Heart Matters

Host: Matthew Sorrentino, MD Guest: Jennifer N. Avari Silva, MD Understanding how and why arteries age has baffled doctors for years, but a recent study may have the answers we’ve been looking for. Dr. Vienna Brunt, a post-doctorate fellow in the Department of Integrated Physiology of Aging Lab at the University of Colorado in Boulder, walks us through her study published in the journal Hypertension exploring how a compound produced in the gut called “trimethylamine N-oxide” can harm the endothelial lining of our arteries and increase the risk of heart disease with aging.

Host: Janet Wright, MD Guest: Peter Nagele, MD Time is of the essence after cardiac arrest; action must be taken within five minutes. Survival rates for patients who arrest outside the hospital are disappointing. How do we help patients who arrest in public or (statistically more likely) in the home, where there is no access to medical equipment and medication? Host Dr. Janet Wright talks with Dr. Peter Nagele, chief of the section of trauma anesthesiology in the department of anesthesiology at Washington University in St. Louis, about revised CPR methods without mouth-to-mouth, and what recent research tells us about the potential for these methods to improve outcomes. And what are plans for training the general public?

Host: Janet Wright, MD Guest: Gary Mintz, MD Acute coronary syndromes in patients who have undergone percutaneous coronary intervention is the subject of the conversation between guest Dr. Gary Mintz, chief medical officer of the Cardiovascular Research Foundation, an independent, academically focused nonprofit organization dedicated to improving the survival and quality of life for people with cardiovascular disease through research and education, and host Dr. Janet Wright. How often do patients who have an acute coronary syndrome have a recurrent event? Their discussion includes protocols, paramaters and outcomes of the PROSPECT trial. The use of ultrasound as well as angiography are also discussed in context to help identify unstable coronary plaques in order to prevent adverse coronary events.

Host: Janet Wright, MD Guest: Jeffrey Anderson, MD Vitamin D insufficiency and deficiency are common because of a number of factors, not the least of which is a lack of exposure to sunlight. What role does vitamin D play in ensuring cardiovascular health, and should clinicians routinely test patients for such deficiency? Dr. Jeffrey Anderson, vice-chair of research in the department of medicine and associate chief of cardiology and director of cardiovascular research at Intermountain Medical Center, discusses current evidence about vitamin D and the heart, but says more prospective studies are needed to determine whether vitamin D plays an associated or causal role related to cardiovascular health. Is routine vitamin D supplementation useful for protecting cardiovascular health, or should clinicians wait for more evidence? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Dan Roden, MD Long QT syndrome can be a silent threat. Although not all patients with congenital long QT syndrome develop symptoms, there is potential for dangerous arrhythmia that can cause sudden cardiac death. Can and should genetic testing guide clinicians in diagnosing and treating this condition? Dr. Dan Roden, professor of medicine and pharmacology and assistant vice-chancellor for personalized medicine at Vanderbilt University School of Medicine, says the concept of personalized medicine goes beyond genetics; it is also about meeting a patient's goals and individual needs. How can genetic testing help physicians decide which medical therapy might be most appropriate for each patient? Dr. Janet Wright hosts.

Host: Janet Wright, MD Guest: Joseph Cleveland, MD Cardiac surgery can improve quality of life, but it also poses risks for patients over the age of 65. Can a screening test as simple as walking speed predict the outcomes of cardiac surgery for our older patients? Dr. Janet Wright hosts this discussion.

Host: Janet Wright, MD Guest: Thad Waites, MD Obesity is a nationwide epidemic, but this is nowhere more apparent than in Mississippi, which was ranked as the state with the highest obesity rate in 2009 by the Centers for Disease Control. How does the obesity issue in Mississippi mirror that of the rest of the nation, and what efforts are underway to address this public health problem? Dr. Thad Waites, director of the cardiac catheterization lab at Forrest General Hospital in Hattiesburg, Mississippi, and interventional cardiologist at the Hattiesburg Clinic, talks about how each player in the healthcare community can target the obesity epidemic. What initiatives and projects are demonstrating success in lowering obesity rates? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Caldwell Esselstyn, Jr., MD Some evidence suggests it is possible to prevent and reverse heart disease by adhering to a plant-based diet, but lifestyle changes are often the most challenging for physicians to prescribe and for patients to adopt. What strategies can physicians use to encourage a plant-based diet for patients who have or are at risk for having heart disease? Dr. Caldwell Esselstyn, director of the cardiovascular prevention and reversal program at the Cleveland Clinic Wellness Institute in Lyndhurst, Ohio and author of the book, Prevent and Reverse Heart Disease, surveys the worst culprits of the Western diet responsible for causing heart disease, and describes the crucial role that nitric oxide released from the endothelium plays in protecting blood vessels. Dr. Esselstyn shares his tips and strategies for promoting and, most importantly, following a plant-based diet, in the midst of a culture riddled with nutritionally-questionable foods. Join us for

Host: Janet Wright, MD Guest: David Kaplan, PhD Although most bypass grafts are sourced from other parts of a patient's body, bioengineers are examining new materials that might be used for bypass grafts to reduce the risk of second-site complications. Silk has been a standard material in sutures for decades, and is now showing promise as a biomaterial in bypass grafts. Might silkworms help repair clogged arteries? Dr. David Kaplan, endowed chair, the Stern Family Professor of Engineering, and professor & chair of the department of biomedical engineering at Tufts University, discusses the advantages of silk protein as a biomaterial and related applications to cardiology. When might this new technology be applied from the bench to the bedside? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Robert Harrington, MD Recent studies have raised doubts about the efficacy of some common treatments for cardiovascular disease, including: the use of PFO closures (based on the CLOSURE trial); some methods of cardiac resynchronization therapy (or CRT, based on the SMART-AV trial); telemonitoring for patients with congestive heart failure (based on the Tele-HF trial); and doubling the dose of clopidogrel in patients who had a poor response to the drug after percutaneous coronary intervention (based on the GRAVITAS trial). Dr. Robert Harrington, director of the Duke Clinical Research Institute at Duke University Medical Center in Durham, North Carolina, reviews the evidence in each of these trials, and gauges the clinical impact of their findings. Dr. Janet Wright hosts. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Rashi Fein, PhD What can we learn from the past century of healthcare policy that can better inform how we develop such policies today? How has the landscape of medicine and economics surrounding health policy changed, and how have these changes influenced health policy? Join host Dr. Jack Lewin as he welcomes guest Dr. Rashi Fein, professor of the economics of medicine emeritus in the department of global health and social medicine at Harvard Medical School in Boston, and author of the book, Learning Lessons: Medicine, Economics and Public Policy. Although the Affordable Care Act is thousands of pages in length, Dr. Fein suggests that policy makers "keep it simple," even with the most complex health policy issues, in order to have an efficient system that is easy to implement. How can such complicated health policy issues be clearly explained? Produced in Cooperation with

Host: Jack Lewin, MD Guest: Harry Greenspun, MD Will healthcare reform do enough to alleviate the current problems in our system, or is the entire delivery model in need of a substantial re-design? Dr. Harry Greenspun, chief medical officer of Dell Services and co-author of the book Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery, says that while health care reform has changed payment models, reform has not done enough to change the delivery system. What elements of our current system are most in need of re-engineering, and how have some organizations successfully transformed their delivery models? Dr. Jack Lewin hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Michael Steinman, MD One of the characteristics of our older patients with heart failure is that they often have other conditions and therefore take multiple medications. How can we reduce the risk of adverse drug events among patients with heart failure and other comorbidities? Dr. Michael Steinman, associate professor of medicine at the University of California-San Francisco and the San Francisco VA Medical Center discusses the challenge of managing medications for older patients with heart failure and offers his ideas on how to reduce drug interactions and encourage adherence. How can we better coordinate care between physicians to optimize care for patients with heart failure? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Richard Lange, MD, MBA First generation drug-eluting stents offer many advantages over bare metal stents, the most significant of which is their efficacy in reducing the rate of restenosis. Now second generation drug-eluting stents are proving to be even more beneficial. How are these second generation drug-eluting stents further reducing the risk of late stent thrombosis, myocardial infarction and repeat revascularization? Dr. Richard Lange, professor and executive vice chairman of medicine at the University of Texas Health Science Center, in San Antonio, Texas, discusses the structural and molecular differences between first and second generation drug-eluting stents. With all the advantages of the newer stents, however, there is also an increased cost. Are second generation drug-eluting stents enough of an improvement upon their first generation counterparts to warrant the higher cost? Dr. Janet Wright hosts.

Host: Janet Wright, MD Guest: Caldwell Esselstyn, Jr., MD Beta blockers, anticoagulants, stenting procedures and bypass surgeries: these are all crucial cornerstones of cardiology that have saved and improved the quality of lives for our patients, yet the underlying causes of coronary artery disease aren't addressed by interventions and medications. Can we prevent and maybe even reverse heart disease by prescribing a plant-based diet? Dr. Caldwell Esselstyn, director of the cardiovascular prevention and reversal program at the Cleveland Clinic Wellness Institute and author of the book, Prevent and Reverse Heart Disease, says heart disease is "an essentially benign, food-borne illness," that can be prevented by adhering to a diet based around plants. What evidence supports this idea? Join us for part 1 of our two-part interview with Dr. Esselstyn. Dr. Janet Wright hosts. For Part 2 of this interview, click here >> Produced in Cooperation with

Host: Janet Wright, MD Guest: James Scheulen, PA-C Guest: Jeffrey Trost, MD Door-to-balloon time for a patient with ST-segment elevation myocardial infarction (or STEMI) should be less than 90 minutes. Wireless electrocardiography (or EKG) programs around the country are helping to reduce door-to-balloon time by transmitting EKG data to hospitals via broadband internet, where a specialist at the hospital makes a diagnosis and prepares to treat the incoming patient. What are some of the challenges, and advantages, of such programs? Mr. Jim Scheulen, chief administrative officer for the Johns Hopkins Department of Emergency Medicine and president of Johns Hopkins Emergency Medical Services, and Dr. Jeffrey Trost, assistant professor in cardiology, director of the Cardiac Catheterization Laboratory and director of the Interventional Cardiology Program at Johns Hopkins Bayview Medical Center, helped create a Baltimore consortium of hospitals that donated wireless EKG technology to the city's par

Host: Janet Wright, MD Guest: Deepak Bhatt, MD One of the biggest risks of antiplatelet therapy is gastrointestinal bleeding. Because of this risk, patients on the antiplatelet clopidogrel are often prescribed proten pump inhibitors, or PPIs. However, there are also concerns about PPIs decreasing the efficacy of clopidogrel. What approach should physicians take for patients at moderate to high risk for upper GI bleeding? Host Dr. Janet Wright welcomes Dr. Deepak Bhatt, chief of cardiology at the VA Boston Healthcare System, director of the Integrated Interventional Cardiovascular Program at Brigham and Women's Hospital & VA Boston Healthcare System, and associate professor of medicine at Harvard Medical School, to discuss evidence about the potential interactions between PPIs and clopidogrel based on findings from the COGENT trial. Produced in Cooperation with

Host: Janet Wright, MD Guest: Ken Fujise, MD Targeted molecular therapy has been successful in cancer therapeutics. How might this approach be applied in cardiology to prevent the development of atherosclerosis? Dr. Ken Fujise, chief of cardiology at University of Texas Medical Branch, where he is also professor of medicine and biochemistry and molecular biology, talks about his preliminary research investigating the role of fortilin in the progression of atherosclerosis and subsequent coronary artery disease. What are the prospects for development of anti-fortilin medication to prevent or slow atherosclerosis? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Prediman Shah, MD It is apparent to most physicians that patients at high risk for having a cardiovascular event should be screened, but what about those patients who fall into the intermediate risk category (classified using the Framingham risk score)? Dr. Prediman Shah, director of the division of cardiology at Cedars-Sinai Heart Institute in Los Angeles, suggests that screening asymptomatic, intermediate-risk patients for subclinical atherosclerosis using non-invasive imaging might be beneficial. Dr. Shah also discusses the limitations of relying solely on the Framingham risk score, and recommends additional ways to classify a patient's risk for developing a cardiovascular event. What specific screening tests are best for detecting subclinical atherosclerosis? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Francois de Brantes, MS, MBA As we all strive to improve quality of care, two crucial questions remain at the heart of the issue: How do we define, and identify, quality in practices, hospitals and other health care settings? Then, how can new methods of identifying quality in practices help improve the standardization of processes and care that patients receive? Join host Dr. Jack Lewin and his guest, Francois de Brantes, executive director of the Health Care Incentives Improvement Institute in Newton, Connecticut, which manages the Bridges to Excellence and PROMETHEUS payment programs. Mr. de Brantes talks about the specific data that can help identify quality, and ways to utilize these data to improve and facilitate quality improvement. How does identifying quality in cardiovascular practices coincide with the increasing interest in value-based health care delivery? Produced in Cooperation with