Inactivity, Excess Weight Linked to Hard-to-Treat Heart Failures

 Prevention is imperative for heart failure with preserved ejection fraction.

Newswise, April 20, 2017– Lack of exercise and excessive weight are strongly associated with a type of heart failure that has a particularly poor prognosis, UT Southwestern Medical Center researchers determined in an analysis of data from three large studies.

Heart failure is a chronic condition in which the heart is unable to supply enough oxygenated blood to meet the demands of the body.

Heart failure is approximately equally divided between two subtypes: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Ejection fraction refers to the percentage of the blood that exits the heart with each contraction.

“Previous studies have consistently found an association between low levels of physical activity, high BMI, and overall risk of heart failure, but this study shows that the association is more pronounced for heart failure with preserved ejection fraction, the type of heart failure that is the most challenging to treat,” said preventive cardiologist Dr. Jarett Berry, Associate Professor of Internal Medicine at UT Southwestern, and the study’s senior author.

The study appears in the Journal of the American College of Cardiology. 

In heart failure with preserved ejection fraction, the heart stiffens. Instead of being soft, it’s rigid and it resists expansion.

Cardiologists often explain the difference between the two types of heart failure by saying that in heart failure with preserved ejection fraction, the heart doesn’t relax enough, while in heart failure with reduced ejection fraction the heart doesn’t squeeze enough. Many treatments have been developed for treating the latter but there are no evidence-based treatments for the former. 

“The five-year survival rate among heart failure with preserved ejection fraction patients is around 30 to 40 percent. While heart failure with reduced ejection fraction survival has improved significantly over the years, heart failure with preserved ejection fraction prognosis is little changed,” said Dr. Ambarish Pandey, a cardiology fellow in Internal Medicine at UT Southwestern Medical Center and first author of the study.

The pooled analysis looked at data from 51,000 participants in three cohort studies, the Women’s Health Initiative, the Multiethnic Study of Atherosclerosis (MESA), and the Cardiovascular Health Study. Among the 51,000 participants, there were 3,180 individuals who developed heart failure.

Of these, 39 percent were heart failure with preserved ejection fraction, 29 percent were heart failure with reduced ejection fraction, and 32 percent had not been classified when the data was gathered.

The incidence of heart failure with preserved ejection fraction was 19 percent lower for individuals who exercised at recommended levels.

Similarly, body mass index (BMI) had an inverse relationship with heart failure with preserved ejection fraction. Higher BMI levels were more strongly associated with heart failure with preserved ejection fraction than with heart failure with reduced ejection fraction.

Heart failure with preserved ejection fraction is a growing problem as the population ages, and is particularly a problem among elderly women.

Medications such as ACE inhibitors, beta blockers, and aldosterone antagonists have been shown in large-scale randomized trials to reduce mortality in patients with heart failure with reduced ejection fraction. Clinical trials have not identified medications that reduce mortality in patients with heart failure with preserved ejection fraction.

Heart transplant is the ultimate option for some patients with heart failure with reduced ejection fraction but is not an option for patients with heart failure with preserved ejection fraction, all of which means that prevention is crucial for heart failure with preserved ejection fraction.

“These findings highlight the importance of lifestyle interventions such as increasing physical activity levels and reducing weight to combat the growing burden of this disease,” said Dr. Berry, Dedman Family Scholar in Clinical Care.

Other UT Southwestern researchers who contributed to this study are Colby Ayers, faculty associate, and Dr. James de Lemos, Professor of Internal Medicine and holder of the Sweetheart Ball‐Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology. 

Funding for this study was provided by the American Heart Association.

Preventing heart failure:

•The American Heart Association recommends 150 minutes per week of moderate exercise, 75 minutes per week of vigorous exercise, or a mix of the two.

•A patient’s cardiorespiratory fitness in middle age is particularly important in predicting the long-term risk of heart failure.

About UT Southwestern Medical Center

UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. The faculty of almost 2,800 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about 80 specialties to more than 100,000 hospitalized patients and oversee approximately 2.2 million outpatient visits a year.

To automatically receive news releases from UT Southwestern via email, subscribe at www.utsouthwestern.edu/receivenews

2016 Was a Record Year for Organ Transplants

Newswise, April 20, 2017– Loyola Medicine performed 246 organ transplants in 2016, the highest number it has recorded during the program’s 45-year history.

Loyola also led all other Illinois centers in heart and lung transplants in 2016. Loyola performed 36 heart transplants, 40 lung transplants, 64 liver transplants and 106 kidney transplants in 2016. Loyola’s previous record year was 2013, when it performed 186 transplants.

Organ transplants nationally and in Illinois also experienced a record year in 2016. In Illinois, Loyola accounted for a large share of the state's increase.

“The growth of our life-saving organ transplant program aligns with our triple aim of providing better health, better care and lower costs,” said Larry Goldberg, Loyola Medicine president and CEO.

 “We are proud of what we accomplished in 2016 and we will continue to put patients at the center of all we do.”

During one 22-hour period last fall, Loyola surgeons successfully transplanted 10 organs into six patients, including a double lung transplant, a single-lung transplant, a heart transplant, a second double-lung transplant, a liver-kidney transplant and an en bloc kidney transplant (two kidneys from one patient).

“We are very experienced and we have a very deep bench,” said Edwin McGee, Jr., MD, executive director, solid organ transplant, and surgical director of Loyola’s heart transplant program.

Loyola is one of only three centers in Illinois that perform transplants on all four of the major solid organs: heart, lung, kidney and liver. Loyola also is among the few centers that perform combination transplants, including heart-lung, heart-kidney, heart-liver, liver-kidney, lung-liver and lung-kidney.

 Loyola has received approval from the United Network for Organ Sharing to begin a pancreas transplant program in 2017. Loyola specialists employ a clinically integrated, evidence-based approach to care that leads to outstanding results.

Loyola takes on the most challenging cases and provides second opinions to patients who have been turned down by other centers. Loyola also is expanding the donor pool and benefitting patients by accepting usable organs that may have been rejected by other centers. Heart: A 53-year-old man recently became the 800th patient to receive a heart transplant at Loyola. Loyola has performed more heart transplants than any other center in Illinois.

The 36 heart transplants in 2016 were the most Loyola has performed since it began Illinois’ first heart transplant program in 1984. Even though Loyola takes on the most challenging cases, its one-month, one-year and three-year patient survival rates for heart transplants exceed national averages.

Lung: For 29 years, Loyola has operated the largest and most successful lung transplant program in Illinois. Nearly 900 lung transplants—by far the most of any center in Illinois—have been performed and in 2016, Loyola’s 40 lung transplants were more than all other programs in Illinois combined. Loyola’s lung transplant program regularly evaluates and successfully performs transplants in patients who have been turned down by other centers in Chicago and surrounding states and consistently records outstanding outcomes.

Liver: Loyola’s liver transplant program is one of the fastest growing programs in the country.In just four years, the number of liver transplants performed at Loyola more than quadrupled, from 14 in 2012 to 64 in 2016. The program makes it convenient for patients from throughout northern Illinois to see transplant specialists. Patients can see Loyola hepatologists and surgeons at Loyola’s main campus in Maywood and at Loyola Centers for Health in Burr Ridge, Elmhurst, Park Ridge, Homer Glen and Oakbrook, and at other practice sites in Naperville, Elk Grove Village, Rockford, Moline, Peoria, downtown Chicago and Chicago’s Chinatown. Another clinic is planned in Peru/Ottawa. Loyola offers the highest level of multidisciplinary, integrated care for liver disease and liver failure patients who may be considering a liver transplant.

Kidney: Loyola’s organ transplant program began in 1971 when it performed its first kidney transplant. Since then, Loyola has performed more than 1,700 kidney transplants. The kidney transplant program recently was expanded with the addition of 10 clinical and administrative staffers. In 2016, Loyola performed 106 kidney transplants, breaking its previous record, and physicians expect to perform even more kidney transplants in 2017. Loyola has begun several initiatives to make kidney transplant an option for more patients. For example, Loyola launched a new kidney transplant clinic for Spanish-speaking patients and Loyola is participating in the Illinois Transplant Fund, which provides financial assistance to patients who cannot afford health insurance premiums. Loyola also joined a paired kidney donation program to help patients find matching living donors.

A Softer Approach to Colon Cancer Screening: A Q&A with Samir Gupta

Newswise, April 20, 2017 — Perhaps you’ve seen the commercial: an animated box sitting on a toilet that tells you to “just go” — that is, collect your stool — and ship the sample to a lab to be screened for cancer and pre-cancer. This DNA-based, non-invasive test is just one option now available to screen for colon cancer.

In the past, colonoscopies were the go-to form of screening. While some people sign up for regular checkups, not everyone is so willing to be probed when they may not feel symptoms of disease. However, cancer can grow without noticeable signs and when disease becomes obvious, it may already be advanced.

Samir Gupta, MD, is a board-certified gastroenterologist at UC San Diego Health and Veterans Affairs San Diego Healthcare System with expertise in colorectal cancer screening and prevention., so we asked him about the importance of early detection and less intrusive testing, including fecal and blood tests, that might increase participation in screening for disease.

Question: Why are colorectal cancer screenings necessary?

Answer: Colorectal cancer is the second leading cause of cancer death in the United States. According to the National Cancer Institute, an estimated 134,000 new cases were diagnosed in 2016 and nearly 50,000 people died. But when discovered early through screening, colorectal cancer is highly treatable. Screening can even prevent cancers from developing through detection and removal of precancerous polyps. Also, screening can detect polyps and cancer before you even have symptoms.

Q: Which screening tests should be used?

A: The best test is the one that is most acceptable to you. The one that you are willing to have done now. Your physician might recommend a specific test based on your medical and family history, but ultimately it’s up to you. Tests include http://jamanetwork.com/learning/video-player/13030589 a traditional colonoscopy, a CT colonography, a stool test to check for blood or abnormal DNA or a sigmoidoscopy.

According to the United States Preventive Services Task Force (USPSTF), an independent group of national experts in prevention that makes evidence-based recommendations about clinical preventive services, including screenings, there is no information demonstrating that any one is better than another so pick one and get screened based on your personal preferences.

For example, if you want to place the greatest emphasis on sensitivity for colon cancer and polyps, ability to detect and remove polyps if present and a long interval between normal exams, colonoscopy may be the best test for you. If you prefer the convenience of a non-invasive, at-home test and don't mind repeating a test frequently, consider a stool test that checks for blood or blood and abnormal DNA. Your doctor can also help you decide the best test for you.

Q: Who should be screened for colorectal cancer and when?

A: Men and women of all racial and ethnic groups should be screened for colorectal cancer. The USPSTF recommends that men and women start screening for colorectal cancer at age 50 and continue until age 75. After that, it’s best to have a conversation with your physician to make individualized decisions on whether it is necessary. For people 85 and older, screening is no longer recommended. Although it is most often found in people 50 years or older, incidence in people younger than 50 is on the rise. If you’re under 50 and you have family history or notice a change in bowel movements, blood in your stool and/or weakness or fatigue, talk to your physician. It may be nothing, but to use an old cliché, isn’t it better to be safe than sorry?

Q: What happens if the test shows abnormalities?

A: Should the results of a test come back indicating the presence of polyps or cancer, your physician may request further tests.

Nursing Home Improvement Program Identifies Ways to Improve Care for People with Heart Disease

 Newswise, April 20, 2017 – Heart disease is one of the most common chronic

health conditions among nursing home residents.

 Results from the Missouri Quality Initiative for Nursing Homes (MOQI), a partnership between the University of Missouri and the Centers for Medicare & Medicaid Services, indicate that advanced practice registered nurses (APRNs) working in nursing homes to perform primary care duties are improving health outcomes for nursing home residents with heart disease.

MOQI provides full-time APRNs who work in participating nursing home facilities to coordinate care and help staff detect health changes early. In the first three years of the program, potentially avoidable hospitalizations have decreased by 34.5 percent, saving money and reducing stress for residents and their families.

“Cardiovascular disease is a highly prevalent problem in nursing homes; however, through the MOQI project we are seeing significant improvements in the management of care as APRNs are available to assist the medical care of residents,” said Marilyn Rantz, Curators Professor in the Sinclair School of Nursing and lead researcher for MOQI.

“When you get APRNs into nursing homes, they help improve the overall quality of care because they have advanced knowledge of the best evidence-based practices.”

Launched in 2012, MOQI has provided data to Rantz and her team that can help nursing homes improve care for patients. Rantz says nursing homes need to pay attention not only to the symptoms associated with a resident’s heart failure, but also any early signs and symptoms.

 In particular, homes should pay attention to the hydration needs of residents with heart disease as many cardiovascular medications can cause severe dehydration.

“The same advice goes to anyone living with heart disease; they should pay attention to the dehydration risks associated with their medications,” Rantz said. “Anyone taking heart medication should prioritize drinking fluids not only at meal times, but in between meals as well.”

Rantz is a member of the Institute of Medicine, executive director of Aging in Place at TigerPlace and associate director for the Interdisciplinary Center on Aging. She serves as the University Hospitals and Clinics Professor Emerita of Nursing and was the Helen E. Nahm Chair from 2008-2015 within the Sinclair School of Nursing.

How People who are Visually Impaired Can Walk the Monday Mile

Lighthouse Guild Doctor Offers Tips for National Walking Day

Newswise, April 3, 2017-- Nearly 14 million Americans - about one out of every 20 people - have low vision, according to The Centers for Disease Control and Prevention. Eye-care professionals use the term “low vision” to describe significant visual impairment that cannot be corrected with standard glasses, contact lenses, medicine or eye surgery.

According to the National Federation of The Blind, each year, 75,000 more people in the United States will become blind or visually impaired. Though the condition mainly afflicts the elderly, younger Americans are increasingly at risk of irreversible vision loss, particularly as cases of diabetes continue to rise.

Low vision means that even with regular glasses, contact lenses, medicine, or surgery, people find everyday tasks, such as reading, shopping, cooking, watching TV, writing, and exercising difficult to do.

Because of this difficulty, individuals with visual impairments often exhibit lower levels of fitness than their sighted peers, often due to fear and lack of confidence.

Walking, a simple form of exercise with many health benefits, is considered a good choice for people who are visually impaired, according to Laura Sperazza, OD, Director of Low Vision Services at Lighthouse Guild in New York City.

Dr. Sperazza encourages people with low vision, who have been hesitant to venture out and walk for fitness, to participate in the American Heart Association’s National Walking Day on April 5.

The day promotes all the benefits of walking, and people can keep the momentum going throughout the year by starting a Monday Mile in their community.

The Monday Mile is an initiative of The Monday Campaigns, the nonprofit public health organization, associated with Johns Hopkins, Columbia and Syracuse universities. The Monday Mile mission is to encourage people from all walks of life to walk for their health, by using Monday as the starting day.

Research by Johns Hopkins shows that people view Monday as a day for a fresh start and are more likely to begin new healthy behaviors on a Monday, and carry them out for the rest of the week.

What are the best ways for people who are visually impaired to walk the Monday Mile with confidence? Dr. Sperazza offers these tips:

• Walk during daylight hours in order to avoid obstacles.
• Walk with a normally sighted buddy to help avoid obstacles and unforeseen conditions.
• Don’t walk in bad weather.
• Wear proper shoes to avoid slipping.
• Walk in familiar areas so you can anticipate the path.
• Use a ‘sighted cane’ which notifies others that you have an impairment
• For people with a greater level of impairment, train in the use of a ‘sighted cane’ with a mobility specialist, which can help them adjust to different surfaces and unfamiliar areas

For more information on low vision services, visit lighthouseguild.org.

About Lighthouse Guild

Lighthouse Guild, headquartered in New York City, is the leading not-for-profit vision and healthcare organization with a long history of addressing the needs of people who are blind or visually impaired, including those with multiple disabilities or chronic medical conditions. 

With more than 200 years of experience and service, Lighthouse Guild brings a level of understanding to vision care that is unmatched. By integrating vision and healthcare services and expanding access through its programs and education and awareness, we help people lead productive, dignified and fulfilling lives. For more information, visit lighthouseguild.org.

About The Monday Mile
The Monday Mile is part of The Monday Campaigns, a nonprofit organization, which dedicates the first day of every week to health. The organization offers a free Monday Mile Starter Kit and resources for workplaces, campuses and community groups to start their own program. At Syracuse University, Monday Mile routes have been created with accessibility in mind, and are well-lit and feature many flat routes. This Monday Mile program can serve as a great example of how to create an accessible Monday Mile in your community.
Download the Monday Mile Starter Kit at: www.moveitmonday.org/mondaymile
For a Monday Mile infographic: h

New Gene-Based Blood Tests Identify More Skin Cancers

Newswise, April 3, 2017 — Genetic testing of tumor and blood fluid samples from people with and without one of the most aggressive forms of skin cancer has shown that two new blood tests can reliably detect previously unidentifiable forms of the disease.

Researchers at NYU Langone Medical Center and its Perlmutter Cancer Center, who led the study, say having quick and accurate monitoring tools for all types of metastatic melanoma, the medical term for the disease, may make it easier for physicians to detect early signs of cancer recurrence.

The new blood tests, which take only 48 hours, were developed in conjunction with Bio-Rad Laboratories in Hercules, Calif. Currently, the tests are only available for research purposes.

The new tools are the first, say the study authors, to identify melanoma DNA in the blood of patients whose cancer is spreading and who lack defects in either the BRAF or NRAS genes, already known to drive cancer growth.

Together, BRAF and NRAS mutations account for over half of the 50,000 cases of melanoma diagnosed each year in the United States, and each can be found by existing tests. But the research team estimates that when the new tests become available for use in clinics, the vast majority of all melanomas will be detectable.

“Our goal is to use these tests to make more informed treatment decisions and, specifically, to identify as early as possible when a treatment has stopped working, cancer growth has resumed, and the patient needs to switch therapy,” says senior study investigator and dermatologist David Polsky, MD, PhD.

Polsky presents his team’s latest findings at the annual meeting of the American Association for Cancer Research in Washington, D.C.

The new tests, says Polsky, the Alfred W. Kopf, MD, Professor of Dermatologic Oncology at NYU Langone and director of its pigmented lesion section in the Ronald O. Perelman Department of Dermatology, monitor blood levels of DNA fragments, known as circulating tumor DNA (ctDNA), that are released into the blood when tumor cells die and break apart. Specifically, the test detects evidence of changes in the chemical building blocks (or mutations) of a gene that controls telomerase reverse transcriptase (TERT), a protein that helps cancer cells maintain the physical structure of their chromosomes.

Polsky says the detected changes occur in mutant building blocks, in which a cytidine molecule in the on-off switch for the TERT gene is replaced by another building block, called thymidine. Either mutation, C228T or C250T, results in the switch being stuck in the “on” position, helping tumor cells to multiply.

According to Polsky, the blood tests may have advantages over current methods for monitoring the disease because the tests avoid the radiation exposure that comes with CT scans, and the tests can be performed more easily and more often.

The Bio-Rad tests, once clinically validated, are also likely to gain widespread use quickly, he says, because his previous research had shown that similar blood tests for BRAF and NRAS mutations worked better in identifying new tumor growth than existing blood tests for the protein lactate dehydrogenase. Lactate dehydrogenase levels may spike during aggressive tumor growth, but can also rise as a result of other diseases and biological functions.

As part of the ongoing study, researchers checked results from the new tests against 10 tumor samples taken from NYU Langone patients diagnosed with and without metastatic melanoma.

They also tested four blood plasma samples (the liquid portion of blood) — from NYU Langone patients with and without the disease. Blood test results matched correctly in all cases known to be either positive or negative for metastatic melanoma. Successful detection occurred, they say, for samples with as little as 1 percent of mutated ctDNA in a typical blood plasma sample of 5 milliliters. Meanwhile, TERT mutations were absent in tests of normal blood plasma and tonsil tissue.

Polsky says further study of the new blood tests are planned to gauge their use in monitoring progression of the aggressive cancer, and to more quickly determine when switching to an alternative therapy is warranted, as well as whether the tests can used to detect other types of cancer, such as brain tumors, that also have TERT mutations.

Funding support for the study was provided by National Cancer Institute grant R21 CA198495, with in-kind support from Bio-Rad, which provided chemical supplies.

Besides Polsky, other NYU Langone/Perlmutter researchers involved in the study were lead study investigators Broderick Corless, BS; and Gregory Chang, MBA; and study co-investigators Mahrukh Sayeda, MS; and Iman Osman, MD. Additional research support was provided by study co-investigators Samantha Cooper, PhD; and George Karlin-Neumann, PhD, at Bio-Rad Laboratories