News Tips from the American Heart Association Scientific Sessions 2021
The Importance of Collaboration Between Cardiologist and Stroke Physicians
Nov. 13, 2021 – On Demand
With an annual mortality rate of about 5.5 million, stroke is the second leading cause of death worldwide behind heart disease. In 2018, 1 in every 6 deaths from cardiovascular disease in the U.S. was due to stroke, according to the U.S. Centers for Disease Control and Prevention. Top causes of stroke — high blood pressure, high cholesterol, smoking and obesity — are all contributing factors of heart disease. Neurologist Michelle Johansen, M.D., Ph.D., will discuss the global burden and commonalities between stroke and heart disease at the ends of the age spectrum: the younger and older adult.
Johansen will present results of a large epidemiology cohort study of people with left atrial dysfunction, which increases the risk of having an imaging marker of brain change necessary in developing Alzheimer’s dementia. Could it be that cardiac disease might be a direct cause of brain injury? Johansen will discuss the possibility of cardiac disease playing an important role in cognitive impairment through stroke, subclinical stroke or lack of blood flow to the brain.
“I can’t take care of a stroke patient without a cardiologist providing expertise on cardiac structure and function,” says Johansen. “Working together helps us do a better job in diagnosing stroke mechanisms, performing a complete stroke workup and thinking about the best treatment strategies and evidence in taking care of both young and old stroke patients.”
Johansen is an assistant professor of neurology and attending physician in the cerebrovascular division at The Johns Hopkins Hospital, and she is associate faculty with the Welch Center in the Johns Hopkins Bloomberg School of Public Health. She is the recipient of the American Heart Association Mentored Clinical and Population grant, the American Heart Association Career Development Award and a grant from the National Institute of Neurological Disorders and Stroke, which enables her to study the relationship between stroke and heart health. Other topics being discussed at the session, which Johansen moderates, will include patent foramen ovale closure after stroke, diagnosis of atrial fibrillation detected after stroke, and management of patients with stroke, atrial fibrillation and high bleeding risk.
Prevention of Cardiovascular Disease in Women Across a Lifespan
Nov. 13, 2021 – On Demand
Among the traditional risk factors of cardiovascular disease, there are disparities by sex, such as diabetes, smoking and blood pressure, that contribute to a greater risk in women than in men. On average, women have lower blood pressure than men earlier in life, but are on a steeper trajectory of it rising after the age of 60.
Erin Michos, M.D., M.H.S., will discuss the unique risk factors some women experience throughout their lifespan that men don’t experience related to early menstruation, infertility, polycystic ovary syndrome, pregnancy complications and premature menopause. She’ll talk about the importance of taking a more comprehensive reproductive history of women patients to identify those who might benefit from more intensive prevention.
“Women-specific factors of early menopause and adverse pregnancy outcomes, like preeclampsia, are considered risk-enhancing factors for cardiovascular disease,” says Michos. “A woman who might be borderline or intermediate risk could be placed in a higher risk category that would favor more intensive therapies for cardiovascular disease prevention if we look more closely at reproductive history.”
Michos will touch on the need for more data relating to cardiovascular disease in transgender women and transgender men. The transgender community faces a higher burden of traditional risk factors compared with their cisgender counterparts due to social stress and hormone therapies.
“We really need much more data, including trials, to understand the safety of different hormone therapies to help improve the cardiovascular health of this population and provide a culturally sensitive plan for cardiovascular care,” says Michos.
Michos is an associate professor of medicine within the Division of Cardiology at the Johns Hopkins University School of Medicine, associate director of preventive cardiology with the Ciccarone Center for the prevention of cardiology disease and director of women’s cardiovascular health at Johns Hopkins Medicine. Michos has authored or co-authored more than 450 manuscripts in peer-reviewed journals.
Prevention Strategies for Cardiovascular Disease
Nov. 13, 2021 – 11:30–11:40 a.m.
Although there have been improvements in atherosclerotic cardiovascular disease (ASCVD) outcomes in recent decades, it remains the leading cause of death globally. According to the U.S. Centers for Disease Control and Prevention, 1 in every 4 deaths are contributed to heart disease. However, 80% of cardiovascular disease is preventable.
In 2019, Roger Blumenthal, M.D., co-chaired the ACC/AHA Primary Prevention of Cardiovascular Disease Guidelines, which consolidated existing recommendations and various recent scientific statements, expert consensus documents and clinical practice guidelines into a single guidance document focused on the primary prevention of ASCVD. The new guidelines include newly generated recommendations for aspirin use, exercise and physical activity and tobacco use.
Blumenthal will focus his discussion on the importance of the “ABCs of Prevention”: Assessment, Antiplatelet agent, Blood Pressure, Cholesterol, Diet/Weight and Exercise.
“The ABCs of Prevention is a very useful framework that the Ciccarone Center has employed for two decades to make the various cardiology guidelines understandable and actionable for clinicians, patients and their family members. The cornerstone of prevention is optimizing lifestyle habits in conjunction with judicious use of medications,” says Blumenthal.
Blumenthal is the Kenneth Jay Pollin Professor of Cardiology, professor of medicine and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. He is on the official national spokesperson panel for the American Heart Association and has co-written more than 600 articles dealing with many aspects of coronary heart disease and atherosclerosis management.
Adverse Pregnancy Outcomes and Cardiovascular Disease
Nov. 15, 2021 – 5:02–5:10 p.m. (On Demand)
High blood pressure, also called hypertension, is the most common medical problem encountered during pregnancy, as cardiovascular disease continues to rise among younger women. In the United States, high blood pressure impacts 1 in every 12 to 17 pregnant women ages 20 to 44, according to the U.S. Centers for Disease Control and Prevention.
During the AHA’s Scientific Sessions, Garima Sharma, M.D., offers her expertise in adverse pregnancy outcomes and cardiovascular risks in two separate discussions focusing on health care disparities and monitoring women with pregnancy complications or preterm deliveries.
Two abstracts will be presented that explore adverse pregnancy outcome disparities, such as preterm birth, preeclampsia and gestational diabetes among the birthing population in the U.S. The research revealed that U.S.-born women had worse cardiovascular risk factor profiles compared with their foreign-born counterparts, and this disparity continued in non-Hispanic Black women for preterm birth and preeclampsia. Further analysis showed cardiovascular disease risk factors worsened with duration of residence in the U.S. among all race and ethnicity groups, such that women who stayed in the U.S. for greater than 10 years actually had similar cardiovascular risk profiles to women born in the U.S.
“This data focuses on the unhealthy assimilation and acculturation of immigrants, but also highlights the importance of management of cardiovascular risk factors in the young birthing population in the U.S.,” says Sharma. “Cardiovascular risk factors should be addressed in all stages of a woman’s life, but pregnancy provides a unique opportunity to discuss this with women.”
Sharma is an assistant professor of medicine in the Division of Cardiology at the Johns Hopkins University School of Medicine. Her clinical and research interests are in cardiovascular disease prevention in women and management of cardiovascular disease in pregnancy, specifically in those with adverse pregnancy outcomes such as preeclampsia, preterm birth, gestational diabetes, obesity and cardiovascular risks, post-partum prevention of complications from hypertensive disorders of pregnancy and gender equity. Sharma is co-author of the American Heart Association Scientific Statement on Cardiovascular Consideration in Caring for Pregnant Patients and a Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association.
Bridging the Digital Divide and Putting Patients in the Driver Seat of Their Cardiovascular Health
Nov. 15, 2021 – 3:30–3:40 p.m.
Heart health technology continues to evolve, introducing new ways patients can manage and monitor heart disease and underlying risk factors such as high blood pressure, high cholesterol, smoking and obesity. Technology such as smartphones and smartwatches enable instantaneous and personalized data collection that can help consumers remain in control while granting clinicians access to a larger dataset to aid in diagnosis and treatment.
Seth Martin, M.D., is the co-developer of Corrie, an app that has proven to lower hospital readmission rates for heart attack survivors by more than 50% by helping patients manage medications and lifestyle changes. As director for the Johns Hopkins American Heart Association Health Tech Strategically Focused Research Network (SFRN), Martin will discuss tech goals related to heart health, problems and accomplishments.
“Our center’s mission is to leverage mobile and wearable technologies to empower patients and clinicians, enhance quality of care, increase value and achieve equity in the diagnosis and management of heart diseases and stroke,” Martin says. “In our initial project, our team is further developing mobile technologies for stroke diagnosis and virtual cardiovascular rehabilitation.”
Martin is a core faculty member at the Ciccarone Center for the Prevention of Cardiovascular Disease, where he directs the Advanced Lipid Disorders Clinic and the Digital Health Innovations Lab. With research grounded in preventive cardiology, Martin focuses on multiple complementary areas including digital/mobile health technology, lipidology, cardiovascular risk assessment, big data and precision medicine.
Reducing Disparities in Cardiovascular Health with the Use of Technology
Nov. 13, 2021 – ON DEMAND
In this presentation, Martin will discuss the evidence of disparities in accessing digital health technologies across sociodemographic groups and offer strategies to bridge the “digital divide.” These strategies include a device-loaning program paired with technology coaching for patients with cardiovascular disease, much like the Corrie Health program, which puts patients in the driver seat of their own cardiovascular health.
Preeclampsia and Implications for Cardiovascular Prevention
Nov. 14, 2021 – 3:30–4:30 p.m.
Preeclampsia is a potentially dangerous pregnancy complication that is associated with high blood pressure and other organ damage, usually the kidneys, affecting 5%–8% of pregnancies in the U.S. It usually begins after 20 weeks of gestation in women whose blood pressure may have been normal before becoming pregnant, otherwise known as gestational hypertension. It can be superimposed on women who have chronic hypertension prior to pregnancy, which remains a high risk factor.
Cardiovascular disease is the leading cause of maternal mortality in the U.S. It disproportionately affects women of color and American Indian and Alaska Native women, who are two to three times more likely to die from pregnancy complications than white women. Erin Michos, M.D., M.H.S., director of women’s cardiovascular health at Johns Hopkins, says it is believed that 3 out of 5 pregnancy deaths can be prevented.
Michos will discuss how preeclampsia and cardiovascular disease are related, and the short- and long-term impacts they could have on women’s cardiovascular health. The risk of cardiovascular disease extends many years after pregnancy, and women with a history of preeclamptic pregnancy are twice as likely to have a cardiovascular event later in life, such as a heart attack or stroke.
“There are a lot of opportunities to implement prevention to reduce this elevated risk early on,” says Michos. “My plea to clinicians is to take a comprehensive reproductive history, to ask women about their previous pregnancies, because we can identify women at higher cardiovascular risk who may not experience traditional risk factors.”