Weekend Links

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We’ve hand-picked a mix of Massachusetts General Hospital and other research-related news and stories for your holiday weekend reading enjoyment:

When love and science double date – coverage of research by Mass General psychiatrists Richard Schwartz and Jacqueline Olds, mentions study led by Mass General investigator Robert Waldinger

Caring for Ms. L. — Overcoming My Fear of Treating Opioid Use Disorder – written by MGH Chelsea Health Center physician Audrey Provenzano

Fecal transplants move into the mainstream to treat difficult infection – features research by Mass General investigator Elizabeth Hohmann

Go Figure: Why Olympic Ice Skaters Don’t Fall Flat on Their Faces

Nature, Meet Nurture

Top illustration by Sophie Blackall

Could Strenuous Exercise Be Bad for Your Heart?

marathon running.jpgIf you’ve noticed a trend in runners signing up for half-, full-, or even ultra-marathons, it isn’t just your subconscious guilting you into exercising — the number of recreational endurance exercise participants has in fact increased in recent years, and RunningUSA predicts the number of participants will continue to rise.

Research has already confirmed that moderate-intensity exercise (like walking briskly, water aerobics, or tennis) on a regular basis can improve heart health. But a recent review conducted by Massachusetts General Hospital’s Aaron L Baggish, MD, director of the Corrigan Minehan Heart Center Cardiovascular Performance Program, found that the same may not be applicable for high-intensity, strenuous exercise. His results were recently published in Current Atherosclerosis Reports.

What did the report find?

Baggish found that among endurance athletes, long-term training has been associated with early onset atrial fibrillation (an irregular heartbeat), changes in the size, shape, structure, and function of the heart, and increased coronary artery calcifications which increases risk for heart attacks and heart failure.

Additionally, data suggests that long-term participation in strenuous levels of physical activity may reduce the life-saving benefits associated with moderate-intensity exercise.

What are the implications for clinicians and patients?

The studies reviewed in this report have produced data that is worth a closer look, but Baggish says that it is too early to draw any definitive solutions. Many of the studies had too small of a sample size to provide any generalizable findings.

Based on the data available, there is no definitive evidence to support clinicians advising against high doses of exercise in healthy athletes. Clinicians who care for highly-active patients should monitor for signs of heart conditions and establish an open dialogue with patients and collaborate on decision making regarding exercise plans.

The results also shouldn’t discourage individuals from sticking to a consistent exercise routine. The American Heart Association suggests at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). Visit the AHA’s website to get ideas on exercise activities.

This article has been adapted from a post on Massachusetts General Hospital’s Advances in Motion.

Could Part of Our Genome Predict Future Risk for Heart Disease?

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Research from Saumya Das, MD, PhD, co-director of the Resynchronization and Advanced Cardiac Therapeutics Program at Massachusetts General Hospital, focuses on studying irregular heartbeats (known as arrhythmias) in patients with heart failure, discovering new tests to better identify who is at risk for developing heart failure or arrhythmias, and uncovering new therapies to treat heart failure.

More specifically, Das is looking at a type of RNA called non-coding RNA which comprise a majority of the genome. Das’ research focuses on identifying RNA biomarkers in the blood that may forecast future risk of heart failure or arrhythmias.

A Mass General and Brigham and Women’s research team, led by Das, is currently validating a newly discovered set of RNA markers in over 4,000 patients as a part of a large-scale, NIH-funded study. Das hopes one day, certain RNA markers might translate in the clinic as a test to help stratify patients based on their risk for heart disease.

Learn more about Das’ research in this video from Advances in Motion:

Women’s Heart Health Program Leaders Look Ahead

Cardiovascular disease — including heart attacks, stroke and heart failure — is the number one killer of adults, but more women die of it than men. The Elizabeth Anne and Karen Barlow Corrigan Women’s Heart Health Program was launched in 2007 to focus awareness, treatments and research on the unique issues women face in maintaining heart health. It was established through a gift from Jerry Corrigan and Cathy Minehan. Program co-directors Malissa Wood, MD, and Nandita Scott, MD, discuss what they’ve learned over the past ten years and the challenges ahead.

Nandita Scott, MD and Malissa Wood, MD, co-directors of  the Corrigan Women’s Heart Health Program

Nandita Scott, MD (left), and Malissa Wood, MD, co-directors of the Corrigan Women’s Heart Health Program

What led you to specialize in cardiology?

Dr. Scott: I went into cardiology because it’s one of those fields where you can make a big difference in people’s lives. There are great diagnostic and treatment tools.

Dr. Wood: The biggest fascination for me was the recognition that cardiovascular disease is the number one killer. I trained a decade before Nandita, when new treatments were emerging. I wanted to use my talents to apply those techniques to help patients have better outcomes.

Why is there a need for a heart health program for women?

Dr. Wood: Cardiovascular disease is underdiagnosed in women. To close the big gaps in care, we wanted to pull together people who understand the pathophysiology of the heart of women, which is quite different than a man’s. Women’s hearts and arteries are smaller, for example. Symptoms of a heart attack can be different for a woman. Another difference is that blockages in smaller blood vessels as opposed to larger arteries are more often the cause of chest pain or angina in women. Our program seeks to tailor therapy and research to women.

When in life should women be most concerned about heart health?

Dr. Wood: All through life. We see patients from age 18 to 100.

Dr. Scott: There are dramatic changes in the cardiovascular system during pregnancy, for example. Blood volume increases and the heart is required to work harder. Pregnancy is like a stress test, a window into future heart health. Those who develop preeclampsia [a potentially dangerous condition that causes high blood pressure] have increased risk of future cardiovascular disease. We formed the Pregnancy and Heart Disease Program to address the needs of women with preexisting heart disease and who develop heart disease during pregnancy.

Dr. Wood: Cardiovascular disease is a major cause of death for women after they give birth. Maternal mortality is worse in the United States than other developed countries and we need to address that.

Your program is now the go-to for young women who have a heart attack due to spontaneous coronary artery dissection, or SCAD, a tear in the artery wall that blocks blood flow. What have you learned about it?

Dr. Wood: It used to be considered rare but that’s because it was underdiagnosed. Because so many are referred here, we have a large register of SCAD patients we are studying. Over 90 percent of them are thin, fit and athletic. Mark Lindsay, MD, PhD, looked at genetic differences and found that only 9 percent have a genetic abnormality. We are also finding that the cumulative effects of stress can trigger a SCAD-related heart attack in women, whereas men were more likely to have a heart attack while exercising. Reducing stress in our lives is extremely important for all women.

Women fear breast cancer but isn’t heart disease more likely?

Dr. Scott: One in ten women gets breast cancer and at least one in three women develops some form of cardiovascular disease. In women, it causes more deaths each year than the next two causes combined — cancer and chronic lower respiratory disease.

Besides exercise and a healthy diet, what should women do to maintain heart health?

Dr. Wood: We found some answers to that question in our Happy Heart study at the MGH Revere HealthCare Center. Lifestyle changes reduced blood pressure, weight and cholesterol, all of which change unfavorably after menopause. We found, too, that chronic stress is a significant risk factor for women and that mind-body therapies can reduce risk. Heart disease is preventable.

What challenges does the program face over the next ten years?

Dr. Scott: We would love to have more staff to accommodate all the women who want to be seen. Seven years ago, Maria Vivaldi, MD, joined us and has a thriving practice at the Revere clinic, helping women who often need us the most. Heart disease in women is now getting more attention; however, there are still many unanswered questions that we would like to research further.

This article originally appeared on the Massachusetts General Hospital Giving website.

Weekend Links

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We’ve hand-picked a mix of Massachusetts General Hospital and other research-related news and stories for your weekend reading enjoyment:

Brain aneurysm survivors share unique support after ruptures – Patients at Mass General Hospital help each other recover from anxiety, isolation

Finding Love in the Mass General Hospital Cafeteria

Universities Should Encourage Scientists to Speak Out about Public Issues

It’s not just athletes: Doctors at the Olympics have also worked years to get there

Finding Meaning in Machine Learning

Top illustration by Charlotte Ager

Surveys Show How Symptoms and Their Impacts Differ Among Adults with a Congenital Heart Defect

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When it comes to treating the symptoms of patients with a congenital heart defect, researchers from Massachusetts General Hospital are finding that a one-size-fits-all approach won’t meet all patients’ needs. The results of their recent survey provide insight into how clinicians can best tailor care for these patients.

What is CHD?

A congenital heart defect (CHD) is a problem with the structure of the heart that is present at birth. The defects can involve the walls and valves of the heart, and the arteries and veins near the heart. They can disrupt the normal flow of blood through the heart — blood flow can slow down, go in the wrong direction or to the wrong place or be blocked completely.

Complications associated with CHD include abnormal heart rhythms (arrhythmias), heart infection, stroke, and heart failure. CHD is the most common type of birth defect, with approximately 40,000 children born with this condition every year in the United States.

With new treatments and increased survivorship, the number of adults with congenital heart disease (ACHD) has grown significantly over the last 20 years. It’s estimated that more than 1.2 million adults in the U.S. are living with ACHD. However, despite this rise in population, there is still little data available about which symptoms most impact patients’ lives and thus are the most important to manage.

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Ami B. Bhatt, MD

To identify symptoms and help ACHD specialists improve care for their patients, researchers including Ami B. Bhatt, MD, director of the Mass General Adult Congenital Heart Disease Program, and Mass General cardiovascular research fellow Ada Stefanescu Schmidt, MD, MSc, surveyed health care providers and patients to identify the most significant symptoms of ACHD. Their results were published in Circulation: Cardiovascular Quality and Outcomes.

Surveying physicians and patients

First, to create a pool of potentially important symptoms to target for treatment, the researchers surveyed six ACHD physicians, who provided a list of 39 symptoms commonly reported by their patients.

Next, the researchers surveyed 124 ACHD patients and asked them to rank the importance and frequency of these 39 symptoms using 5-point Likert scales. The group was also asked to expand the list by contributing additional symptoms.

Lastly, to confirm the results reported by this initial group, 40 additional ACHD patients from Mass General were given the same survey.

The symptoms

Researchers divided responses into seven groups depending on the severity of the patient’s disease. Six symptoms were identified as being the most troublesome, regardless of disease severity:

  • Shortness of breath (windedness, trouble breathing)
  • Feeling different than other people
  • Having to go to the hospital or emergency room
  • Feeling mentally slower than other people
  • Concerns with sexual function
  • Bluish or dusky colored skin

The Mass General confirmatory group revealed similar results to the larger group with only five of the 39 symptoms differing from the initial group. Of note, the Mass General group rated the symptom “Concern about my children having health problems like mine” higher than the initial group.

The Mass General ACHD Program has already incorporated the findings into their ACHD Health and Wellness Program, run out of the MGH West Facility where physicians and nurses work with patients to address their lives in a holistic manner.

The research team plans to expand their investigation in the future with focus groups and cognitive testing.

This article is an adaptation of a post on Mass General’s Advances in Motion.

 

Understanding Why Exercise Works for Just About Everything

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Editor’s note: This article was originally posted on the Partners Innovation blog, and was written by Gregory Lewis, MD, a cardiologist at Massachusetts General Hospital. 

Centuries ago, the Greek physician Hippocrates noted that when the body is “unused and left idle, it becomes liable to disease, defective in growth, and ages quickly.” These observations—made without the benefit of the exhaustive medical research and detailed studies that we have today—are just as valid now as they were then.

Exercise is a natural medicine available to all. Cardiac research has proven that moderate exercise improves the circulation and metabolism, which reduces the chance of heart attack. Regular exercise also lowers both heart rate and blood pressure, improves the cholesterol profile and helps to prevent the development of life-threatening plaque within the heart’s arteries.

Of course, exercise alone—even if one were to walk more than 100 miles a week—does not grant immunity from life-threatening events such as heart attack and stroke. It can, however, greatly reduce the chances of sudden-death: An exercise study conducted by researchers from the state universities of North Carolina and Washington found that sedentary individuals who devote fewer than 20 minutes a week to vigorous exercise have a 56 times greater risk of dying during their normal activities than do those who exercise for more than 20 minutes daily.

The findings from this study suggest that Americans need to move a lot more: It’s now estimated that 70 percent of Americans are overweight or obese, and approximately 50 percent of adults don’t get enough exercise. Sedentary lifestyle has been directly linked to upwards of 200,000 deaths annually due to coronary artery disease, diabetes, and colon cancer. Some experts now believe that not exercising regularly does as much harm to the body as smoking a pack of cigarettes each day.

Exercising several times a week can be a big step toward improving cardiovascular endurance, muscular strength, muscular endurance, and flexibility—the four basic elements of physical fitness. While each of these elements is essential to overall health, cardiovascular endurance—the ability of the heart, lungs, and circulatory system to do their job—is the most important.

Cardiovascular endurance is built up through exercises or fitness activities that cause the body to deliver increased amounts of oxygen to the exercising muscles. To achieve this, activities must utilize the large muscle groups (such as those in the legs) and, most important, the exercise must be sustained for at least 20 minutes. Importantly, health benefits can be derived from even low-level exercise activities such as walking, hence the “no pain, no gain” paradigm is not the case.

Although fitness has been shown to be among the most potent predictors of future cardiovascular disease, it is one of the only major risk factors that is not routinely assessed by physicians.

Boston researchers are now investigating if specific tests of exercise capacity—and the presence or absence of dozens of molecules in the bloodstream, called metabolites—can be used to identify patients who may benefit from early treatment to prevent cardiovascular disease. The research will also examine how lifestyle, genetic variations, inherited family traits and measurements of heart structure and function match with changes in metabolism during exercise.

This study represents a paradigm shift away from focusing on only resting measurements and a small number of physiologic measurements during exercise in evaluating risk of cardiovascular disease. Instead, the scientists will study breath-by-breath measurements of oxygen uptake as well as a broad array of circulating metabolites during exercise in order to understand metabolic responses to exercise in the population and the ability of exercise response patterns to detect and prevent future cardiovascular disease.

Based on this research, it’s expected within a few years that simple exercise testing equipment will be used in doctors’ offices to assess heart health with a 7-minute test.

For more information about Dr. Lewis’ research, please contact Partners HealthCare Innovation by clicking here.

A Link Between Flu and Heart Attacks? Mass General Cardiologist Weighs In

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New research has found yet another reason to avoid catching the flu this season- it could increase your risk of a heart attack if you’re over the age of 35.

A recent study from investigators at the Institute for Clinical Evaluative Sciences and Public Health Ontario in Canada have found that you’re six times more likely to have a heart attack during the week after being diagnosed with the flu, compared to the year before or after the infection.

However, your chances of having a heart attack when you have the flu depends on your baseline risk. Most of the people who had a heart attack in this study were over the age of 65, and a lot of them had risk factors for heart disease, such as high blood pressure, high cholesterol or diabetes.

Malissa Wood, MD, Co-Director of the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, says that these results confirm the connection between cardiovascular events, such as a heart attack, and respiratory infections like the flu.

“The flu is like a stress test for the heart,” says Wood in this NBC Boston news clip.

Of course, the best way to reduce your risk of flu-related health complications is to avoid getting the flu in the first place. Learn about preventative steps that you can take.

Weekend Links

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We’ve hand-picked a mix of Massachusetts General Hospital and other research-related news and stories for your weekend reading enjoyment:

Tiny Marvels – Miniature versions of organs help scientists understand disease and fine-tune treatments in ways that work in mice can’t match.

Global C-Section Rates on the Rise – Caesarean section rates have increased in most countries during the past decade, with substantial variations between and within countries, Massachusetts General Hospital researchers reported.

Study links smartphone use with depression in teens – Research from Steven Schlozman, a child psychiatrist at Massachusetts General Hospital’s Clay Center for Young Healthy Minds, suggests excessive cell phone use by teens may be contributing to a mental health crisis in that age group.

Why teenagers eat Tide pods

A Mysterious Amnesia, Related to Opioid Overdose, Creeps Beyond New England

The Communicator’s Art – Richard Besser’s insights from a career talking public health to the public

top photo courtesy of Proto Magazine

New Research Uncovers Gender Differences for Risk of Developing Heart Disease

Mass General Research Institute goes red for heart month

Did you know that heart disease is the leading cause of death for both men and women in the United States? American Heart Month, celebrated in February, is an opportunity to raise awareness about heart disease and how people can prevent it.

Researchers and clinicians at Massachusetts General Hospital are working to improve treatment and care for patients with this disease. Over the next few weeks we’ll be featuring some of their research – stay tuned for more!


We can all agree that carrying a lot of fat on our bodies isn’t healthy. But when it comes to heart health, where the fat is located and the type of fat can make a big difference—especially for women.

New research from Massachusetts General Hospital finds that having a certain type of body fat known as ectopic fat in the midsection may put women at a greater risk for developing heart disease and other cardiovascular health issues in comparison to men.

Before we jump into the research, let’s define a few terms:

  • Coronary artery disease (CAD): the most common type of heart disease and the leading cause of death in the United States in both men and women. CAD develops when plaque builds up in the arteries that supply blood to the heart.
  • Cardiometabolic risk: your risk of developing conditions including diabetes, heart disease or stroke
  • Ectopic fat: a dangerous type of fat that accumulates around vital organs such as the liver and abdomen

Previous studies have shown that the way fat is distributed in the body may be a health threat. For example, people with fat accumulation in and around their abdomen (often referred to as apple-shaped bodies) have a higher risk for coronary artery disease compared to individuals who store fat in their hips and thighs (commonly known as pear-shaped bodies).

Now new research presented at the Radiological Society of North America (RSNA) 2017 Annual Meeting, led by Miriam A. Bredella, MD, radiologist at Mass General, finds that gender also plays a key role.

Exploring differences between men and women

Bredella and her research team examined 200 overweight and obese but otherwise healthy adults. 91 of the participants were male, and all participants had a similar body mass index (BMI) and age.

The researchers found that female participants had more total body fat and more superficial “pinchable” fat in their thighs, but had a lower lean body mass (the amount of weight you carry on your body that isn’t fat). Male participants had more ectopic fat in the abdomen (commonly referred to as a “beer belly”) and in their liver and muscle cells.

What’s more, the study found that the risks of carrying ectopic fat at the abdomen differed for men and women. Ectopic fat did not increase men’s risk of cardiometabolic disease but it significantly increased cardiometabolic risk in women with the same BMI.

“The detrimental fat depots deep in the belly, muscles, and liver are more damaging for cardiometabolic health in women compared to men,” said Bredella in an interview with Medical News Today.

This discrepancy could be due to the fact that men typically have higher muscle and lean mass, which are protective for cardiometabolic health.

More research is needed to better understand this discrepancy between men and women. More insights into the connections between body shape, gender and risk of CAD or other cardiometabolic disorders could also help to guide new treatment strategies for overweight patients.

However, there are actions that all individuals can take to reduce their cardiometabolic risk. Maintaining a healthy lifestyle with a balanced diet and exercise can help to increase muscle tissue and promote weight loss, both of which are beneficial to heart health.

This article was adapted from a post on Massachusetts General Hospital’s Advances in Motion. Read the original post here.