October 5, 2012
NIH Podcast Episode #0169
Balintfy: Welcome to episode 169 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode, a recent study showing aspirin alone is enough to prevent a type of stroke, and…
All institutes do strategic planning but in this case the eye institute is the first to use this particular novel opportunity to solicit ideas.
Also, it’s the anniversary for The Heart Truth®. But first, this news update. Here’s Craig Fritz.
Fritz: One subtype of breast cancer shares many genetic features with high-grade serous ovarian cancer, a cancer that is very difficult to treat, according to researchers supported by NIH. The findings suggest that the two cancers are of similar molecular origin. Analyses of genomic data have confirmed that there are four primary subtypes of breast cancer, each with its own biology and survival outlooks. These findings are based on a large number of breast cancer specimens that capture a complete view of the genomic alterations. Scientists uncovered marked genomic similarities between one breast cancer subtype and serous ovarian cancer. The types and frequencies of genomic mutations were largely the same in both cancer types. Analysis shows that the breast cancer subtype and serous ovarian cancer might both be susceptible to agents that stop blood vessel growth, cutting off the blood supply to the tumor, as well as to compounds that target DNA repair, which include chemotherapy drugs such as cisplatin.
Long stretches of DNA once considered inert dark matter appear to be uniquely active in a part of the brain known to control the body’s 24-hour cycle, according to researchers at NIH. Working with material from rat brains, the researchers found some expanses of DNA contained the information that generates biologically active molecules. The levels of these molecules rose and fell, in synchrony with 24-hour cycles of light and darkness. Activity of some of the molecules peaked at night and diminished during the day, while the remainder peaked during the day and diminished during the night. The material came from the brain structure known as the pineal gland. Located in the center of the human brain, the pineal gland helps regulate the body’s responses to day and night cycles. At night, the pineal gland increases production of melatonin, a hormone that synchronizes the body’s rhythms with the cycle of light and dark. Scientists say more research is needed as they are only beginning to understand how the pineal gland helps maintain the body's 24 hour rhythms.
For this NIH news update – I’m Craig Fritz.
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up how you can enter a contest to help guide eye research, 10 years of The Hearth Truth, and an aspirin combo shows no advantage, that’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Aspirin-clopidogrel no better than aspirin alone for patients with lacunar stroke
Balintfy: A recent study has shown that aspirin combined with the antiplatelet drug clopidogrel is no better than aspirin alone for stroke prevention in people with a history of lacunar strokes. To better understand the importance of this study, I’m talking with Dr. Walter Koroshetz at the NIH’s National Institute of Neurological Disorders and Stroke. First, Dr. Koroshetz, what exactly is a lacunar stroke?
Koroshetz: Well there’s many different types of stroke and lacunar strokes are actually the small strokes that occur usually in the very deep parts of the brain and they’re due to the occlusion, a blockage of a very tiny vessel that you would only see under the microscope.
Balintfy: What is the latest research showing about the treatment for this kind of stroke?
Koroshetz: Well lacunar strokes – these what we call white matter, small vessel disease strokes – are extremely common and they are related primarily to hypertension. So in some instances, it’s thought that maybe 40% of people will have a silent small stroke at some time in their life and most of these are these small vessel strokes. There’s also a type of disease in the same area, which is a little bit more mysterious. Some people believe that it’s the confluence of many small strokes, others believe it’s a more mild diffuse ischemia that leads to cognitive decline in the elderly as well. But everything seems to be related to blood pressure that these blood vessels, which are very unique, they dive into the deep parts of the brain and they’re affected by hypertension much more than any other blood vessels in the body.
Balintfy: Some study results have been recently published in the New England Journal of Medicine about these lacunar strokes. Dr. Koroshetz, can you explain the scope of the study?
Koroshetz: That’s right. So we ran a fairly large study. Dr. Oscar Benaventi who’s at the University of British Columbia was the principal investigator and they enrolled over 3000 patients with small vessel stroke and they had two interventions that they were testing. One was aggressive blood pressure lowering, as I mentioned blood pressure is the key risk factor for these strokes, and the other one was comparing a combination of two antiplatelet agents to aspirin alone. The study that came in in the New England Journal basically showed that the combination of the two antiplatelet agents was no better than aspirin alone. We were hoping that we’d have a more potent therapy, but it turns out that the simple aspirin is really the best thing. So that was one of the parts of the study.
The other part that’s in the paper, in the New England Journal is that in the patients enrolled in the study, because of the attention that was brought on their blood pressure control and their other stroke risk factors such as elevated blood lipids, their recurrent stroke rates were much lower than expected. So based on natural history, the investigators estimated that the three-year stroke rate would be about 20% to 25% and in this trial it turned out to be less than 10%. So the conclusion is that something has changed. That people probably are taking better care of themselves, getting their hypertension under better control, their lipids under better control and actually the standard care that they’re getting is reducing stroke risk dramatically.
Balintfy: So it sounds like there’s good news in that there is more awareness of the connection between blood pressure and stroke risk.
Koroshetz: That’s right and I must say also that the trial, which is still ongoing because it’s still comparing standard blood pressure control to a really aggressive blood pressure control below the usual limits that have been set by agencies like the American Heart Association and so forth. So that the study is ongoing, testing whether the real aggressive blood pressure lowering is superior to standard blood pressure control and we await the final results of that study.
Balintfy: Back to the clopidogrel part of the trial, aspirin itself is an antiplatelet, isn’t it?
Koroshetz: Yes. So the trial was actually half the people were treated with clopidogrel plus aspirin and the other half with aspirin alone and you’re right they’re both antiplatelet agents.
In heart disease, particularly in patients who have had stents or heart attacks, the combination has been shown to be superior to aspirin alone and that was the kind of the basis for the trial going forward. But in this and some other stroke trials, it has also been demonstrated the combination is not more helpful than a single antiplatelet agent.
Balintfy: Besides stroke, Dr. Koroshetz, how do you see controlling risk factors, like high blood pressure, affecting a person’s health risks in particular regarding dementia?
Koroshetz: Well that’s a great question and that’s one of intense studies. A much more difficult thing to get at than the recurrent stroke is what is someone’s risk of developing dementia over time or cognitive impairment over time. And as I mentioned small vessel disease seems to be one of the major associations with developing dementia later in life. Multiple institutes and the NIH are now actually involved in a large, very large study called Sprint and that study is looking at whether very aggressive control of blood pressure below the currently recommended limits will prevent heart disease, stroke, and cognitive decline over time. So that’s a really big study. It’s ongoing now, but it’s aimed at trying to determine whether really tight blood pressure control will actually decrease your risk of developing dementia as you get very old.
Balintfy: Thanks to Dr. Walter Koroshetz at the National Institute of Neurological Disorders and Stroke. For more information on this study, and to learn more about strokes and stroke risk, visit the website stroke.nih.gov.
NEI Challenge to Identify Audacious Goals in Vision Research and Blindness Rehabilitation
Balintfy: Ever wonder how the institutes here at NIH get ideas for what to study? Of course there is lots of careful and strategic planning and consideration. And now, for the first time an NIH Institute is using a challenge and a prize competition to solicit ideas that will become part of the strategic planning process.
The NIH’s National Eye Institute has created a new venture to expand and enhance its strategic planning effort. To learn more about what that means, I’m talking with Dr. Paul Sieving, the director of the NEI. So Dr. Sieving, what is this new program?
Sieving: The National Eye Institute is charged in this country with funding vision research that leads to preserving and prolonging vision for people and as part of that, we need to have the best research that we can do. To accomplish this, we are seeking right now to gather up information and ideas that can be used to help direct programs for vision research over the next decade or so.
Balintfy: The program itself is called the NEI Challenge to Identify Audacious Goals in Vision Research and Blindness Rehabilitation. What is meant by audacious goals?
Sieving: An audacious goal is something that will fundamentally change how we do vision research or provide vision care for people who have vision problems. If you think about research, research investigates the unknown and to set out on a path that you don’t know exactly where it’s going to take you means that on many occasions, you encounter gaps in knowledge or bottlenecks that are quite unexpected. What we would like to is to anticipate some of those gaps or bottlenecks and to set out ideas that are big enough to warrant the effort that we’re putting into this. It would be those big ideas that would be audacious goals. We’re looking for big, bold innovative ideas that we can use to address the NEI mission.
Balintfy: How are you going to collect these ideas?
Sieving: I think we have a rather novel way to do this. The White House America Competes Initiative of the current administration has enabled us to use prizes and challenges to set agendas and collect these ideas. Challenges are a way to generate novel and exciting ideas, novel and exciting responses and we’re going to use that challenge competition to generate the audacious goals.
Balintfy: What can people win with this challenge Dr. Sieving?
Sieving: What we’re going to do is to set aside about $60,000 and this will go to 20 individuals who have submitted entries, one-page summaries of an idea, 20 individuals and each of them will receive a $3,000 challenge award. Now that money is not meant to do research. It’s too small an amount to do research, but in fact it will help to get the interest of young people, young investigators, young scientists, young physicians and clinicians. It will help to get their interest in applying
Balintfy: What are you going to do with the ideas once you have them compiled?
Sieving: Well some of the ideas, some of those ideas, we will in fact have money from the eye institute to tackle ourselves. But we expect that there will be so many ideas, so many big important ideas that there will be plenty left for other agencies and other institutions to work on.
Balintfy: Can really anyone submit an idea?
Sieving: Oh, that’s an interesting question. Yes. If you have an idea, if you think your idea is a big, bold, important idea for vision research, in fact we want to hear from you. It’s easy for you to get information to do this. Again just go to the web, go to the National Eye Institute homepage. The National Eye Institute is one of the institutes of the National Institutes of Health here in Washington DC. Our particular area of work as our title says is eyes and vision. If you go to the National Eye Institute website, you can get information and submit an audacious challenge and we would love to hear from you.
Balintfy: Thanks to Dr. Paul Sieving, director of the NIH’s National Eye Institute. For more information on the NEI Challenge to Identify Audacious Goals in Vision Research and Blindness Rehabilitation, visit www.nei.nih.gov.
And coming up next on NIH Research Radio, what women need to know about their hearts.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
The Heart Truth® anniversary
Balintfy: Over the past ten years, nearly 200 celebrities have supported The Heart Truth® by walking the runway at Red Dress Collection fashion shows. Recently one celebrity, Rosie O’Donnel suffered a heart attack. She blogged about experiencing heart attack symptoms but failing to call 9-1-1. With that recent news and the past month marking the 10th anniversary for The Heart Truth, I’m talking with Dr. Nakela Cook at the NIH’s National Heart Lung and Blood Institute. Dr. Cook, what do women in general need to know about the symptoms of heart attack, and what should they do if they have any of these symptoms?
Cook: That’s an important question that women should actually ask their doctors is what are the symptoms for a heart attack and how do I know if I’m having such symptoms and what should I do. It’s important that we get the word out that if you’re having symptoms of heart disease that it’s important to take your risk seriously and take your symptoms seriously and call 911 if you’re having symptoms.
The most common symptom of heart disease is having chest pain or chest tightness or a discomfort in the chest and a lot of times this is referred to as angina and people may have heard that term before. But it’s also important to recognize there can be other symptoms of heart disease such as shortness of breath and women maybe more likely to have symptoms such as nausea or chest or back pain or jaw pain or even just an overwhelming sense of fatigue that may actually be a symptom for them for heart disease. So it’s important to understand that all of these things could be symptoms, but particularly the constellation of multiple of these together should really kind of peak someone’s concern about heart disease and really take action to force them to call 911 in order to get the treatment that they need.
What we know is that every minute that someone’s having heart attack symptoms are really important because if we can save minutes, we can save heart muscle. So the time it takes for you to call 911, get into an emergency ambulance where you can have treatment and get to the emergency room where you may be able to be seen sooner because you arrive by ambulance, all matters in terms of the degree in which we can protect the heart function in the setting of a heart attack.
Balintfy: Are there more details about what women need to know about their hearts?
Cook: I think it’s important that women actually understand what it is that coronary heart disease is and when we talk about heart disease, we’re talking about a disease that affects the arteries that supply the blood flow to the heart. Those arteries actually are important in order to get the blood and the oxygen and rich nutrients that the heart muscle needs to the muscle itself. When a woman develops heart disease or a man develops heart disease, it actually is related to plaque buildup in those arteries and that’s a process that’s called atherosclerosis. The plaque itself can be composed of fat or cholesterol or calcium but what’s important is that it actually can build up in the arteries and narrow then arteries over time and that can diminish the blood flow to the heart muscle. Occasionally, one of those plaques can actually rupture or break and when that occurs, a blood clot can actually form on the surface of the plaque and that itself can block the flow of blood to the heart muscle and cause a heart attack.
What’s important to know about the process of atherosclerosis and coronary heart disease is that it’s process that occurs over time and actually can start at very young ages even in teenager or in the 20s types of years. So it’s highly important that we recognize that time and taking action early in life is important in order to prevent heart disease development.
Balintfy: Are there particular women who are more susceptible to risk, whether they be in minority groups or other specific risk factors that you mention?
Cook: So when we think about the risk factors for heart disease, we know that there are different distributions of those risk factors across different segments of our population in the United States. Particularly, when we talk about high blood pressure or hypertension, we know that African-Americans in the United States have much higher rates of hypertension and have more complications of hypertension as compared to others in the United States. So yes, there can be greater risk related to certain subpopulations.
We are additionally starting to understand further the trends related to being overweight or obese and although we know that our country as a whole is struggling with this problem, there are certain segments of the population that seem to have a higher burden of that risk factor as compared to others. Those include some of the minority populations as well as women. So we’re recognizing that there are different trends related to some of the heart disease risk factors.
But in addition to understanding the risk factors, we also know that when someone develops heart disease there are differences in the way that care is delivered in the United States and that some women as well as some minority groups may not get the same level of care related to heart disease as others would. So it’s important that we all understand our risks, that we all understand how to be advocates for ourselves and how to navigate healthcare systems to make sure that we can get the optimal care when we’re actually seen with the problem.
Balintfy: Over the past ten years of The Heart Truth, what advances have you seen?
Cook: We’re very proud of the progress that we’ve made with the Heart Truth Campaign in terms of raising awareness for women that heart disease is the number one killer of women. What we know is that in 2009 about 54% of women actually reported that they are aware that heart disease is the number one killer of women and that’s up from somewhere in the 30% range back in 2003. So we know we’ve made progress in terms of increasing awareness for women. What we also have recognized is that awareness has led to action and specifically we know that women that are aware of their risk for heart disease are more likely to actually take action to reduce their risk and as well as report that they do things such as lose weight more frequently than women who are less aware. So we do think the Heart Truth Campaign has helped to make a difference in turning the tide on heart disease in women. We’ve seen steady declines in the rates of death from heart disease over the last decade and we continue to hope to educate women in the future about their risk for heart disease and continue that trend.
Balintfy: Where can people learn more about The Heart Truth campaign and find additional resources on heart disease and heart health?
Cook: Yes. Actually on our website at www.nhlbi.nih.gov, we have lots of information about The Heart Truth campaign, about heart disease topics in general and your risk factors for heart disease, what you can do to reduce your risk factors and lots of explanations about what heart disease actually is and a better explanation for families as well as individuals that are struggling with issues around heart disease in order to find resources and help.
Balintfy: Thanks to Dr. Nakela Cook at the National Heart Lung and Blood Institute. Again, to find out more about The Heart Truth, visit www.nhlbi.nih.gov.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, October 19 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
Announcer: NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.