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

Does Statin Use Reduce Psychiatric Hospitalizations and Emergency Room Visits?

 

A new paper out this week led by my colleague, Dr. Teo Postolache raises the intriguing question as to whether patients prescribed statins have lower rates of psychiatric based hospital admissions as compared to non-statin users.  The rationale for this study was based on prior work suggesting that statins not only slow cognitive decline and reduce the risk dementia but also decrease hospitalization rates as much as 25% in men and women with a history of major depression.  Additional support for statin use includes inherent beneficial effects on oxidative stress, neuroinflammation and immune function, all of which that are commonly aggravated in psychiatric illnesses.

In the current study of ~680,000 Veterans with a history of schizophrenia or bipolar disorder studied, statin use was associated with a 15-30% lower likelihood of psychiatrically based hospitalization and emergency room visits.  While this study cannot prove cause-effect (that is, statin use being directly implicated in lowering hospitalization rates) it does support further investigation testing various statins -including those that dissolve in fat (lipophilic) or do not (hydrophilic) – and monitoring hospitalization rates between randomization of assigned statin and the prespecified follow-up period.

Listed below are additional considerations related to psychiatric illness and cardiovascular disease.

1. Adults with major depressive illness experience a 15-25% increased risk of heart attacks, cardiovascular death and all-cause mortality compared to those without depression.
2. Optimism is associated with a 35% lower risk of future heart attack, stroke or death from heart disease.
3. Serious mental illness (schizophrenia, bipolar disorder, major depression) is associated with a 78% increased risk of future cardiovascular events (heart attack/stroke) than those without mental illness.
4. Serious mental illness is also associated with a 2-fold increased risk of cardiovascular death. A comprehensive risk reduction program (IDEAL trial) is underway to assess whether innovative interventions can reduce risk.
5. A Japanese study found that rarely or never laughing was associated with a 20% higher risk of heart disease and 60% higher risk of stroke compared to those who laughed daily.
6. A new study finds robust evidence that statins are unlikely to lead to depressive symptoms in the general population.
7. A recent analysis of more than 500,000 men and women found no association between statin use and ALS (amyotrophic lateral sclerosis) or Lou Gehrig’s disease.
8. Statins have no significant adverse effect on sleep duration and efficiency.  In fact, statins significantly reduce wake time and number of awakenings.
9. Statin treatment is not related to cataract development or progression.
10. There is no good evidence to suggest that statins increase the risk of tendonitis or tendon rupture.
11. There is no need to avoid statin therapy in patients with stable chronic liver disease and normal or modestly elevated transaminases (up to 3 times the ULN).
12. At the present time, however, there is no conclusive evidence for a causal relationship between statin treatment and peripheral neuropathy.

 

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Let’s Keep this Party Going: New Insights into Laughter’s Cardiovascular Benefits

In case you missed it, World Laughter Day was celebrated this past Sunday.  Yet, our understanding of laughter’s influence on the cardiovascular system continues to grow since the inaugural World Laughter Day in 1998.  In fact, my interest in this area began in 1997, when Dr. Adam Clark, a recent graduate of Albert Einstein School of Medicine and one of our Medical Residents, approached me seeking a research project in cardiovascular prevention.  At that time, our laboratory was studying families with extreme levels of HDL (the good cholesterol); one of our interests was evaluating high HDL in protecting against heart disease.

We reasoned that if HDL served to counteract some of the adverse effects of LDL (the bad cholesterol) on the heart, might a similar story be played out when evaluating emotional health and heart disease.  While studies had previously established emotional stress as a contributor to heart disease, information was simply lacking as to whether positive emotions may offset this effect.

Our initial study of a 40% lower risk of heart disease among those who were able to find certain daily stressful situations humorous led to other studies that ultimately supported a direct link between laughter and vascular health; click here for the review paper co-authored with Dr. William Fry, the late Stanford University professor and pioneer in the field.

As additional research has been conducted in recent years, we’ve gained new insights into the role of laughter and cardiovascular health.  Listed below are some of the reasons why we should keep this party going (daily rather than yearly):

1. A Japanese study of nearly 21,000 men and women (aged 65 years and older) found that daily laughter was associated with a 60% lower risk of a stroke compared to those who never or rarely laughed.
2. A 15-year study in Norwegians found a greater than 70% higher survival rate from cardiovascular disease in women with a high sense of humor.
3. Watching a funny video reduces stress cortisol levels (that in turn, increases inflammation/cardiovascular risk), improves short-term memory and learning ability.
4. Laughter reduces/offsets some of the symptoms associated with a stressful event that promote inflammation and cardiovascular disease.
5. Maintaining a humorous perspective about personal experiences is associated with resilience and better psychological -and by extension, cardiovascular, health.
6. In the elderly, laughter therapy has been shown to reduce chronic pain (that in turn, raises blood pressure/cardiovascular risk) and improve overall life satisfaction.
7. Laughter may slow/delay the onset and progression of vascular complications associated with diabetes.

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: The Positive Emotions Prescription to Prevent and Reverse Heart Disease.”: published by Penguin Random House.