's principal investigator. "The biological basis is not just chronic pain, and there is much more that we need to understand." Endometriosis is an extremely painful condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus. The disease manifests in a wide array of symptoms including pelvic, abdominal, and low back pain, heavy bleeding, painful sexual intercourse, painful urination and bowel movements, constipation or diarrhea, bloating, nausea, fatigue, and infertility. In this new study, the Yale research team obtained data from the UK Biobank which included more than 8,200 patients with endometriosis and 194,000 healthy controls. First, they investigated if depression, anxiety, and eating disorders were more prevalent in those with endometriosis, accounting for chronic pain, socioeconomic status, age, body mass index, various medications, and co-morbid conditions. They found that having endometriosis significantly increases the odds of having these three psychiatric conditions. through running a genetic correlation analysis, they found a significantly high genetic correlation between endometriosis and each of the three disorders. 

The following question refers to Section 5.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by MGH medicine resident Dr. Christian Faaborg-Andersen, answered first by Dr. Patrick Azcarate, and then by expert faculty Dr. Laurence Sperling. Dr. Laurence Sperling is the Katz Professor in Preventive Cardiology at the Emory University School of Medicine and Founder of Preventive Cardiology at the Emory Clinic. Dr. Sperling was a member of the writing group for the 2018 Cholesterol Guidelines, serves as Co-Chair for the ACC's Cardiometabolic and Diabetes working group, and is Co-Chair of the WHF Roadmap for Cardiovascular Prevention in Diabetes. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #29 What percentage of the European population currently meets the recommended physical activity guidelines (150 minutes moderate-intensity activity weekly or 75 minutes vigorous-intensity activity weekly)?A75% Answer #29 ExplanationThe correct answer is A: