The Centers for Disease Control and Prevention (CDC) recently awarded funds to 28 state and local health departments across the United States to design, test and evaluate new, innovative approaches to address significant health problems. Over 67.2 percent of adults in Michigan are currently diagnosed with diabetes, hypertension, heart disease and obesity. In 2016, nearly 60,000 adults in Michigan died due to these conditions and there is growing interest in finding ways to reduce the impact.
The Michigan Department of Health and Human Services (MDHHS) was one of 21 state health departments to receive this funding. As part of this, a new partnership has been forged with Wayne State University researchers who will directly work with MDHHS in their efforts to prevent and manage cardiovascular health and diabetes.
“Our goal is to leverage emergency departments as a location for comprehensive population health initiatives, starting with a focus on undiagnosed or poorly controlled hypertension and hyperlipidemia,” says Phillip Levy, M.D., MPH, FACEP, FAHA, FACC, the Edward S. Thomas Endowed Professor and Associate Chair for Research in the Department of Emergency Medicine, and assistant vice president for Translational Science and Clinical Research Innovation. Levy will lead the Wayne State team on five major objectives to address these growing health problems.
“To achieve this, we are piloting a program called Bring It Down, which will utilize community health workers as a conduit to link patients to accessible primary care providers,” Levy says.
The researchers will also explore and test innovative ways to promote the adoption of evidence-based quality measurements at the health care provider level. “This objective will incorporate dashboard measures to monitor health outcomes among high-burden populations, and ultimately create geocoded hypertension and cholesterol data maps,” Levy added. “This will help residents, communities and health care providers become more aware of local information related to these health issues so that they can be better addressed, decreasing the likelihood of complications.”
The team will also implement systems to facilitate bi-directional referrals to community programs and resources and health care systems, ultimately aiming to improve lives. The team will explore and test innovative ways to expand the use of telehealth Smartphone applications to promote better management of hypertension and high blood cholesterol.
“The ultimate goal of this project is to improve the health of our local communities, particularly in areas where residents are at risk for developing complications such as heart disease,” Levy added. “We are proud to be a part of this nationwide effort that is rigorously aiming to prevent and manage diseases that affect the lives of millions.”
Healthier Hearts Equal Healthier Guts
It turns out that exercise can do more than slim down your waistline and boost heart health. It might also make what's inside your gut healthier, according to a recent study by San Francisco State University. In this first-of-its-kind study, published in the International Journal of Sport Nutrition and Exercise Metabolism, recent SF State graduate student Ryan Durk and Assistant Professor of Kinesiology Jimmy Bagley partnered with the SF State Health Equity Research (HER) Lab to test the relationship between gut health and cardiovascular fitness.
Durk recruited 20 men and 17 women, mostly from the SF State campus, and tested their cardiovascular fitness on a treadmill. He also assessed their body composition in the lab's BOD POD, an air displacement chamber that determines a person's fat and fat-free mass. Participants kept food logs for seven days and provided stool samples at the end of the week.
The HER Lab then extracted DNA to analyze the bacteria composition in the samples. The researchers were investigating the ratio of bacteria called firmicutes to another group, bacteroides, which can be used to gauge overall gut health and composition.
Analysis showed that participants with the best cardiovascular fitness had a higher firmicutes to bacteroides ratio. While most gut bacteria can be beneficial - even bacteroides in some cases - firmicutes bacteria are associated with metabolic byproducts that help prevent bacteria in the gut from leaking into the body. "These metabolic byproducts help strengthen the intestinal lining and help prevent leaky gut syndrome," said Durk. This research reinforces the idea of "exercise as medicine." "When we say that phrase, we think of it as meaning that exercise will help people stay healthier and live longer,” Durk continued.
“But you don't think about your gut bacteria. We now know that exercise is crucial for increasing beneficial bacteria in the gut." Findings from this study and other studies about the gut microbiome could eventually be used to create individual exercise prescriptions to improve gut and overall health. "We're not there yet," Durk added, "but this helps create that foundation."
Predicting Heart Health
Two University of Kentucky researchers are working to make predicting heart health a reality for the 5.7 million adults in the U.S. with heart failure. Combining physiology and engineering, UK's Kenneth Campbell and Jonathan Wenk are developing computer software to deliver better therapies for patients with life-threatening heart failure. The National Institutes of Health recently awarded the team a $3 million, five-year grant to create a computer model of the heart that can be customized to individual patients and predict long-term results.
"If you gave a patient a drug, how would their heart beat in the next second?” says Campbell, associate professor of physiology and cardiovascular medicine. “Folks are pretty good at predicting that, but we're trying to predict how their heart will grow over months and years after taking a pill or having a genetic mutation."
The computer model would take MRI or genetic data of a patient and build a multi-scale simulation of their heart, leading to more personalized treatment plans. The model could also serve as a screening tool for scientists and drug companies who are trying to develop new therapies. "This model will have tremendous predictive power, meaning it will change and adapt in response to treatment or disease," added Wenk, an associate professor of mechanical engineering and Gill Professor in Engineering. "For doctors, this is another tool that could guide them in their decision process."
Developing A Better Design
Only a handful of teams in the world are working in this area, and few are as collaborative. With Wenk's engineering skills and proficiency in organ-level function and Campbell's expertise in medicine and molecular-level function, they are among the first to incorporate the effects of genetic mutations into a model of the heart. The team, which includes collaborators at Michigan State University and Pennsylvania State University, will specifically aim to better understand familial hypertrophic cardiomyopathy, a genetic mutation and the most frequently inherited heart defect that affects about 700,000 Americans.
"This is when the college sports athlete suddenly goes into cardiac arrest on the field with no warning," Campbell said.
The defect often causes the heart to enlarge over time. The computer model will enable the researchers to test how and why certain genes are causing the heart to grow. And if they understand this, they will be able to intervene in that pathway and potentially reverse the abnormal growth. The computer technique is virtually the same used for classic engineering applications, such as simulating a bridge or a car crash.
"Whether it's a heart or a piece of steel, as long as we understand their governing equations, we can harness them to develop a better design," Wenk said. With this project and others, the researchers are aiming to develop a top-tier computational cardiology team at UK - because if computers can be used to model better bridges, they can be used to model healthier hearts.
Healthy Heart Now, Healthy Brain Later
People who take simple steps to keep their heart healthy in young adulthood - such as exercising, eating a healthy diet and controlling blood pressure and cholesterol - may keep their brain from shrinking decades later. People who take care of their heart health in young adulthood may have larger brains in middle-age, compared to people who do not take care of their heart health, according to a study published in Neurology, the medical journal of the American Academy of Neurology.
"We know that when people take certain steps like exercising and eating well, they have healthier hearts," said study author Michael Bancks, Ph.D., of Northwestern University Feinberg School of Medicine in Chicago. "The American Heart Association created seven simple steps everyone can take to improve heart health called Life's Simple 7 and recent research has shown that people who score higher on that assessment also score higher on thinking tests. We wanted to see if maintaining a healthy heart, as defined by these seven factors, affected the physical make-up of the brain as well."
The American Heart Association's Life's Simple 7 includes the following factors: maintaining a healthy blood pressure, controlling cholesterol, reducing blood sugar, being active, eating better, losing weight and stopping smoking. For the study, researchers looked at data on 518 people with an average age of 51 who had been followed for 30 years. Participants were initially screened for height, weight, blood pressure, cholesterol, blood sugar, and interviewed about diet and exercise. They then received follow-up exams every two to five years and also had brain scans 25 years after starting the study.
Researchers scored each participant on how well they followed each of the seven steps to heart health at the start of the study and then at year 25, giving participants zero points for poor adherence, one point for intermediate and two points for ideal, with total scores ranging from zero to 14. Scores of zero to seven were considered poor adherence, eight to 11 were intermediate and 12 to 14 were ideal. At the beginning of the study, five percent had poor adherence, 62 percent intermediate and 33 percent ideal. By year 25, 26 percent had poor adherence, 58 percent had intermediate and 16 percent had ideal.
They found that people who had better heart health scores at the beginning of the study had a higher average brain volume as a percentage of their total head size in middle age. This was also true for people who had a better average of the beginning score and the score at year 25. Bancks said that every point increase in the Life's Simple 7 score was roughly equivalent to one year of aging in the amount of brain shrinkage that occurred.
There was a stronger association between current smoking and smaller brain volume than other factors. "These findings are exciting because these are all changes that anyone can make at a young age to help themselves live a long and healthy life," Bancks said. "This may mean that heart health may have an impact on brain function in early life, but more study needs to be done to confirm this theory."
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