Opening Session: Improving CV health status and brain health
Imagine the future, despite a global obstacle of pandemic size. That message was loud and clear during Wednesday’s International Stroke Conference (ISC) Opening Main Event.
Imagine the future, despite a global obstacle of pandemic size. That message was loud and clear during Wednesday’s International Stroke Conference (ISC) Opening Main Event. Through myriad examples, an impressive lineup of leaders in stroke health charted the path forward in research and patient care for cardiovascular (CV) and brain health.
American Heart Association (AHA) CEO Nancy Brown literally and figuratively set the tone with her welcome remarks, preceded by a spirited parade that only New Orleans can deliver. But it was her look at recent AHA and American Stroke Association (ASA) successes that brought life to the hard work of improving care and outcomes for stroke patients.
“I’m pleased to say we’ve made great strides related to stroke and brain health, most prominently in preventing and managing hypertension,” Brown said.
Brown noted that one part of the AHA’s role in this step forward was its $20 million dollar investment in the Health Equity Research Network. As of last summer, research teams at five institutions have focused on under-resourced populations that historically have the highest prevalence of high blood pressure. This work aligns with AHA nationwide, $32 million, multiyear collaboration with the federal government to address hypertension in communities across the country, she said.
Funding and partnerships fueled additional success, she said, including a $3 million donation from Quest Diagnostics to the AHA to establish community programs within federally qualified health centers and Sanofi U.S.’s $35 million investment CHANGE AFib to improve outcomes for atrial fibrillation patients.
Support from the Leona M. and Harry B. Helmsley Charitable Trust, the Henrietta B. and Frederick H. Bugher Foundation and Gates Ventures has also been valuable in moving stroke research into the future, Brown said.
A younger, whole-body approach
Perhaps the most intriguing look into the future was provided by AHA President Donald Lloyd-Jones, MD, ScM, FAHA. Dr. Lloyd-Jones is the chair of the Department of Preventive Medicine and the Eileen M. Fole Professor of Heart Research, and a professor of Preventive Medicine, Medicine and Pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois. In his presentation, “Promoting Cardiovascular and Brain Health Across the Life Course,” he underscored the need to tackle heart and brain health early — even when a child is in utero.
“I see a path to a future with far fewer strokes, and far better, overall cognitive function. The key to making this happen, I believe, is by focusing on cardiovascular and brain health in new ways,” Dr. Lloyd-Jones said.
It begins when a person becomes “at risk,” rather than when they are sick, he said. To illustrate his point, Dr. Lloyd-Jones introduced a patient case study: A 29-year-old man, significantly overweight, diagnosed with pre-diabetes, hypertension, inactivity, a smoker, and presenting with an intracranial hemorrhage. Four months later, he presented with an acute ST-elevation myocardial infarction (MI). Thankfully, he survived, with the help of a team of stroke neurologists and lifestyle changes. This patient’s tale “reveals a hard truth,” Dr. Lloyd-Jones said.
“Had we done a better job as a health care community — and as a society — had we really been active throughout his life course to promote cardiovascular and brain health, David might never have suffered both a hemorrhagic stroke and an acute MI in his 20s,” he said.
Tackling brain and heart health earlier requires the creation of a new construct of cardiovascular health (CVH). Through his work with volunteers on this front, Dr. Lloyd-Jones said he defines CVH as the confluence of seven metrics: Blood pressure, cholesterol, blood glucose, body weight, diet, physical activity and smoking status. he said.
“It’s Life’s Simple 7,” he said. “Ideal CVH is the state in which all seven metrics are maintained at optimal levels.”
The need to start earlier is supported by numerous studies, he said. According to Framingham investigators, studies have shown that better CVH status in middle age is associated with a lower 10-year incidence of stroke and dementia, including both Alzheimer’s and vascular dementia, he said. It’s also associated with improved cognitive function and less brain atrophy in later life.
Even more compelling is data from the Coronary Artery Risk Development in Young Adults (CARDIA) study of young adults, which showed that cardiovascular health status at a mean age of 25 years was significantly associated with better performance on three measures of cognitive function at 50 years of age.
“Our current data show that the CVH status of mothers — and fathers — at the time of pregnancy is a very important indicator, not just for that child, but also for that child’s future children!” he said.
Of course, there’s more work to do, Dr. Lloyd-Jones said. AHA and ASA’s advocacy, key partnerships and research funding play a critical role. But there’s more, he added.
“Social, environmental and behavioral exposures from early life can limit people’s chance to have and maintain ideal cardiovascular and brain health.”
Karen C. Johnston, MD, MSc
Dr. Lloyd-Jones’ insight was the perfect introduction to the William M. Feinberg Award for Excellence in Clinical Stroke Lecture: “Clinical Research Rigor: Considering Intentional Disruption Opportunities.” Karen C. Johnston, MD, MSc of the University of Virginia delivered the lecture, having worked with Dr. Feinberg on a large clinical trial. Her focus on the health inequities that exist in stroke care began with a look at the inequities in care for COVID-19 patients. In a Kaiser Family Foundation study, Dr. Johnston noted that in all instances of COVID hospitalizations and deaths, American Indian or Alaskan native, Black, Hispanic and Asian patients fared far worse than white individuals.
“COVID highlights the disparities in other diseases as well,” she said, and illustrated her passion for health equity with a 1992 Margaret Whitehead quote, that reads, ‘Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential, if it can be avoided.’”
Dr. Johnson highlighted a 2020 National Institute of Neurological Disorders and Stroke (NINDS) Health Disparities initiative to address health disparities and inequities in neurological conditions. Its goal is to develop a comprehensive plan for NINDS to reduce disparities through research investment over the next five to 10 years.
As leaders, how do we “intentionally disrupt” these inequities, she posed? It’s achievable through an increase in funded work at the local, regional and national level to submit rigorous health equity research; protocol and manuscript review; scientific programming; and our own interventional trials, she said. Also important is to teach research rigor in our communities and among our legislative representatives.
“As clinical and translational stroke researchers, we must address the science that will allow us to mitigate these inequities and intentionally reject all forms of bias in our research,” Dr. Johnson concluded.
