The journey of a marathon sleeper

A marathon sleeper who got away left some clues for Emory and University of Florida scientists to Read more

A push for reproducibility in biomedical research

At Emory, several scientists are making greater efforts to push forward to improve scientific research and combat what is being called “the reproducibility crisis.” Guest post from Erica Read more

Exosomes as potential biomarkers of radiation exposure

Exosomes = potential biomarkers of radiation in the Read more

heart

Clinical trial for patients with atrial fibrillation tests implantable device in place of blood-thinning drug

Clinical Trial for Patients with A-fib

A new clinical trial underway for patients with atrial fibrillation will test an implantable device in place of a common blood-thinning medication, according to researchers at Emory University Hospital Midtown.

Atrial fibrillation (commonly called A-fib) is a heart condition in which the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to pool and form clots in the left atrial appendage (LAA). If a clot forms in this area, it can increase the chances of having a stroke.

Many patients with A-fib are prescribed blood-thinning medications, such as warfarin (brand name Coumadin), to prevent blood from clotting. This medication is effective in reducing the risk of stroke, but may cause side effects such as bleeding. It also requires frequent blood draws to monitor dosage levels.

The trial, called PREVAIL (Prospective Randomized EVAluation of the Watchman LAA Closure Device In Patients with Atrial Fibrillation Versus Long Term Warfarin Therapy), involves implanting a small, umbrella-shaped mesh device called the Watchman closure device, into the heart chamber via catheter. This is a confirmatory study (and the third study testing the implant), which will also look at safety and efficacy of the device.

David De Lurgio, MD, associate professor of medicine in the Division of Cardiology, Emory University School of Medicine, is the principal investigator of the trial. He explains that by implanting this device into the left atrial appendage of the heart, it closes that area off. That, in turn, prevents blood clots from escaping and entering the blood stream, which could lead to a stroke.

Patients are randomly selected by computer to either receive the device or remain on Coumadin without the device (control group). Those selected to receive the device will remain on Coumadin for 45 days following implant. If the heart tissue has healed after those 45 days, participants will be taken off Coumadin and placed on aspirin therapy and possibly clopidogrel (Plavix), an anti-platelet medication.

Researchers will then follow study patients with and without the device for five years, monitoring those who are no longer taking Coumadin very closely. If the FDA approves the device at the end of this clinical trial, participants in the control group will then have the option to receive the device.

De Lurgio and his colleagues have had five years of experience with this technology, thus far. Emory Healthcare is the only health system in Georgia providing access to this device through participation in this clinical trial.

For more information, please call 404-686-2504.

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A good reason to enjoy a little Valentine’s Day chocolate

From the Clinic to You

BY CHERYL WILLIAMS, RD, LD

If you’re looking for an excuse to indulge in the yummy chocolate you get this Valentine’s Day, research suggests it may not be so bad for you.

A number of studies, conducted over the last decade have associated cocoa and dark chocolate consumption with heart health benefits. These benefits come from cocoa, derived from the cacao plant, which is rich in flavonoids (cocoa flavanols to be exact). Flavonoids are antioxidants also found in berries, grapes, tea, and apples. As a whole, antioxidants prevent cellular damage and inflammation which are two major mechanisms involved in the development of heart disease.

So what does the research say?

A study published in the American Journal of Clinical Nutrition found that high-flavanol dark chocolate reduced bad cholesterol (LDL) oxidation and increased good cholesterol (HDL) levels. LDL oxidation promotes the development of plaque and hardening of the coronary arteries, thus lessening oxidation could help to prevent heart disease.

A Harvard research study found that flavanol-rich cocoa induced nitric-oxide production, which causes blood vessels to relax and expand, thus improving blood flow. Improved coronary vasodilation could potentially lower the risk of a cardiovascular event.

In a double-blind randomized Circulation study flavonoid-rich dark chocolate (containing 70% cocoa) reduced serum oxidative stress and decreased platelet activity (clumping) in heart transplant recipients. This favorable impact on vascular and platelet function is relevant because vascular dysfunction and platelet activation (adhesion upon damaged cell wall) are the basis of atherothrombosis (blood clotting) and coronary artery disease.

How can you reap chocolate’s potential benefits?

Not all cocoa products and/or chocolates are created equal. Milk chocolate, for example, is not rich in flavanols (contains only 10-20% cocoa solids) and white chocolate contains none at all. In addition, some cocoa products and chocolates are processed with alkali, which can destroy flavanols.

Follow these tips for heart healthy chocolate consumption:

  • Avoid cocoa products processed with alkali (dutched) as seen in the ingredient list
  • Choose dark chocolate with at least 70% cocoa
  • Enjoy 100% unsweetened non-dutched cocoa (great for hot chocolate!)

Also, remember that chocolate is not a health food, as it is high in calories, fat and added sugar. Thus, make room for dark chocolate by cutting extra calories elsewhere in your diet. Additionally, stick to small amounts (e.g. 1 ounce) and do not eat in place of plant-based whole foods such as vegetables and fruits.

Cheryl Williams is a registered dietitian at the Emory Heart & Vascular Center. She provides nutrition therapy, wellness coaching, monthly nutrition seminars and healthy cooking demonstrations working with the Emory HeartWise Cardiac Risk Reduction Program.

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Higher education linked to improved heart disease outcomes in richer countries

A higher level of education is associated with reduced risk of heart disease and stroke for people who live in rich countries, but not for those in low- and middle-income nations, according to the findings of a recent study led by Emory epidemiologist and cardiologist Abhinav Goyal, MD, MHS.

Abhinav Goyal, MD, MHS

The study published in the Sept. 7, 2010, issue of the journal Circulation, a publication of the American Heart Association, is one of the first international studies to compare the link between formal education and heart disease and stroke. It examined data on 61,332 people from 44 countries who had been diagnosed with heart disease, stroke, or peripheral arterial disease, or who had cardiovascular disease risk factors such as smoking or obesity.

Goyal and team found that highly educated men in high-income countries had the lowest level of cardiovascular disease. However, their findings suggest that research conducted in richer nations can’t always be applied to poorer countries.

“We can’t simply take studies that are conducted in high-income countries, particularly as they relate to socioeconomic status and health outcomes, and extrapolate them to low- and middle-income countries,” says Goyal, assistant professor of epidemiology and cardiology at Emory’s Rollins School of Public Health and Emory School of Medicine. “We need dedicated studies in those settings.”

The research team was surprised to find that despite decreased heart disease risk among the higher educated in industrialized nations, nearly half of the highly educated women from high-income countries smoked, compared with 35 percent for those with the least amount of schooling. For men, smoking rates were virtually the same across educational groups in low- and middle-income countries.

“Everyone needs to be educated about the risk of heart disease in particular, and counseled to adopt healthy lifestyles and to quit smoking,” Goyal says.

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Heart disease pioneer named ‘Georgia Woman of the Year’

Many people know that heart disease is currently the number one killer of women in the United States. But a little more than a half a century ago it was widely believed that cardiovascular disease only affected men. Renowned cardiologist, Nanette K. Wenger, MD, challenged this theory and thanks to her pioneering efforts over the last 50 years women today know better.

2010 Georgia Woman of the Year, Nanette K. Wenger, MD

Wenger, a professor of medicine in the division of cardiology at Emory University School of Medicine and former chief of cardiology at Grady Memorial Hospital, is being honored as the 2010 Georgia Woman of the Year for her lifetime commitment to reducing women’s disability and death from cardiovascular disease.

She joins the ranks of other distinguished Georgia women including First Lady Rosalynn Carter who was named the first Georgia Woman of the Year in 1996 by the Georgia Commission on Women. In addition to this prestigious accolade, Wenger has accumulated dozens of awards throughout her celebrated career including the Lifetime Achievement Award from the American College of Cardiology in 2009. She is a sought after lecturer for issues related to heart disease in women, heart disease in the elderly, cardiac rehabilitation, coronary prevention and contemporary cardiac care.

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Ventricular Assist Therapy Helping More Heart Failure Patients

After a long battle with congestive heart failure, former Vice President Dick Cheney this month was implanted with a left ventricular assist device (LVAD) in order to help improve the pumping function of his ailing heart.  Cheney, who has had numerous documented heart problems and hospitalizations, undoubtedly opted to have the small internal heart pump installed in order to help him live a better quality of life, and potentially reduce his hospital visits in the near future.

An LVAD is a battery-operated, mechanical pump that aids the left ventricle in pumping blood into the aorta.  Most commonly, an LVAD is installed to help patients survive the wait until a fully-functioning heart is available for transplant. However, in some cases the LVAD is used as a form of destination therapy (in place of a transplant) for patients who are not candidates for heart transplant. In 2006, surgeons at Emory University Hospital implanted Georgia’s first ventricular assist device (VAD) as destination therapy.

“When offering LVAD destination therapy, our goal is to safely integrate patients back to their respective communities and normal mode of living,” according to David Vega, MD, surgical director of the Emory Heart Transplant Program.

“Ventricular assist devices offer new hope and a much greater quality of life for individuals who are not transplant candidates, patients who do not want a transplant or those who may be transplant eligible in the future.”

According to the United Network for Organ Sharing (UNOS) there are more than 3,100 Americans – 34 in Georgia – who are currently awaiting a heart transplant. Regardless of the number of donor hearts available, many patients are not candidates for a heart transplant for a variety of reasons including cancer, personal and religious beliefs, blood clotting problems, and other debilitating health conditions.

“There are approximately five million Americans who suffer from congestive heart failure, with another half million diagnosed each year. Many of these people are limited by the severity of their heart failure, yet are not able to be transplanted for one of many reasons,” adds Dr. Vega. “These devices may be a viable option for many patients, allowing them to resume a much more normal lifestyle and improved quality of living.”

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NIH at Emory to advance women’s heart health

NIH meets at Emory to discuss women's cardiovascular health and research

The National Institutes of Health (NIH) has convened a key meeting at Emory on women’s cardiovascular health and research. The meeting, co-hosted by the Office of Research on Women’s Health and Emory School of Medicine, is focused today and tomorrow on NIH planning of the women’s health research agenda for the next decade.

Vivian Pinn, MD, associate director for research on women’s health, and director of the Office of Research on Women’s Health at NIH, opened the meeting with Emory’s conference chair, Nanette Wenger, MD, professor of medicine (cardiology), Emory School of Medicine, and chief of cardiology at Grady Memorial Hospital.

Nanette K. Wenger, MD

In a career that spans more than 50 years, Wenger’s dedication to reducing women’s disability and death from cardiovascular disease has made her one of the country’s most-respected experts on coronary heart disease in women. In 2009, Wenger received the Lifetime Achievement Award from the American College of Cardiology.

Although Wenger has earned dozens of awards in her celebrated career, she says her greatest professional achievement has been to help change a major paradigm in cardiology: the assumption that heart disease affects only men. A half a century ago heart disease was thought of as a “man’s disease.”

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Heart Month: Helping narrowed aortic valves

Celebrating February’s American Heart Month at Emory Heart & Vascular Center

Emory cardiologists are using a promising new non-surgical treatment option for patients with severe aortic stenosis.

Emory University Hospital is one of about 20 hospitals nationwide, and the only site in Georgia, to study this new technology – with 75 patients receiving new valves at Emory since the clinical trial started in October 2007. Researchers hope to receive U.S. Food and Drug Administration approval in late 2011.

The life threatening heart condition affects tens of thousands of Americans each year when the aortic valve tightens or narrows, preventing blood from flowing through normally.

Peter Block, MD

Peter Block, MD, professor of medicine, Emory School of Medicine, and colleagues are performing percutaneous aortic valve replacement as part of a Phase II clinical trial, comparing this procedure with traditional, open-heart surgery or medical therapy in high-risk patients with aortic stenosis.

The procedure provides a new way for doctors to treat patients who are too ill or frail to endure the traditional surgical approach.

During the procedure, doctors create a small incision in the groin or chest wall and then feed the new valve, mounted on a wire mesh on a catheter, and place it where the new valve is needed.

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Emory Heart & Vascular Center advances medicine

American Heart Month 2010

Learn about Emory Heart & Vascular Center advances during American Heart Month.

Research led by John Puskas, MD, professor of surgery and associate chief, Division of Cardiothoracic Surgery, Emory School of Medicine, has shown that off-pump bypass surgery reduces the risk of complications for high-risk patients, such as those that are especially frail or those with diabetes, obesity, kidney disease or a history of stroke.

This conclusion comes from a 10-year history of coronary bypass patients at Emory recently published in the Annals of Thoracic Surgery.

Puskas also recently presented long-term follow-up data from the first randomized U.S. trial to compare off-pump with conventional on-pump surgery.

The results from the landmark SMART (Surgical Management of Arterial Revascularization) study, which started in 2000, show that participants who had the off-pump procedure lost less blood, had less damage to their hearts during surgery and recovered more quickly than those who underwent on-pump surgery.

Beating-heart patients in the study also were able to breathe on their own sooner after surgery, spent less time in intensive care and left the hospital one day sooner, on average, than conventional coronary bypass patients.

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Study looks for treatment for pediatric heart disease

There have been tremendous advances in cardiac surgery over the years. Physicians can now operate on children with heart defects in the first month or week of their lives. But very little is known about how the human heart develops especially in that first year after birth.

Emory and Children’s Healthcare of Atlanta researcher Mary Wagner, PhD, is leading a project looking at how the heart develops during the first year of life. This is critical, she says, because children’s hearts respond differently to medications and surgery than adults’ hearts, and many treatments currently available to pediatric heart patients were designed and tailored specifically for the adult heart.

Wagner, associate professor in Emory’s School of Medicine, and her research team will examine the physiological properties of human heart tissue from pediatric patients. The samples are tissue that needs to be removed as part of the surgical repair of the patient’s heart and would otherwise be discarded.

The ultimate goal of Wagner’s research is to examine the differences in the human heart in the first year after birth and identify novel target therapies for the pediatric cardiac patient.

Wagner’s research labs are housed at The Emory-Children’s Center, a joint venture between Emory Healthcare and Children’s Healthcare of Atlanta.

Her research is funded by a stimulus grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

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Risk of death, stroke in postmenopausal women using antidepressants

Older women taking antidepressants could be at increased risk of stroke and death according to the authors of the Women’s Health Initiative (WHI) study. Cardiologist Nanette K. Wenger, MD, professor of medicine, division of cardiology, Emory School of Medicine, and chief of cardiology at Grady Memorial Hospital, is a co-author of the study published in the Dec. 14 issue of Archives of Internal Medicine.

Nanette K.Wenger, MD

Nanette K.Wenger, MD

The researchers report that postmenopausal women who reported taking an antidepressant drug had a small but statistically significant increase in the risk of stroke and of death compared with participants not taking antidepressants. They say the results of the study are not conclusive but do signify a need for additional attention to patients’ cardiovascular risk factors.

Depression is a serious illness with increased risk for cardiovascular disease and other health risks. The researchers stress that no one should stop taking their prescribed medication based on this one study as antidepressants have been proven lifesaving for some patients. Because of their potential for negative effects on heart function, tricyclic antidepressants are used less frequently. In contrast, selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which doctors say could protect against clot-related cardiovascular disorders.

Since the use of antidepressants has increased greatly in recent years and since older women are also at risk for cardiovascular disease, a team of researchers from several academic medical centers examined the link between antidepressant use and cardiovascular disease in such patients.

The WHI study followed more than 160,000 postmenopausal women in the United States for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.

The authors call for additional research, says Wenger, because the study does not confirm whether this risk truly is attributable to the drugs and not to depression itself and whether participants were being treated for depression or for anxiety, which also has cardiovascular risks. Above all, patients should talk with their physicians about individual concerns and risk factors to determine the benefits of various treatment options, Wenger notes.

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