30 Years of Heart-Related Discoveries/Advances at the University of Maryland School of Medicine

As my 30-plus years as a faculty member at the University of Maryland School of Medicine and Medical Center has drawn to a close, I fondly recall 10 heart-related findings/discoveries and newsworthy events that gained worldwide attention, ending with the first genetically altered pig heart transplanted at UMMS last week.  Here they are in no special order.

1.         Poe likely died of rabies, doctor’s review shows: https://www.baltimoresun.com/news/bs-xpm-1996-09-11-1996255015-story.html

2.         Having high cholesterol levels early in life leads to heart problems by middle age: https://www.eurekalert.org/news-releases/823756

3.         Air Pollution and Diabetes: https://www.loe.org/shows/segments.html?programID=14-P13-00002&segmentID=5#:~:text=We’ve%20long%20known%20that,fatty%20diet%20can%20promote%20diabetes.

4. U.S. Amish gene trait may inspire heart protection: https://www.reuters.com/article/us-heart-gene/u-s-amish-gene-trait-may-inspire-heart-protection-idUKTRE4BA6JQ20081211

https://www.loe.org/shows/segments.html?programID=14-P13-00002&segmentID=5

5.         Want a McMuffin? Take your McVitamins: https://greensboro.com/want-a-mcmuffin-take-your-mcvitamins/article_20be3661-d342-549f-9118-a2e355f4175a.html

6.         UMMC Implants the World’s Smallest Pacemaker: https://www.umms.org/ummc/news/2017/ummc-implants-the-worlds-smallest-pacemaker

7.         University Of Maryland School of Medicine Study Shows Laughter Helps Blood Vessels Function Better: https://www.sciencedaily.com/releases/2005/03/050309111444.htm

8.         Study finds no value in heart supplement: CoQ10 not shown to relieve symptoms, UM cardiologist says: https://www.baltimoresun.com/news/bs-xpm-1999-09-27-9909270293-story.html

9.         Secondhand Smoke Ups Heart Disease in Unique Group of Female Nonsmokers – Amish Women: https://www.umms.org/ummc/news/2017/amish-secondhand-smoke

10.       In a First, Man Receives a Heart from a Genetically Altered Pig https://www.nytimes.com/2022/01/10/health/heart-transplant-pig-bennett.html?smtyp=cur&smid=tw-nytimes

Dr. Michael Miller is Chief of Medicine, Corporal Michael J Crescenz VAMC in Philadelphia, PA   Check him out on twitter: @mmillermd1

Did You Hear That? If Not, Blame it on Your Heart

As we age, the loss of high frequency sounds becomes a common sign of hearing impairment due to degenerative changes in the inner ear.  High frequency hearing loss is common in the U.S. (~1 in 5 adult men and women are affected) and the classic sign is a decreased ability to hear high pitched sounds (voices of children/women) as well as to decipher conversations in a crowded room.  Loss of low frequency sounds (voices of men, thunder, bass) is less common but is also an important cause of hearing loss.

A study from the Yale School of Medicine suggests that having a history of cardiovascular disease or at least 1 cardiovascular risk factor (diabetes, high blood pressure, history of smoking) also raises the risk of both high and low frequency hearing loss.

Bottom Line: While heart related risk factors may promote hearing loss, it still remains to be determined whether intensive management of these risk factors delays progression of this process.

Listed below are some tips related to hearing and cardiovascular health

1. High frequency hearing loss is common in patients with diabetes (Type 1 and Type 2) due to disease of small blood vessels of the (cochlear) inner ear.
2. Treatment of high cholesterol with statins has been shown to improve tinnitus (ringing of the ears).
3. In a study of 274 men and women aged 45-64 years, hearing loss was 2-fold greater among those with hypertension (140/90 or higher) than with normal blood pressure.
4. A study conducted in Korea found that obese men and women with elevated cholesterol and triglyceride levels were at increased risk of high frequency hearing loss.
5. Data from the Nurses’ Health Study found that women who consumed 2-4 fish meals per week experienced a 20% lower likelihood of hearing loss compared to women who consumed less than 1 fish meal per month over the 18-year followup period.
6. Cigarette smoking cessation eliminates the excess risk of hearing loss within 5-years of quitting.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland. 

Lift Weights to Lose Weight

 

A new study shows that lifting weights/resistance training 2 or more days a week for as little as 30 minutes per session is associated with or a 20-30% lower risk of developing obesity over a 6 year period. In addition to traditional weight machines and free weights, muscle strengthening/tone activities include full body squats, pushups, planks and other core exercises.

This study adds to the growing evidence that muscle toning exercises are cardioprotective.  Among the first studies to demonstrate heart protection was the “Harvard Health Professionals’ Follow-Up Study, which found that weight training for at least 30 minutes each week resulted in a 23% lower risk of a heart attack or death from heart disease”**

Shown below are several other reasons why weight/resistance training aimed at muscle toning should be part of your overall physical fitness prescription to improve cardiometabolic health by reducing the following:

1. Type 2 diabetes: A study of nearly 4700 adults found that moderate weight training that resulted in increases in muscle mass (assessed by bench and leg press) reduced the risk of developing Type 2 diabetes by 32% over an 8-year period.
2. Conversion from Pre-diabetes to Type 2 diabetes: Another study of men and women with prediabetes (fasting glucose between 100-125 mg/dL) found resistance training (1 hour thrice weekly) to reduce conversion to Type 2 diabetes by 65%!
3. High Cholesterol: A Study of more than 7300 men found that ~1 hour of resistance training per week was associated with a 32% lower risk of high cholesterol (equal to or greater than 240 mg/dL) over ~20 years of followup.
4. Quitting Smoking: A study funded by the National Cancer Institute found that men and women who engaged in two 1-hour sessions of resistance training over a 12-week smoking cessation program were 2x as likely to successfully quit than their non- weight lifting counterparts.

Dr. Michael Miller is Director, Center for Preventive Cardiology at the University of Maryland Medical Center in Baltimore.

**from “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease”

Another Reason to Eat an Apple a Day…

 

The original proverb, “Eat an apple on going to bed and you’ll keep the doctor from earning his bread,” is well recognized in its simplified form (“an apple a day…”) and may now also “keep diabetes away” based on a study released earlier this week.   The new Australian study surveyed dietary habits in more than 7,500 men and women and found that consumption of at least 2 servings of fresh fruits daily was associated with ~35% decrease in developing Type 2 diabetes over the 5-year follow-up period.

Fruits that contributed to this benefit were apples, bananas, oranges and other citrus fruits whereas drinking fruit juice had no effect.   Among the individual fruits tested, only apples were independently associated with lower blood glucose levels and improved insulin sensitivity.

In addition to being a rich source of fiber that slows the absorption of glucose (thereby keeping the pancreas from overworking/overproducing insulin that over time may lead to insulin resistance), apples also contain the flavonoid, quercetin, that suppresses inflammation, a chronic process that promotes insulin resistance.

Because there is a tight intersection between metabolic syndrome, Type 2 diabetes and heart disease, cardiologists are becoming more involved in coordinating care with our diabetes and endocrine specialists.  Ironically, two of the newer classes of medications used to treat diabetes, the SGLT2 inhibitors and GLP1 agonists are being embraced by heart specialists because of proven benefit in reducing cardiovascular risk.

Below are some useful tools to reduce the risk of diabetes and/or lower heart related complications associated with Type 2 diabetes.

1. A new study suggests that eating  an apple a day may also keep diabetes away!
2. If you are overweight and prediabetic (fasting blood glucose 100-125 mg/dL), losing 5-7% of body weight is associated with ~50% reduction in conversion to diabetes; losing 10% of body weight correlated with an 85% decreased risk.
3. The flavonoid quercetin has potent anti-inflammatory properties to combat insulin resistance. Foods with the highest quercetin content include onions, apples, blueberries, broccoli and kale.
4. Large waist size (at least 35 inches in women/40 inches in men) is associated with a greater than 20-fold increased risk of diabetes compared to smaller waist size (less than 31 inches in women/37 inches in men).
5. Treatment with the highly purified EPA compound, Icosapent Ethyl reduced the risk of a heart attack, stroke or death from cardiovascular disease in Type 2 diabetics with elevated triglycerides.
6. Treatment with the diabetic medication known as SGLT2 inhibitors (dapagliflozin, empagliflozin) reduces the combined risk of cardiovascular death or hospitalization from heart failure (with low ejection fraction) in the presence or absence of diabetes.
7. Treatment with the diabetic medication known as GLP1 agonists (liraglutide, semiglutide, dulaglutide) reduces the risk of heart attack, stroke and heart-related deaths in diabetic patients with a history of heart disease, or in the case of dulaglutide, with or without heart disease.
8. The GLP1 agonist, semiglutide used to treat diabetes was just approved by the FDA as a weight management drug to treat overweight/obese adults with diabetes, hypertension or high cholesterol in addition to lifestyle (diet and physical activity) measures.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland and author of  “Heal Your Heart….”: published by Penguin Random House.