Cardiologists moving to positron emission tomography (PET) scans to diagnose heart diease, rather than SPECT scans

Image by Artemis Diana, iStock/Getty Images Plus

By Dr. Talal Alnabelsi

University of Kentucky

When it comes to diagnostic imaging of your heart – such as MRI, CT, SPECT, or PET – it can be overwhelming to know what kind of scan is right for you. What is your doctor looking for, and what exactly does the imaging show?

Imaging is vital in assessing and treating coronary artery disease (CAD), a condition in which plaque gradually builds up in the blood vessels. Over time, as the plaque accumulates, the blood vessels become narrower, reducing the blood supply to the heart muscle, which in turn could lead to symptoms such as chest pain or shortness of breath or a heart attack.

Risk factors for CAD are high cholesterol, high blood pressure, family history of heart disease, diabetes, smoking and obesity. It’s important for cardiologists to have a clear image of the heart to determine the extent of the plaque buildup or whether the plaque is causing any blockage in order to develop an effective treatment and prevention protocol.

Traditionally, cardiologists have relied on a type of imaging called single photon emission computed tomography (SPECT) to diagnose coronary artery disease and the extent of blockage in your heart. This involves the injection of a radioactive tracer into the veins while a special camera picks up the traces of the tracer, photographing it as it moves through the heart. The photographs are assembled into a three-dimensional image, showing areas of tissue damage and reduced blood flow.

There is a new movement among cardiologists to use positron emission tomography, or PET scans, to assess coronary artery disease. Although the procedure for a PET scan is similar to SPECT – both involve photographing radioactive tracers as they move through the heart – PET scans are more accurate and have a better image quality than SPECT.

Other benefits of PET scan for cardiac imaging include:

• Overall scan time is shorter than for SPECT imaging, vital for patients who may find it difficult to be in the enclosed space of the imaging machine for a prolonged period
• Allows assessment of not just the blood flow, but how well the heart muscle itself pumps blood
• The ability to determine your coronary-artery calcium score
• Can diagnose patients who continue to have chest pain despite no obvious blockage on cardiac catheterization or heart CT (microvascular disease)
• Lower dose of radiation, beneficial to patients who have to go undergo frequent imaging
• Image and assess patients who are suspected to have other conditions, such as cardiac sarcoidosis or endocarditis, scarring in the heart muscle or an infection from an implantable device such as a pacemaker.

Beyond heart disease, cardiac PET scans can image patients who have other suspected conditions including cardiac sarcoidosis or infections of implanted devices (pacemakers/defibrillators) or prosthetic heart valves.

While PET scans are not as widely available as SPECT, they give cardiologists a more complete picture of your heart’s health, reducing the need for alternative imaging tests or unnecessary invasive procedures. If your local health-care facility does not offer PET imaging, ask your cardiologist for a referral.

Talal Alnabelsi, M.D., is a cardiologist at UK HealthCare’s Gill Heart & Vascular Institute.

Anthem is among health insurers now covering anti-obesity drug if it is prescribed to reduce the risk of heart attack and stroke

One of Kentucky's major health insurers is among the first that have "agreed to start paying for the popular anti-obesity drug Wegovy for certain people on Medicare with heart-related conditions," The Wall Street Journal reports. Kentucky has the highest share (about 2.1%) of a state's population that have prescriptions for the new class of weight-loss drugs.

Elevance Health, the corporate parent of Anthem, joined CVS Health and Kaiser Permanente in covering Wegovy to reduce the risk of heart attacks and strokes in beneficiaries "who have cardiovascular disease, meet body-weight criteria and are covered by a Medicare drug-benefit plan," report the Journal's Peter Loftus and Anna Wilde Mathews.

State table shows Medicaid coverage numbers for March. FFS
means "fee for service," which is separate from managed care.

"Elevance, which operates many Blue Cross and Blue Shield health plans, also said it would extend coverage to people insured by a commercial plan" and would make the change in the next few weeks. "A committee of outside advisers to Elevance Health’s CarelonRx unit, which manages pharmacy benefits, has approved the use of Wegovy to reduce the risk of major cardiovascular events. . . . The company also is working with state-government agencies to determine Medicaid coverage of Wegovy." Anthem manages the Medicaid care of about 172,000 Kentuckians; county-level numbers are available.

"The insurers’ moves open up reimbursement of the coveted but costly class of weight-loss drugs, which had previously been excluded from Medicare coverage by a U.S. law and which many private health plans had resisted reimbursing because of the expense," the Journal notes. "The decisions will ease the financial burden on people who had been paying more than $1,000 out of pocket each month because their health plan wouldn’t cover the medicines, and spur use among people who couldn’t afford the heavy cost or didn’t want to pay for it. Other Medicare and commercial health plans might now feel pressure to follow suit and begin coverage. But the widening coverage could result in billions of dollars in additional drug spending by health insurers that have struggled to keep a lid on rising health costs. Wegovy lists for about $1,349 a month."

U.S. Sen. Bernie Sanders (I-Vt.), chair of the Senate's health committee, this week called on insurers to charge Americans no more than they charge in Canada for the drugs. That would lower their prices by about two-thirds.

"The insurers’ decisions arose from new guidance issued last week by the Centers for Medicare and Medicaid Services," the Journal notes. Medicare Part D plans, "which are administered by private insurers, might cover anti-obesity medications if the drugs receive approval for an additional use. Their use for weight-loss alone would still be excluded from coverage. That new guidance applies to Wegovy because the Food and Drug Administration this month approved the weight-loss drug’s use reducing the risk of heart attacks and strokes in people with a history of heart disease, and who have a body-mass index above certain thresholds. A study showed Wegovy reduced cardiovascular risk by about 20% versus a placebo."

Kentucky-based Humana, which manages the care of 155,000 Kentuckians on Medicaid and has a broad paying-customer base in the state, said it is reviewing the CMS guidance. UnitedHealth Group, which covers more than 91,000 Kentucky Medicaid beneficiaries and has many paying customers in the state, declined the Journal's request for comment.

UK researchers, with samples from patients, help map how heart muscle behaves; that could lead to new heart-disease treatments

The research was led by Kenneth Campbell, Ph.D., of UK's College of Medicine.

By Lindsay Travis
University of Kentucky

A University of Kentucky researcher has helped solve a 60-year-old mystery about the human heart and published his findings in one of the world's top scientific journals.

Kenneth S. Campbell, director of translational research in the Division of Cardiovascular Medicine in the UK College of Medicine, helped create a molecule-level map of an important type of heart tissue. The study was published in the peer-reviewed journal Nature earlier this month.

The heart has billions of cells. Each cell contains thousands of smaller structures that are the building blocks of muscle. In each block are hundreds of filaments of myosin, a motor protein. If the heart is a continent, Campbell and fellow researchers are looking at single strands of hair.

“Each filament has roughly 2,000 molecules arranged in a really complicated structure that scientists have been trying to understand for decades,” said Campbell. “We knew quite a lot about the individual molecules and people thought the myosins could be arranged in groups of six that were called crowns, but not much beyond that.”

Working with researchers at the University of Massachusetts Chan Medical School, the UK researchers produced three-dimensional reconstructions of the cardiac filaments, provide=ing a new framework for interpreting structural, physiological and clinical observations.

Campbell said their most interesting discovery was that there are three different types of crowns. “We think this means that heart muscle can be controlled more precisely than we had realized,” he said. “We were also excited to see how myosin binding protein C, another protein that is linked to genetic heart disease, sits within the structure. It gives us a new level of information about how the molecules are arranged in the heart. . . . It gives us a much better understanding of how the molecules in our hearts interact.”

He said the study could help development of new drug therapies for heart disease, which is the leading cause of death in Kentucky, which among the top 10 states with the highest heart-disease death rate, according to the Centers for Disease Control and Prevention.

The research team collected heart samples from the 15-year-old Gill Cardiovascular Biorepository, of which Campbell is the director. Samples are donated for research purposes from patients who receive cardiovascular care at UK. “We’ve built a huge resource with roughly 15,000 samples from nearly 500 people,” Campbell said. “To the patients at UK HealthCare who’ve donated samples to us, we hope they know how much they’ve helped drive world-class research to, hopefully, help others who get sick.”

The samples are shared with researchers around the world, and “This study in Nature comes from one of those collaborations,” Campbell said.

Nature is a weekly international journal and is considered one of the most prestigious and widely respected scientific journals in the world. It covers a wide range of scientific disciplines and publishes original research, review articles, opinion pieces and news related to various fields of science.

“If you get a paper published in Nature, it means that scientists think that this work is important to everybody, not just people who specialize in that particular area,” said Campbell. “It’s a career highlight.”

Campbell, who holds a joint appointment in cardiovascular medicine and physiology, has taken an undergraduate degree in physics and transformed it into a career focused on helping people. “I used to care a lot about math and molecules,” he said. “But after hearing a friend who’s a cardiothoracic surgeon talk about patients, I realized I could take my scientific skills and do research that has a chance of helping people. It’s given my science purpose.”

More than 1/3 of U.S. heart-attack and stroke survivors don't take aspirin to prevent a second one, 40 years after it was first advised

People who have experienced a heart attack or stroke have prevented another one from happening by taking a daily aspirin. But fewer than half of heart attack or stroke victims worldwide take the inexpensive medication, according to a study in the Journal of the American Medical Association.

“Survivors of heart attacks and stroke often face a high risk of having subsequent events,” said lead researcher Dr. Sang Gune Yoo,  a cardiovascular disease fellow at the Washington University School of Medicine in St. Louis. “In fact, many people die from having recurring attacks. Aspirin offers one effective and relatively low-cost option for reducing the likelihood of additional events in individuals with established cardiovascular disease, and yet most people who could benefit from a daily aspirin don’t take it.”

Graphic by Mike Worful, Washington University, adapted by Ky. Health News

For more than 40 years, research has established that aspirin can reduce the risk of a second heart attack or stroke, by about 25 percent. But more than a third of survivors in the United States and other high-income countries do not take it, according to the study, which looked at a wide range of countries. Generally, the lower a country's average per-capita income, the less likely survivors were to take aspirin; in low-income nations, only 17% do.

The study didn't explain those figures, but Yoo said likely reasons include varying access to health care, inconsistent messaging surrounding use of the drug, and the fact that aspirin is a prescription drug in some countries.

Aspirin is a blood thinner, preventing small blood cells called platelets from forming clots. These clots can block arteries and contribute to a reduction in the amount of oxygen-rich blood being delivered to vital organs. Such blockage also can cause other complications, including a heart attack or stroke.

The study notes that cardiovascular disease, including heart attack and stroke, is the world's leading cause of death. Contributing factors include smoking, diabetes, unhealthy diet, genetics, lack of exercise, obesity and air pollution. 

The researchers analyzed data from nationally representative health surveys in 51 countries. The surveys included questions about people’s medical history of cardiovascular disease and on aspirin use. The study included 125,505 people, with 10,590 self-reporting a history of cardiovascular disease.

The heat is on; here's how to keep your heart healthy in summer

By Dr. Vincent Sorrell

Chief of cardiology, UK HealthCare

Memorial Day marks the unofficial start to summer. From outdoor barbecues to lounging by the pool, summertime means more time spent outdoors with friends and family. But fun in the sun comes with risks.

Humans regulate heat through blood flow. A healthy heart dissipates heat by pushing blood toward the skin. We also shed heat through sweat. People with pre-existing heart conditions are especially at risk, as heat can put extra stress on the heart. According to the Centers for Disease Control and Prevention, more than 600 people die every year from preventable, heat-related illnesses. More than 65,000 are treated in the emergency room for heat stroke, heat exhaustion and dehydration.

It’s important to recognize the signs of heat exhaustion and heat stroke and what to do is someone is in danger. With heat exhaustion, look for signs such as heavy sweating, paleness, muscle cramps, fatigue, and dizziness or fainting. It can be treated by moving the person indoors and cooling them off with a cool cloth. If they don’t improve in an hour, seek medical help.

Heat stroke is more severe. Symptoms include high body temperature (above 103º F), skin that’s red and hot but not sweaty, rapid pulse, throbbing headache, and dizziness and confusion. Heat stroke is a medical emergency — call 911 right away if you see someone in distress.

Dehydration can begin within just a few hours of the onset of extreme heat. Signs of dehydration include fatigue, headache, muscle cramps, dizziness and dry mouth. Dehydration causes the heart to pump harder, which can put heart patients at further risk. Elderly patients in particular need to drink up, as they may not feel thirsty until they are dehydrated. Some patients may still not feel thirsty even after they become dehydrated.

Here are some ways you can stay safe in the sun:

Drink lots of water. Hydration helps the heart pump more easily and helps the muscles work more efficiently. The more you sweat, the more you need to replenish fluids. Skip the alcohol, coffee and tea as it can further dehydrate you. It’s important to keep drinking, even if you don’t feel thirsty.

Keep your cool. In excessively hot temperatures, stay indoors. If you must be outside, find a shady spot and use a fan or a damp towel to stay cool. At the peak of heat in the early afternoon, avoid being outside for prolonged periods of time. Wear loose, light-colored clothing as well as a hat.

Monitor medications. Due to the extra strain of heat, heart patients need to be diligent in keeping up their prescription regime.

Be smart when it comes to exercise. Exercise is important for long-term heart health. If you don’t have the option to take your work out indoors, stick to the early hours of the day. Take it easy — avoid excessive or intense effort in extreme heat.

New Kentucky website provides data, maps and charts on how the environment affects human health, county by county

The website's address is Healthtracking.ky.gov.

The state Department for Public Health has launched a new resource for tracking a variety of topics that affect health in Kentucky. 

The website Healthtracking.ky.gov not only includes information and data about how the environment affects human health in a number of ways, but also presents data in map, chart or table formats for subcategories in each topic area. 

For example, under the category of heart disease and stroke, the site also provides information about the age-adjusted rate of hospitalization for heart attacks in each county, the crude rate of hospitalizations for heart attack in each county, and the number of hospitalizations for heart attack in each county. 

Other topics include: air quality, asthma, birth defects, cancer, childhood lead poisoning, chronic obstructive pulmonary disease (COPD), carbon-monoxide poisoning, climate and weather, drinking water, heat-related illness, radon (a naturally occuring, cancer-causing gas) and reproductive and birth outcomes. 

Data on the new site comes from several counrse, including the Centers for Disease Control and Prevention, the Environmental Protection Agency, the Kentucky Cancer Registry, state and local Health Departments and many others. Data can be examined at a state or county level.

The site also offers online maps with information about local health departments, prescription assistance, social vulnerability, and community vulnerability to Covid-19. It is managed by the health department's Environmental Public Health Tracking Program.

UK study finds children who were exposed to opioids before birth are more likely to develop chronic diseases when they grow up

By Lindsay Travis
University of Kentucky

What happens to the cardiovascular health of babies exposed to opioids in the womb?

A new study at the University of Kentucky suggests that children born to mothers who use opioids during pregnancy may be more likely to develop chronic diseases as adults, including cardiovascular and metabolic diseases. 

Opioid abuse is a key public-health challenge in Kentucky and the U.S., which saw over half a million opioid-related overdose deaths in 2022 alone. The use and misuse of opioids during pregnancy have grown rapidly over the past decade. On average, about one baby born every 15 minutes in the U.S. has an array of symptoms stemming from opioid use during pregnancy, called neonatal opioid withdrawal syndrome.

NOWS symptoms are usually treatable in babies, but scientists have known little about the potential long-term health impacts of in utero opioid exposure once these children grow up.

Analia Loria, Ph.D.

“It is challenging to predict the long-term impact on the cardiovascular health of children from women with opioid misuse and opioid overdoses due to the lack of follow-ups after discharge,” said Analia Loria, Ph.D., senior study author and an associate professor in the Department of Pharmacology and Nutritional Sciences in the University of Kentucky College of Medicine. “However, our studies provide insights regarding how opioids could affect the programming of the mechanisms regulating cardiovascular function and increase the cardiovascular risk.”

The researchers developed a rat model that mimics the use of drugs during pregnancy and studied what happens to the offspring from birth until adulthood. They found that babies of mothers who used drugs while pregnant were shorter at birth and weighed less during the breastfeeding stage. When they started eating independently, they gained weight quickly and caught up to their non-exposed peers, a pattern that has been found to increase the risk of cardiovascular and metabolic disease.

“Overall, we found that the systems that control blood pressure and how sugar and lipids are processed in our bodies are altered in drug-exposed babies,” said Nermin Ahmed, a registered dietitian and UK doctoral candidate in pharmacology and nutritional sciences. “This could mean that adults who were exposed to drugs in the womb are more likely to develop chronic diseases like high blood pressure, diabetes, chronic kidney disease and high cholesterol, and they may also be more susceptible to other drugs and environmental stressors. This prenatal exposure can permanently change how the body handles a second exposure to opioids.”

As adults, rats exposed to drugs in the womb had higher blood pressure, poorer blood sugar control and increased levels of bad cholesterol despite eating the same type of diet as the nondrug-exposed rats. The researchers also observed differences in the expression of certain proteins and receptors involved in regulating how the brain responds to drugs, raising the possibility that people exposed to opioids in the womb may also face a higher risk of drug dependence later in life.

The study draws attention to the effects of the opioid epidemic on childbearing women and the importance of screening for prenatal opioid exposure. Researchers say that knowing more about such exposures could help to inform disease prevention and treatment approaches throughout the lifespan.

Researchers presented their work in April to the American Physiological Society. The study was published in the American Heart Association’s journal Hypertension, online here.

Ernie Scott of Letcher County dies of rare brain aneurysm at 46; had been director of the State Office of Rural Health since 2013

Ernie Lee Scott

Funeral services were held Friday for Ernie Scott, who was director of the State Office of Rural Health in the University of Kentucky Center of Excellence in Rural Health. He did Sunday, March 12, at his home in Partridge, in Letcher County. He was 46.

The cause of death was a "random and rare" aneurysm in the brain, Coroner Perry Fowler told The Mountain Eagle of Whitesburg.

Scott started his career as a radiology technologist, earned a bachelor’s degree in health care administration at Midway College, was director of planning and special projects for Mountain Comprehensive Health Corp. in Whitesburg, and became director of the Office of Rural Health in 2013.

In 2014 Scott received the Emerging Leader Award from the National Organization of State Offices of Rural Health, and in 2020 he won the Kentucky Rural Health Association's Dan Martin Award for lifetime contributions to rural health. Last year, the office was one of three organizations in the nation to receive a three-year, nearly $900,000 grant from the federal Office of Rural Health Policy to improve access to health care for veterans living in rural Kentucky and to improve coordination of veterans' care.

Scott is survived by his wife, Tiffany Bullock Scott, and their daughter, Addyson Grace Scott. The couple owned and operated the General Store at Pine Mountain Crossing on US 119 and ran a hospital gift shop. Other survivors include his mother, Iris Jean Scott; siblings Howard Wayne Scott (Renee) and Sherry Scott Geiger (David); and many nieces and nephews.

"To know Ernie was to love him," his obituary says. "He quickly became a friend to all he met. He always greeted folks with a smile and often a big hug. He was a planner, a goal setter, and achiever. He loved his family, friends, church, and his community. He poured his heart and soul into Letcher County (specifically Cumberland River) and made huge impacts in many other rural communities."

His funeral was at Lewis Creek Pentecostal Church, along the Poor Fork of the Cumberland River in Partridge, with burial in the D.L. Creech Cemetery four and a half miles downstream, at Cumberland. Tri-City Funeral Home was in charge. Memorial donations may be made to a health-care scholarship fund in Scott’s name at Commercial Bank, 1701 E. Main St., Cumberland KY 40823.

American Heart Month and Black History Month are the same month, and are related; Blacks are likelier to have heart disease

By Dr. Daniel Brunner

In February, we commemorate both American Heart Month and Black History Month, which presents an opportunity for us to raise awareness about cardiovascular health, remember the contributions of African Americans who helped shape the nation and reflect on the continued struggle to overcome disparities. As February ends, I urge everyone to commit to mind the teachings of American Heart Month and Black History Month throughout the year. That’s because a particular disparity that impacts the African American community is heart disease – the leading cause of death for African Americans and all adults across the U.S.

Daniel Brunner, M.D.

According to the Centers for Disease Control and Prevention, more than 20 million U.S. adults — approximately 7% of the U.S. population — have heart disease. The disparity lies in the fact that nearly 48% of African American women and 44% of African American men have some sort of heart disease. This is a lot higher than the 36% of white, non-Hispanic adults in the U.S. who have heart disease. In Kentucky, where heart disease is the commonwealth’s leading cause of death, 11.8% of the African American population has been diagnosed with a cardiovascular disease — higher than the national average of 9%.

While many factors contribute to their increased risk, what matters is that heart disease is killing Black Americans at a higher rate than any other group in the U.S., and the best way to fight this disparity is to successfully treat the risk factors.

Here is what people need to know:

Screening: Getting screened by a medical professional will help identify risk factors for heart disease early enough to treat it. Medical screening will identify if there are genetic risks or if factors such as weight, environment and habits are putting a person at higher risk of disease and death. Getting screened at least once a year is crucial for all adults.

Medication management: It’s not only important for people to take prescribed medication as directed for heart disease and other conditions that cause heart disease (such as diabetes, high cholesterol and high blood pressure), but is also important to communicate with a doctor to help manage conditions and adjust medication when required.

Staying active: Staying physically active reduces and helps manage weight. It may reverse early diabetes and cut cholesterol levels. It can even help control stress and hypertension. All it takes is 30 minutes a day, at least five days a week of exercise that is enjoyable, like walking, running, swimming, cycling, dancing, playing a sport or anything that gets the heart pumping.

Diet: It is extremely important to watch your diet to help maintain a healthy weight and heart. Certain ethnic food or diets and sugar-sweetened beverages are widely embraced in many communities. Some diets may be associated with a significantly increased risk of heart disease. With risk factors as high as they are, it is critical to be diligent with limiting foods that are rich in sugar, fat, calories and sodium.

Lifestyle choices: While it is not possible to change genes that are inherited, it is possible to make lifestyle changes that can influence heart health. Cutting smoking, getting six to eight hours of quality sleep at night and refraining from overeating could make a positive difference in heart health. Also important is cutting stress, since stress can increase hormones that elevate blood pressure. If stress continues long-term, it can lead to permanent hypertension, an irregular heart rhythm or a permanent heart condition.

Fighting back against heart disease doesn’t have to be undertaken alone. It’s obvious that people need their doctors to help, but in many cases, people can also turn to their health insurer for support. Many health plans offer special assistance in the form of case managers who work with patients and providers to determine a course of action that best serves a patient’s needs.

Accessing no-cost screenings, managing medication, and utilizing benefits designed to help members stay active or access diet programs are key to ensuring a healthy life. Reach out to your health plan to manage the thing that is most important – your health.

Daniel Brunner, M.D., is medical director for Anthem Blue Cross and Shield Medicaid in Kentucky. He is an emergency medicine physician based in Northern Kentucky.

Bedbugs, long thought to pose no risk to human health, produce large amounts of inflammatory histamines, UK researchers find

Bedbugs in an entomology lab (Photo by Matt Barron, UK)

By Haley Simpkins
University of Kentucky

Bedbugs produce large amounts of histamine that may pose risks to humans, entomologists at the University of Kentucky and North Carolina State University have discovered in a study. 

Histamines are naturally produced chemical compounds that may cause inflammation and alert the immune system to threats. They can cause allergic reactions, rashes and respiratory problems. A previous study showed links between excess histamines and headaches, gastrointestinal issues, irregular heart rate and asthma, especially in people with histamine intolerance.

Sudip Gaire, a post-doctoral scholar in the UK Department of Entomology, and Zach DeVries, assistant professor of entomology, led the latest study. It looked at levels of histamines excreted by bedbugs across the bugs’ different life stages, different populations and varying lengths of time, and the effects that feeding on blood had on the bugs’ histamine production levels.

The study, recently published in The Journal of Medical Entomology, showed bedbugs can produce large amounts of histamine. It found that a hypothetical infestation of 1,000 bugs could produce up to 40 milligrams a week, more than 2 grams per year without even considering natural population growth of the infestation.

“That's an amount you can actually see, and we don't see that with any other containment,” DeVries said. “When we talk about pesticides, allergens, any other thing in our home that some invading organism is producing, it's always on microscopic levels, not something where you could actually hold it in your hand.”

Scientists typically haven't considered bedbugs a great risk to human health, aside from their bites, because they are not known to carry pathogens. However, high-level histamine production reveals a potential risk. While scientists don’t know the specific health impacts of histamine produced by non-human animals, DeVries, Gaire and their fellow entomologists do suspect that it may have negative clinical effects.

“It’s not only the fact that they’re producing histamine, but they’re producing it right next to where you spend the most time, generally speaking, within our homes, which is in our beds or sleeping areas,” DeVries said.

The research also has social-justice implications, DeVries said: “Anybody can get bedbugs, but it’s only those who have the means and resources who can actually get rid of the problem. There is a significant portion of the population who either don't have the money or the resources to do this, and so they're left to deal with bed bugs on their own. So, we have disadvantaged communities, who are not only having to deal with bed bugs, but maybe dealing with the health ramifications of them as well.”

One important discovery of the study was that blood-fed bed bugs produced “significantly higher” amounts of histamine than those feeding on saline or those that were starved. “Blood is the primary factor for histamine production, but we don’t know how exactly they are producing the histamine,” Gaire said.

Gaire said close exposure to histamine is also a concern for agriculture. Bedbugs are common in poultry houses, and previous studies have found histamines reduce egg production.

DeVries and Gaire said that while their study answered important questions, scientists need to do more research before sounding an alarm. DeVries received funding for the study through his 2019 National Institutes of Health Director’s Early Independence Award, which will fund similar future studies through 2024.

Women, trust your gut if you suspect a stroke; here's how to judge

Stroke is the fourth-most common cause of death in women, and rural women are particularly in danger because stroke victims must get treatment quickly to improve their odds of a good outcome, and that can be harder to find in rural areas, Madelyn Ostendorf reports for Successful Farming. 

When women have a stroke, they're more likely than men to experience sudden confusion as an initial symptom. Here are some other common symptoms:

• sudden loss of limb control
• loss of vision
• difficulty speaking
• drooping of one side of the face

Less common but still important signs to watch for are:

• difficulty reading
• double vision
• trouble balancing
• tingling in the limbs

To assess whether someone, including oneself, is having a stroke, remember the acronym FAST:

• F: Face drooping. Does one side of the face droop, or is it numb? Ask the person to smile. Is the person's smile uneven?
• A: Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S: Speech difficulty. Is speech slurred?
• T: Time to call 911.

Recent genetic and medical study of 371,000 in United Kingdom concludes that no amount of alcohol is good for your heart

WebMD photo

By Melissa Patrick
Kentucky Health News

Although observational studies have indicated that moderate alcohol consumption is good for your heart, a new genetic and medical study of 371,000 people in the United Kingdom determined that any level of alcohol consumption is linked with a higher risks of heart disease – and the more you drink, the greater the risk. 

Not only does the study suggest that alcohol can lead to cardiovascular disease, there are "unequal and exponential increases in risk at greater levels of intake," the researchers conclude. They said that "should be accounted for in health recommendations around the habitual consumption of alcohol." 

The study, published in JAMA Network Open, found that the risk of cardiovascular disease is "relatively modest" for those who consume up to seven drinks per week, but that risk increases exponentially with more alcohol. 

The researchers question whether an average consumption of two drinks per day should be considered low-risk behavior and emphasize the need for "aggressive efforts to reduce alcohol intake among heavy drinkers." 

The researchers define light alcohol consumption as up to eight drinks per week; moderate consumption as 8 to 15 per week; heavy consumption as 15 to 24; and abusive consumption as more than 24 drinks per week.

While this study found that moderate drinkers have less heart disease than heavy drinkers or those who abstain, it suggested another cause for that: Those with light to moderate alcohol consumption also had healthier overall lifestyles, such as smoking less or not at all, exercising more, and eating healthier. 

"The reported cardioprotective effects of light to moderate alcohol consumption may be the product of confounding lifestyle factors," says the report.

The study looked at the connection between genes that are linked to alcohol consumption and cardiovascular disease for more than 371,000 people who participate in the U.K. Biobank, a large-scale biomedical database that allows researchers to study participants' genes and their relationship to health. Their average age was 57 and they reported consuming an average of 9.2 drinks per week. 

Understanding your alcohol intake can help assess how alcohol may affect your health, Dr. Danielle Anderson, an addiction medicine specialist with UK HealthCare, said in a recent article titled, "When One More Drink Can be Dangerous to Your Health." 

Assessing alcohol intake starts with counting the number of “standard drinks” you have in a week, Anderson writes. A “standard drink” is a 12-ounce beer containing 5% alcohol, a 5-ounce glass of wine, or 1.5 ounces of liquor containing 40 percent alcohol (80 proof). 

The federal government's Dietary Guidelines for Americans recommend that men of legal drinking age either abstain or limit intake to two drinks or less in a day, and that women abstain or limit intake to one drink or less in per day. The guidelines say drinking less is better for health than drinking more. 

The National Institute on Alcohol Abuse on Alcoholism defines binge drinking as consuming five drinks for men or four drinks for women on the same day within a couple hours. 

If you have alcohol-use disorder, the current medical term for was once called alcoholism, treatments are available that include medications, therapy and involvement in mutual support programs such as Alcoholics Anonymous or the Supportive Medication And Recovery Treatment (SMART), Anderson notes. 

Anderson, an assistant professor in the UK Department of Psychiatry, advises, "Talk to your provider about your health conditions and medications prior to using alcohol. If you are drinking above the recommended amounts of alcohol, talk with your provider about your concerns."

U.S. Rep. Andy Barr writes about bill, named for his late wife, to spur research into the heart ailment that killed her in June 2020

The late Carol Barr with her husband and daughters Eleanor and Mary Clay.

By Andy Barr

Though every holiday season without my wife Carol will be difficult, this year I am comforted by the fact that her legacy will be enshrined through the Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act, which passed the U.S. House of Representatives on Wednesday.

The CAROL Act makes historic investments in treatments for valvular heart disease to close the gaps in understanding about what risk factors make valvular heart disease a potentially life-threatening condition.

On June 16, 2020, my and my two daughter’s lives changed forever when my wife and best friend Carol unexpectedly passed away at 39 years old from sudden cardiac arrest. The medical examiner and Carol’s doctors told us that her fatal heart attack was likely brought on by a ventricular arrhythmia.

At a young age, Carol had been diagnosed with an underlying condition called mitral valve prolapse (MVP), or floppy valve syndrome—a typically benign condition that results in sudden cardiac death in only .2% of cases.

What factors placed Carol in the 0.2% versus the 99.8% category? In my discussions with top cardiologists, medical experts, researchers, and advocates following Carol’s passing, I learned the extent to which the medical community seriously lacked answers to this critical question. So, I decided to take action and introduce the CAROL Act, to better equip our medical community with the resources needed to develop predictive models, inform communities, and possibly save the lives of other loved ones.

Specifically, the CAROL Act authorizes a grant program administered by the National Heart, Lung, and Blood Institute, to support research on valvular heart disease, including MVP. This legislation martials the full power of 21st-century medical innovation and encourages the utilization of technological imaging and precision medicine to generate data on individuals with valvular heart disease. It is through this research that we can help identify Americans at high risk of sudden cardiac death from valvular heart disease and develop prediction models for high-risk patients, enabling interventions and treatment plans to keep these patients healthy throughout their lives.

Additionally, the CAROL Act will instruct the Centers for Disease Control and Prevention to increase public awareness regarding symptoms of valvular heart disease and effective strategies for preventing sudden cardiac death.

This week, the CAROL Act, which has earned 179 bipartisan cosponsors, passed the U.S. House of Representatives. My friend and fellow Kentuckian, Sen. Mitch McConnell and Arizona Sen, Kyrsten Sinema, whose sister also passed away from valvular heart disease, are leading the companion bill to the CAROL Act in the Senate.

We are rapidly approaching the finish line of this legislation becoming law. No matter what, Carol Barr’s greatest legacy will always be our two beautiful daughters, Eleanor and Mary Clay. Now, through the CAROL Act, her legacy also offers an element of hope that countless families will not have to experience the tragedy that has so profoundly impacted ours.

Andy Barr is a Republican representing the Sixth Congressional District.

UofL Health-Jewish Hospital team is second in U.S. to implant a new type of artificial heart; Indiana man 'doing well' after 5 days

The University of Louisville announced Wednesday that UofL Health-Jewish Hospital had implanted a new type of artificial heart in a Southern Indiana man, making it the second U.S. hospital to implant the French-made device.

Mark Slaughter, M.D. (University of Louisville photo)

The heart was implanted Aug. 20 by a surgical team led by Dr. Mark Slaughter, the lead cardiothoracic surgeon at the hospital and chair of cardiovascular and thoracic surgery in the U of L School of Medicine. "The recipient, whose identity is being withheld upon request . . . is doing well," a U of L news release said.

The Aeson heart "serves as a bridge to transplant for patients with end-stage biventricular heart failure – heart disease affecting both left and right sides of the heart – allowing more time for the patient to receive a permanent heart organ transplant," the release said. "The new device is designed to solve the limitations of left-ventricular assist devices, which pump blood in just one chamber, by pumping blood in both heart chambers."

It also has sensors that detect blood pressure and position and adapt blood output accordingly, and has an external power supply, the release said: "The device is medically approved in Europe, where approximately 20 devices have been implanted. The first Aeson artificial heart in North America was implanted in July at Duke University," in a 39-year-old man from North Carolina.

The release noted past pioneering cardiac efforts at U of L and Jewish, which the university took over in 2019 "to preserve its storied organ-transplant program," notes Deborah Yetter of the Courier Journal. "On July 2, 2001, U of L cardiothoracic surgeon Laman Gray led the surgical team that implanted the first self-contained artificial heart in the United States at Jewish Hospital," the release said. "The AbioCor artificial heart was implanted into Robert Tools, who lived five months on the device. The UofL surgical team also performed the first heart transplant in Kentucky at Jewish Hospital in 1984."

State's poor health rankings are a caution flag in pandemic, but virus shouldn't keep you from making regular visits to doctors

Ben Chandler

By Ben Chandler
President and CEO, Foundation for a Healthy Kentucky

A new state-by-state comparison of the nation’s health ranks Kentucky near the bottom in a variety of significant categories. Though the 2020 America’s Health Rankings Annual Report from the United Health Foundation may underscore Kentucky’s longstanding position as a state with serious health challenges, this year’s rankings also provide a great service by raising a caution flag related to Kentucky’s battle against Covid-19.

First, consider that Kentucky is ranked 49th among all states for percentage of residents (15 percent) who suffer from three or more of these chronic conditions: arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease (COPD), cardiovascular disease, cancer, depression and diabetes.

Though the study was performed prior to the Covid-19 pandemic, its findings spark concern related to the current crisis. Notably, the Centers for Disease Control and Prevention states that adults with any of these chronic conditions are at increased risk of severe illness from the virus that causes Covid-19.

Also, the United Health Foundation study shows 36.5% of Kentucky adults are obese (compared to 31.9% nationally). And the CDC reports that adults who are obese also face increased risks related to the virus.

Of course, more broadly, the rankings are a reminder that chronic health conditions and generally poor health make us more susceptible to a wide range of risks – and not just during this current global pandemic. So these rankings are also a call to action: a rallying cry to each of us as individuals and community leaders to continue addressing Kentucky’s chronic health conditions and other health needs despite the pandemic.

As Covid-19 cases have climbed in Kentucky, one major concern is that Kentuckians still may be skipping preventive and non-Covid-related visits to the doctor to reduce their risk of exposure to the virus. But the decision to delay such visits – which may include screenings such as mammograms and colonoscopies, as well as annual wellness exams – could have serious health consequences, especially for those with chronic conditions that require regular, ongoing medical attention.

We don’t have to skip these important visits. In recent months, health providers and clinics have taken a variety of steps to reduce the risks of contracting Covid-19. In addition to mask requirements, doctors’ offices are implementing strict social distancing policies, limiting the number of people in waiting rooms, and instructing patients to wait in their cars until their appointments begin. And many providers are offering telehealth options, where patients can meet their providers without leaving their homes.

So, while Kentuckians must remain vigilant in their efforts to avoid contracting or spreading the coronavirus, we cannot neglect our broader health care needs.

For the record, America’s Health Rankings also include some positive observations about Kentucky. They note that the commonwealth’s air pollution has decreased 12.6% from 2009 to 2019. We are ranked third in percentage of adults who are high school graduates (90.3%), which is important because education attainment generally equates with more secure employment, higher earnings and better health. Our poverty rate also has been declining, from 19.4% in 2012 to 16.3% in 2019. These represent movement in the right direction. And though Kentucky has dropped slightly in recent years, we are ranked 14th in percentage of residents (93.6%) covered by private or public health insurance.

In this Covid-19 era, managing our health is a multi-pronged approach. We need to keep ourselves safe and prevent the virus from spreading, yet also ensure we aren’t adding to its toll through delayed care or missed diagnoses. And then there is the even bigger picture: Challenging ourselves, our loved ones and our communities to improve our state’s health through policies that increase access to health care, reduce exposure to health risks and improve health equity. As we close out a year full of turmoil and uncertainties, there has never been at better time to pursue a healthier Kentucky.

Hospitals invest in interventions and public education to fight heart disease, which is the number-one killer of Kentuckians

https://www.lanereport.com/130324/2020/09/hospital-tech-takes-on-kentuckys-top-killer/?utm_source=Faster%20Lane%20Newsletter&utm_medium=Email&utm_campaign=

Regular marijuana use may enlarge the heart's main blood-pumping chamber, limited study in United Kingdom suggests

Image from Marijuana Direct

Regular use of marijuana could cause changes in the structure of the heart, suggests a study conducted in Britain and reported in a journal of the American College of Cardiology.

"People who regularly use marijuana tend to have a larger left ventricle, which is the main pumping chamber of the heart, according to the findings," reports Dennis Thompson of HealthDay. "Routine stoners also appeared to have early signs of impaired heart function, measured by how the fibers of the heart muscle deform during contraction."

However, when marijuana use stops, "The heart appears to recover in both size and function," Thompson reports. "The researchers warn that the study 'should be interpreted with caution, and more research is required' to understand the potential mechanisms and dose-related effects of cannabis use."

That being said, "The results jibe with concerns people have had about the effects of pot on the heart, said Dr. Martha Gulati, editor-in-chief of the cardiology college's patient-education website.

"There's so much we don't know about cannabis use and its effect on the heart, but one of the things we do know is that when people use marijuana, particularly if they smoke it, the heart rate and the blood pressure go up, and the heart has to work harder," she said.

The study was published in one of the college's peer-reviewed journals, JACC Cardiovascular Imaging. (A review in the same journal said marijuana can interact with common heart medications, including statins and blood thinners, potentially putting patients at risk, NBC News reports.)

The study was observational, not controlled, so other factors may have caused the heart-structure changes, said Dr. Mary Ann McLaughlin, a cardiologist at Mount Sinai Hospital in New York City, who reviewed the findings for HealthDay.

"Alcohol can also cause similar types of changes in the left ventricle with chronic drinking, which can get better when people stop drinking," McLaughlin said. "They said they adjusted for alcohol use in this study, but the question is whether the use was adequately assessed."

Thompson notes, "Europeans also are known to mix their marijuana with tobacco, which has notoriously harmful effects on the heart," citing Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws. "Experts also noted that the number of pot users in this study was very small." It observed 47 current, regular users and 105 previously regular users. The rest of the 3,400 sample from the United Kingdom "rarely used pot, if at all."

While more research is needed, Thompson writes, "Until there are more answers, people with heart problems might want to avoid pot, the experts said."

Gulati said, "If you have heart disease, you should really use marijuana with caution. In fact, I, as a cardiologist, would recommend you not to use it because of the physiologic effects of increasing your heart rate and putting more demand and stress on the heart."

Award-winning regional network organized by Norton Healthcare works to quickly treat the most deadly type of heart attack

Hospitals in the Louisville region partner with
Norton to give their patients access to the care.

Norton Healthcare has received the American Heart Association's 2019 Mission: Lifeline Regional Trailblazer Award for its regional program that provides care for a certain type of heart attack that is deadly if not treated quickly. Norton was Kentucky's only winner of the award this year, reports The Lane Report.

The program is designed to treat a type of deadly heart attack called an acute ST elevation myocardial infarction, or STEMI heart attack. ST is the distance between two junctures of an electrocardiogram.

“A STEMI heart attack begins with a sudden disruption of a mild cholesterol plaque in the wall of the coronary artery that supplies blood the heart. This leads to a buildup of a clot in an attempt to heal it. However, this clot formation results in total blockage of the artery,” Dr. Vipul R. Panchal, interventional cardiologist with Norton Heart & Vascular Institute, and medical director of interventional cardiology at Norton Brownsboro Hospital, told The Lane Report.

“It usually occurs in an artery with only mild blockage initially and can occur suddenly without warning. Unfortunately, the rapid progression to total blockage leads to loss of blood supply to the heart. The heart muscle stops working within minutes of this and dies within minutes to hours unless the artery can be opened back up.”

For a larger version of the image, click on it.

With a STEMI heart attack, quick intervention is important to restore blood flow. Diagnosis requires an electrocardiogram, and treatment requires an emergent cardiac catheterization to open the blocked artery or to administer clot-busting medication directly to the artery -- but not every hospital has emergency cardiac catheterization capability.

To combat this issue, Norton Heart & Vascular Institute established a regional STEMI network to ensure that patients from across the region have access to this lifesaving care. The network includes 12 community hospitals, emergency ground and air medical services, and three Norton Healthcare STEMI-ready hospitals, notes The Lane Report: "The goal of the network is to stabilize patients wherever they seek help and transport them to one of the receiving hospitals for cardiac catheterization to restore blood flow to the coronary artery as quickly as possible."

Panchal told The Lane Report that in 2018 Norton Healthcare had a median time of 46 minutes for its care of STEMI heart attack patients; the AHA's goal is 90 minutes or less from the time a patient seeks help to an intervention to restore blood flow.

“We see dramatically different outcomes depending on the time it takes to restore blood flow,” Panchal said.

Norton Heart & Vascular Institute STEMI Network members in Kentucky are: Breckinridge Health, Hardinsburg; Carroll County Memorial Hospital, Carrollton; Flaget Memorial Hospital, Bardstown; Jane Todd Crawford Hospital, Greensburg; Louisville VA Medical Center; Spring View Hospital, Lebanon; Twin Lakes Regional Medical Center, Leitchfield; and Norton Women’s & Children’s Hospital, Louisville. Four of the hospitals are in Indiana: Harrison County Hospital, Corydon; King’s Daughters Health, Madison; Clark Memorial Health, Jeffersonville; and Scott Memorial Health, Scottsburg.

The network receiving hospitals are Norton Audubon Hospital, Norton Brownsboro Hospital, and Norton Hospital. All three receiving hospitals have been recognized by the American Heart Association with Mission: Lifeline STEMI Receiving Center Gold awards.

U of L moves to maintain heart transplants at Jewish Hospital

Doctors perform a heart transplant. (Photo from WBUR, Boston)

The heart-transplant program at Jewish Hospital in Louisville may continue after all, now that the University of Louisville plans to take over the facility on Nov. 1.

KentuckyOne Health, which is selling the hospital and other facilities to the university, is asking the national organ-donor network to disregard its July 18 request that the program be put on long-term inactivation, Kentucky One and the university announced Friday. Letting the program go inactive could have required recertification by the Centers for Medicare and Medicaid Services, which would take more than a year and cost millions of dollars.

The university has collaborated for 35 years on the program, which is linked to its medical school.  “The heart-transplant program is simply too important for our university, our community and the patients who are depending on this life-saving procedure,” U of L President Neeli Bendapudi said in a news release. “We thank KentuckyOne for working with us to maintain the program. We are taking steps to shore up our efforts, and very soon we will have a plan in place to ensure the viability of the program for the future.” 

The release noted, "The first heart transplant in Kentucky took place on Aug. 24, 1984, at Jewish Hospital. Last year KentuckyOne and UofL celebrated a major milestone after the 500th heart was transplanted."  However, the number of transplants at the hospital has declined greatly; KentuckyOne blamed a change in how hearts are allocated by the United Network for Organ Sharing.

Jewish Hospital also performs lung, liver, kidney and pancreas transplants, "making it one of a select group of hospitals transplanting all five solid organs," the release said. However, kidney and liver transplants at the hospital have also become less frequent.

FDA proposes new, graphic warnings for cigarette packs and ads

A Food and Drug Administration photo illustration shows three  of the 13 proposed warnings.

The Food and Drug Administration has again published a proposed rule to "require color graphics depicting the negative health consequences of smoking be added to cigarette packages and in cigarette advertisements," Inside Health Policy's Beth Wang reports.

The warnings would be the first update to cigarette package warnings in more than 30 years. They were authorized by a 2009 law, but a tobacco-company lawsuit blocked FDA's first attempt.

Wang describes the proposed warnings:

“Tobacco smoke can harm your children,” with an image that shows the head and shoulders of a boy 8 to 10 years old, wearing a hospital gown and receiving a nebulizer treatment for chronic asthma.

“Tobacco smoke causes fatal lung disease in nonsmokers,” with an image showing gloved hands holding a pair of diseased lungs containing cancerous lesions.

“Smoking causes head and neck cancer,” with an image showing the head and neck of a woman 50 to 60 years old who has a tumor protruding from the right side of her neck, just below her jawline.

“Smoking causes bladder cancer, which can lead to bloody urine,” with an image of a gloved hand holding a specimen cup with bloody urine.

“Smoking during pregnancy stunts fetal growth,” with an image of an infant on a medical scale with a digital display reading 4 pounds.

“Smoking can cause heart disease and strokes by clogging arteries,” with an image of a 60- to 70-year-old man with a large, recently sutured incision in his chest as he undergoes monitoring.

“Smoking causes COPD, a lung disease that can be fatal.” There are two versions of the COPD warning. One will have an image of gloved hands holding a pair of diseased, darkened lungs removed from a smoker; the other will have an image of the head and neck of a 50- to 60-year-old man who has a nasal canula under his nose supplying oxygen, with the oxygen tank behind him.

“Smoking reduces blood flow, which can cause erectile dysfunction,” with an image of a 50- to 60-year-old man sitting on the edge of a bed and leaning forward with one elbow resting on each knee. The man’s head is tilted down with his forehead pressed into the knuckles of his right hand while his female partner sits behind him on the bed, looking in another direction.

“Smoking reduces blood flow to the limbs, which can require amputation,” with an image of feet with several toes amputated due to damage resulting from peripheral vascular disease caused by smoking.

“Smoking causes type 2 diabetes, which raises blood sugar,” with n image of a personal glucometer device showing a high blood sugar level.

“Smoking causes age-related macular degeneration, which can lead to blindness,” with the image of a senior man getting an injection in his right eye to prevent additional macular degeneration.

“Smoking causes cataracts, which can lead to blindness,” with the image of a man who is at least 65 years old who has a cataract covering his right pupil.

A lawsuit by public-health and anti-smoking advocates prompted FDA to issue the proposal, Wang notes: "The proposed warnings are required by law to be displayed on half the front and rear panels of cigarette packages, and on the top 20% of the area at the top of advertisements.

"This marks the second time FDA has issued a proposed rule to require graphic warnings on cigarette labels and advertisements," Wang notes. "The first rule was blocked in 2012 by the U.S. Court of Appeals for the District of Columbia in R.J. Reynolds Tobacco Company v. FDA, which argued the proposed rule violated the First Amendment by not justifying why there is a need to issue regulation on commercial speech. In March, however, a federal court ordered FDA to issue the proposed rule by Aug. 15, and a final rule by March 15, 2020."

The Family Smoking Prevention and Tobacco Control Act of 2009 "required nine new health warning statements to be included on cigarette packages and in cigarette advertisements, and it directed FDA to develop color graphics depicting the negative health consequences of smoking to accompany warnings," Wang notes. "After having their initial proposed rule rejected by the court in 2012, FDA undertook a research and development process to consider whether the TCA’s textual warning statements would promote greater public understanding of the risks associated with smoking. Through that process, FDA determined there was support to propose adjusting some of the TCA statements. FDA ended up with 16 statement-and-image pairings to test in a final quantitative consumer research study, which resulted in the 13 cigarette graphic health warnings listed in the proposed rule."