February 1, 2013
NIH Podcast Episode #0180
Balintfy: Welcome to episode 180 of the new NIH Research Radio. The new NIH Research Radio is your source for weekly 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 our news summary at the end of the program includes items on
- a new CT scanner that uses less radiation to get better images
- results showing people with diabetes are controlling their disease better, and
- insights into alcohol use among teenagers.
But first, our feature story...
The Heart Truth® and sudden cardiac death
Balintfy: The Heart Truth® and sudden cardiac death. I’m talking today with Dr. Patrice Nickens, a physician and medical officer at the NIH’s National Heart Lung and Blood Institute. First Dr. Nickens, today is a special day can you explain?
Nickens: So the Heart Lung and Blood Institute has a national campaign, Heart Truth, that has to – that uses the month of February to underscore the importance of heart disease in women. So on Friday, February 1, is National Wear Red Day and on that day we encourage women and men as well to wear red and to demonstrate their understanding that heart disease is the number one killer of women.
Balintfy: I think when most people think of heart disease, they think of a heart attack. Today, I also wanted to talk about a condition called sudden cardiac death because of some study results have been published recently. Is sudden cardiac death the same as a heart attack?
Nickens: No. Sudden cardiac death is not a heart attack. It’s sometimes called sudden cardiac arrest and it’s a condition in which the heart suddenly and unexpectedly stops beating. If this happens, the blood stops flowing to the brain and other vital organs so sudden cardiac death if it’s not treated will result in death.
Balintfy: What are the risk factors for sudden cardiac death?
Nickens: So that’s directly what this study asks in women. So unlike risk factors for coronary heart disease or a heart attack if you will, risks for sudden death are less well understood. Nevertheless, the risk for a heart attack or traditional risk factors such as a previous heart attack or obesity, hypertension, diabetes, smoking are associated with an increased risk for sudden death and likely play a role in sudden cardiac death.
Balintfy: Now this study, which was published in the Journal of the American College of Cardiology found some other risk factors for sudden cardiac death. Can you explain those?
Nickens: So this study also showed – the purpose of this study was to show the incidence or how often women actually have this event, sudden cardiac death, and the incidence or cases per 10,000 persons per year of 2.4 was less than had been identified in previous studies. But additionally to finding, to documenting that traditional risk factors are important, this study in postmenopausal women also showed that older age, African-American race, higher pulse, higher hip-waist ratio, elevated white blood cell count, and increase in heart failure were associated with sudden cardiac death.
Balintfy: Do they know why?
Nickens: So we’re better at documenting this kind of study tells you what and I think further research will help us understand better why. Nevertheless, these findings are extremely important.
Balintfy: Let’s go back to those risk factors again, what are they and is there anything that can be done to control them?
Nickens: Yes. So as I mentioned, traditional heart risk factors, high blood pressure, smoking, being overweight, physical inactivity. These are risks that are associated with myocardial infarction and sudden cardiac death. I should also mention high blood pressure, diabetes, and high blood cholesterol. And these factors are important but are treatable and preventable. So healthy lifestyles, smoking cessation, regular physical activity, low fat, low salt diet, maintaining a healthy weight are very essential to reducing these risks.
In addition, know your numbers. Having high blood pressure, high blood glucose or sugar or high blood cholesterol are treatable conditions. You should talk about these with your physician and if they’re elevated in spite of healthy lifestyles, there are effective treatments to keep those under control. Maintaining your risk factors, controlling your risk factors can substantially reduce your risk for sudden cardiac death.
Now some of the other risk factors identified in this trial are of great interest: African-American women, being older, elevated hip-waist ratio, higher pulse. So let’s talk about race secondarily. These other risk factors the hip-waist ratio, higher pulse rate, elevated white blood count may suggest that inflammation that the body is reacting to some irritant if you will. It may be a casual factor. So this would be a new area for us to explore to see whether are there effective ways of reducing this inflammation.
Regarding African-Americans, so even in the context of a study like the Women’s Health Initiative Study, there is evidence that African-Americans tend to be under recognized and undertreated for traditional risk factors and that they have multiple risk factors, hypertension, diabetes, overweight as examples. If these are underreported and in this study, these were self-reporting, that may account for why race itself picked up patients that would – or conditions that might have been picked up if their recognition and treatment for these conditions were better. So it certainly suggests that African-Americans should try to know their family history and be aware and in control of their risk factors.
Balintfy: One of the things I wanted to touch on is that this particular study is not an NIH funded study, but it was based on NIH funded research, the Women’s Health Initiative you mentioned.
Balintfy: Can you explain how the Women’s Health Initiative helped get these recent findings?
Nickens: Yeah. So thank you for the question. It allows two issues to be underscored. One, it’s very important for people and certainly women to participate in clinical research and clinical studies. So the WHI or the Women’s Health Initiative was a large study funded by the NIH to understand three important questions concerning women’s health. That infrastructure for that large trial, which was very important in understanding hormone replacement therapy and the effects of vitamin D and/or a low fat diet in postmenopausal women, again that infrastructure made possible this very carefully prospectively done study. Using 40 clinical centers, these investigators were able to collect information on over 160,000 patients and follow them for ten years. So this was greatly facilitated by an existing infrastructure and through that, we have very important information on the incidence and prevalence of this disease, which affects women and importantly results in premature death.
Balintfy: Anything else you’d like to emphasize regarding this study, the WHI or heart health in general Dr. Nickens?
Nickens: So I think it’s always important to acknowledge the importance of research in identifying better ways to prevent, identify, or treat conditions. This is an example of a carefully done study that underscores the importance of healthy lifestyles, understanding not only our risks that we can’t change whether our family have a family history of disease but also the importance of diet, behavior, healthy lifestyles and how that can impact favorably on health outcomes and especially cardiovascular disease.
Balintfy: This echoes what we talked about at the beginning about the Heart Truth, doesn’t it.
About This Podcast
Spokesperson: Dr. Patrice Nickens
Topic: heart, heart health, heart truth, wear red, wear red day, cardiac, cardiac death, sudden cardiac death, cardiac arrest, women, heart disease, heart attack, CT, scanner, radiation, diabetes, diabetes control, alcohol, alcohol use, teens, teenagers