Category: Cardiovascular

Wegovy is linked to a reduced risk of heart attack, stroke, and heart-related death, according to the results of a new clinical trial. The findings from Novo Nordisk are the first to show that a diabetes drug commonly used off-label for weight loss can also provide protective benefits beyond weight reduction. Wegovy’s maker released limited details of their findings earlier this month, including that the drug reduced the overall risk of heart attacks, strokes, and cardiovascular deaths by 20 percent. It did not break out the effects of the drug on each individual outcome and did not detail how much weight patients lost or provide any description of the side effects that were experienced. Novo Nordisk said the drug appeared to be “safe and well-tolerated,” which is in line with what has been seen and reported in previous clinical trials. The data has not yet been published in a peer-reviewed journal or reviewed by any outside scientists. The company said it would present its full trial results later this year. “I would bet that when the [full] study comes out, we will see decreases in risk factors including blood pressure, diabetes, and cholesterol,” Ronald Freudenberger, MD, Physician in Chief at Lehigh Valley Heart and Vascular Institute, who was not involved with the trial, told Health. “It will be important for it to go through the peer review process so we can see the details,” he said. “The initial announcement, however, is logical and makes sense.” Getty Images / imyskin Wegovy is currently FDA-approved for chronic weight management in the United States. The company plans to ask the Food and Drug Administration to add cardiovascular benefits to Wegovy’s drug prescription label later this year. “Weight management, even without the use of medications, is important as weight gain is directly tied to several cardiovascular risk factors, such as hypertension and diabetes,” Salim S. Virani, MD, PhD, a cardiologist at The Texas Heart Institute who was not involved with the trial, told Health. “Heart disease is the leading cause of death for both men and women, so being able to control a direct contributor to cardiovascular risk factors can go a long way to slow the progression of these mortality numbers,” he said. The study results add to encouraging research that has found weight loss drugs to help reduce cardiovascular risks. Ozempic, which uses the same ingredient, semaglutide, as Wegovy, had a similar clinical trial conducted that saw a 26% reduction in cardiovascular events. But unlike the new Wegovy clinical trial, that study was only done with participants who had diabetes. The risk factors that contribute to poor cardiovascular health are high blood pressure, high cholesterol, diabetes, family history, and smoking. While you can’t change family history, you can reverse high blood pressure, high cholesterol, and diabetes with weight loss, Freudenberger explained. “Weight loss has a direct, profound effect on decreasing the risk factors for cardiovascular events and cardiovascular disease, so it makes lots of sense that a drug that reverses the risk factors will decrease cardiovascular events,” he said. “It’s directly reversing the contributors to bad cardiovascular health.” Maintaining a healthy weight, with or without medication has also been shown to cause a general sense of well-being, more energy, reduction in stress levels, better sleep, improved immunity, better mental health, balanced hormones, and an overall enhancement in the quality of social life. A potential side effect of the clinical trial is that it could help improve insurance coverage, as the findings undermine the argument that Wegovy is merely a vanity drug. Wegovy currently costs over $1,300 a month before insurance, making it out of reach for many Americans whose insurance providers do not deem the drug medically necessary. Medicare does not cover weight loss medications—some employer insurance plans have refused to pay for them, arguing that the drugs are not essential medical remedies. This new trial could prompt more insurers to pay for the drug, at least for patients who, like the trial participants, already had evidence of pre-existing heart disease. “This outcome study strengthens the case for the use of semaglutide in patients who are overweight and obese,” said Virani. “We hope that this will help improve coverage for this medication.” As more information from the clinical trial is released, its findings will hopefully allow researchers to study the relationship between cardiovascular events and weight loss, potentially providing more answers to how drugs like Wegovy can improve heart health. Virani points out that patients considering taking Wegovy strictly for heart health should discuss their options with their treating clinicians. Experts agree that this trial could change the outlook and narrative around obesity that has long been framed as the responsibility of the individual patient, and the result of their own personal choices. “This study is indeed a landmark study,” said Freudenberger. “It shows that this class of drugs, used specifically for weight loss, decreases cardiovascular mortality, which makes physiologic sense. This makes a lot of sense.”

Specialty

The following is a summary of “Association between hypertensive disorders of pregnancy and cardiovascular diseases within 24 months after delivery,” published in the JULY 2023 issue of Obstetrics and Gynecology by Ackerman-Banks, et al. For a longitudinal population-based study, researchers sought to assess the risk of specific cardiovascular diagnoses during the first 24 months after delivery in patients with hypertensive disorders of pregnancy compared to those without such disorders. The study included pregnant individuals with deliveries between 2007 and 2019, using data from the Maine Health Data Organization’s All Payer Claims Data. Patients with preexisting cardiovascular disease, multifetal pregnancies, or without continuous insurance during pregnancy were excluded. Hypertensive disorders of pregnancy and cardiovascular diseases were identified using diagnosis codes. Hazard ratios were estimated using Cox proportional hazards models, adjusting for potential confounding factors. Out of the 119,422 pregnancies analyzed, the risk of cardiovascular disease within 24 months after delivery differed significantly between patients with hypertensive disorders of pregnancy and those without such disorders. The cumulative risk of specific cardiovascular diseases for patients with hypertensive disorders of pregnancy compared to those without were as follows: heart failure (0.6% vs. 0.2%), ischemic heart disease (0.3% vs. 0.1%), arrhythmia or cardiac arrest (0.2% vs. 0.2%), cardiomyopathy (0.6% vs. 0.2%), cerebrovascular disease or stroke (0.8% vs. 0.4%), severe cardiac disease (1.6% vs. 0.7%), and new chronic hypertension (9.7% vs. 1.5%). After adjusting for potential confounding factors, patients with hypertensive disorders of pregnancy had a higher risk of heart failure (adjusted hazard ratio, 2.81; 95% CI, 1.90–4.15), cerebrovascular disease (adjusted hazard ratio, 1.43; 95% CI, 1.07–1.91), cardiomyopathy (adjusted hazard ratio, 2.90; 95% CI, 1.96–4.27), and severe cardiac disease (adjusted hazard ratio, 1.90; 95% CI, 1.54–2.30) within the first 24 months after delivery compared to those without hypertensive disorders of pregnancy. Additionally, patients with hypertensive disorders of pregnancy had an increased risk of new chronic hypertension diagnosed after 42 days following delivery (adjusted hazard ratio, 7.29; 95% CI, 6.57–8.09). However, there was no significant association between hypertensive disorders of pregnancy and ischemic heart disease (adjusted hazard ratio, 0.92; 95% CI, 0.55–1.54) or cardiac arrest or arrhythmia (adjusted hazard ratio, 0.90; 95% CI, 0.52–1.57). Notably, among pregnant women with hypertensive diseases, the first diagnoses of cardiomyopathy (44%), heart failure (39%), cerebrovascular disease or stroke (39%), and severe cardiac disease (41%) all occurred in the first month following delivery. Within 24 months of giving birth, patients with hypertensive disorders of pregnancy run a higher risk of acquiring new forms of chronic hypertension, heart failure, cerebrovascular illness, and cardiomyopathy. However, there was no significant association with ischemic heart disease, cardiac arrest, or arrhythmia. To enhance mother and newborn outcomes in subsequent pregnancies and protect long-term health, the findings emphasized the significance of focused early postpartum therapies and intensified surveillance in the first 24 months following delivery for individuals with hypertensive disorders of pregnancy. Source: ajog.org/article/S0002-9378(23)00236-3/fulltext

Skin-like microfiber Bragg grating (μFBG) patch. Credit: Compuscript Ltd Cardiovascular disease is the world’s leading cause of death. According to the World Health Organization, 17.9 million people die every year due to cardiovascular diseases. For the prewarning and accurate treatment of cardiovascular diseases, it is important to monitor hemodynamic parameters continuously, including blood pressure (BP), heart rate (HR), peripheral resistance (PR), and vascular elasticity. Soft wearable devices are well suited to monitoring physiological signals such as electrocardiogram (ECG) signals, phonocardiogram (PCG) signals, and pulse waves with the advantages of real-time operation capability, skin-like mechanical properties, and high-SNR sensing capability. However, the human cardiovascular system is complicated and distributed with network circulation. Monolithic hemodynamic parameters achieved by current wearable devices cannot adequately and precisely reflect the health status of regional vasculature. A spatiotemporal hemodynamic monitoring technique is urgently needed to satisfy the ever-growing demand for clinical treatment and daily health management of the cardiovascular system. The distributed optical fiber (DOF) sensing technique represented by the fiber Bragg grating (FBG) is ideally suited for spatiotemporal hemodynamic monitoring. Its spatially distributed multichannel sensing capability, excellent temporal synchronization and lack of electromagnetic interference lay a foundation for multiple high-SNR physiological signal monitoring. However, the traditional optical fiber has a large-distinct mechanical property with the skin and a low response on physiological signals considering its rigid and brittle silica material and thick diameter of 125 μm, making it difficult to be worn on the body stably and comfortably. Flexible packaging technology has been used to address the mechanical mismatch. Nevertheless, excessive thick encapsulation and the low sensitivity of commercial FBG devices pose an obstacle in detecting subtle physiological signals, thereby limiting their potential applications in wearable devices. Optical microfibers have been proven to have excellent flexibility, configurability, and large evanescent fields for high sensitivity sensing. However, the existing devices based on optical microfiber have difficulty achieving spatially distributed, time-synchronized, and multi-parameter sensing capabilities without a wavelength encoding strategy. The authors of an article, published in Opto-Electronic Advances, propose a spatiotemporal hemodynamic monitoring technique based on a skin-like microfiber grating group. The technique employs microfiber and ultra-thin flexible packaging technology to prepare skin-like microfiber patches. By effectively reducing the equivalent modulus of the device and the cross-sectional area of the microfiber, the stress response of the patch is improved by two orders of magnitude (the sensitivity is 5.26 nm/N under a stress within 50 mN). It also shows great repeatability and stability under 10,000 stress circles. In addition, the technique employs femtosecond laser direct writing technology to non-invasively inscribe Bragg gratings into the interior of the microfiber, providing different wavelength encodings for multiple microfiber patches, enabling the synchronous multi-channel sensing capabilities. By connecting microfiber grating (μFBG) patches in series, multiple physiological signals at different nodes of the human body can be detected simultaneously and distinguished by different working wavelengths. Since the light-based physiological signals propagate at close to the speed of light in the μFBG group, the time synchronization is only limited by the FBG interrogator. By detecting the proximal ballistocardiograph (BCG) signal and the distal pulse wave at each superficial artery in the human cardiovascular system, and then calculating the pulse wave transmit time (PTT), the spatiotemporal hemodynamics monitoring technology is established. Configurable spatiotemporal hemodynamic monitoring technique. Credit: Compuscript Ltd By detecting mechanical signals at the proximal and distal ends of the cardiovascular system instead of electrophysiological activity signals, the monitoring technique can present the real dynamics of the systemic cardiovascular system, such as heartbeat, angiectasis, and pulse wave propagation. Three hemodynamic monitoring modes are presented in this study. First, pulse waves of different superficial arteries in the human body, such as carotid artery, radial artery and pedal artery, were collected, and PTTs were analyzed using the BCG signal. Different PTTs arise from the differences in the length, diameter, and elastic modulus of blood vessels. This mode could enable the health assessment of local arterial branches in the cardiovascular system. Second, the μFBG group dynamically recorded the subjects’ dual-channel physiological signals during the process of exercise and rest. The heart rate was calculated by the cardiac cycle, and the pulse wave propagation velocity changed along with the blood pressure. In addition, the μFBG group dynamically recorded the dual-channel physiological signals when the external pressure imposed, and the changes of PTT could sensitively reflect the different degrees of peripheral arterial resistance. This real-time local peripheral vascular resistance monitoring technique was proposed for the first time. This study develops the synchronous multi-channel sensing technology based on the skin-like μFBG group, which has significant advantages such as temporal dynamic, spatial distribution, easy networking and configurability, high sensitivity and high flexibility. The proposed spatiotemporal hemodynamic monitoring technology has the working capability of real-time and dynamic evaluation of local blood vessel health status in the whole cardiovascular system, demonstrating the great potential in the diagnosis of cardiovascular diseases such as arrhythmia, angiosclerosis, hypertension, and thrombosis and facilitating precise clinical diagnosis, the fast screening of lesions, and daily health management. More information: Hengtian Zhu et al, Spatiotemporal hemodynamic monitoring via configurable skin-like microfiber Bragg grating group, Opto-Electronic Advances (2023). DOI: 10.29026/oea.2023.230018 Provided by Compuscript Ltd Citation: Research proposes photonic skin sensing network for cardiovascular health monitoring (2023, August 16) retrieved 16 August 2023 from https://medicalxpress.com/news/2023-08-photonic-skin-network-cardiovascular-health.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

NEW YORK – GeninCode announced Wednesday that it filed a 510(k) submission for its CARDIO inCode-Score (CIC-SCORE) in vitro polygenic risk score (PRS) test for cardiovascular disease with the US Food and Drug Administration. The filing is part of the UK-based company’s effort to expand the US commercial distribution of CIC-SCORE. GeninCode currently offers the CIC-SCORE through the company’s CLIA-certified and College of American Pathologists-accredited lab in Irvine, California via an early access program. The firm partnered with Milwaukee-based Eversana in 2021 to commercialize GeninCode’s products within the US and last year filed its pre-submission for CIC-SCORE with the FDA. The CIC-SCORE recently received a CPT PLA code (0401U) and the firm expects a payment rate for the test to be set by the US Centers for Medicare and Medicaid Services in October. “Approval of the 510(k) kit/medical device filing will complement our US laboratory testing enabling GENinCode to accelerate commercial growth of CIC-SCORE in the US market,” Matthew Walls, CEO of GeninCode, said in a statement. “Our early access program is seeing strong demand for use of our CIC-SCORE CLIA lab test to identify patients at high genetic risk, personalise treatment and prevent [CVD].”

NEW YORK – GenInCode announced Wednesday that it filed a 510(k) submission for its CARDIO inCode-Score (CIC-Score) in vitro polygenic risk score (PRS) test for cardiovascular disease with the US Food and Drug Administration. The filing is part of the UK-based company’s effort to expand the US commercial distribution of CIC-Score. GenInCode currently offers the CIC-Score through the company’s CLIA-certified and College of American Pathologists-accredited lab in Irvine, California, via an early access program. The firm partnered with Milwaukee-based Eversana in 2021 to commercialize GenInCode’s products within the US and last year filed its pre-submission for CIC-Score with the FDA. The CIC-Score recently received a CPT PLA code (0401U) and the firm expects a payment rate for the test to be set by the US Centers for Medicare and Medicaid Services in October. “Approval of the 510(k) kit/medical device filing will complement our US laboratory testing enabling GenInCode to accelerate commercial growth of CIC-Score in the US market,” Matthew Walls, CEO of GenInCode, said in a statement. “Our early access program is seeing strong demand for use of our CIC-Score CLIA lab test to identify patients at high genetic risk, personalize treatment, and prevent [CVD].”

The patterns suggest vaping is being used as a smoking cessation tool—whether that’s a bad or good thing isn’t fully clear. Use of e-cigarettes by people with cardiovascular disease had been on the decline for a few years but then rebounded in 2020 with the emergence of the COVID-19 pandemic, topping out at a prevalence of around 5%, according to an analysis of US survey data. The findings were published online Tuesday as a research letter in JAMA Network Open. “E-cigarettes have been considered a safe means of smoking cessation for combustible cigarettes. However, the evidence of cardiovascular harm of e-cigarettes has been accumulating in recent years, so it is necessary to understand the proportion and trend of e-cigarette use in people with CVD,” said Shanjie Wang, MD, PhD (Second Affiliated Hospital of Harbin Medical University, China), who shares senior authorship on the paper with Yiying Zhang, MD, PhD (Jiamusi University, China). What they found, Wang told TCTMD in an email, is that adults below the age of 60, women, and former smokers are all more likely to use e-cigarettes. The data also show that people who currently smoke conventional cigarettes and those who’ve quit have a higher prevalence of vaping than those who’ve never smoked to begin with, “suggesting that the idea of replacing traditional cigarettes with e-cigarettes cannot be ignored,” he said. Clinicians [should] pay more attention to the cardiovascular health of current tobacco users and former cigarette users who use e-cigarettes when asking about e-cigarette use. Shanjie Wang Wang noted that e-cigarette use is more prevalent in CVD patients than in the general population. “Clinicians [should] pay more attention to the cardiovascular health of current tobacco users and former cigarette users who use e-cigarettes when asking about e-cigarette use. However, there is still no definitive conclusion on whether e-cigarettes can replace traditional cigarettes and relatively improve the cardiovascular health of patients,” he explained. Holly R. Middlekauff, MD (UCLA Health, Los Angeles, CA), commenting on the results for TCTMD, said that the new data interestingly show that while e-cigarette use among people with CVD went up in the last year or so of the study period, the use of traditional cigarettes was on the decline. Moreover, only a tiny slice of the e-cigarette users classified themselves as “never smokers.” This points to the existence of a group—current smokers who wish to quit or cut back—“that would really benefit from doing almost anything besides smoking a tobacco cigarette. It’s that whole harm reduction idea,” she said. “Dual use is not so beneficial from the heart standpoint,” but it seems likely that completely eliminating smoked tobacco by switching to e-cigarettes would be a good move, Middlekauff noted. “We do know that if somebody smokes just one to two tobacco cigarettes a day, they have a similar cardiovascular risk as somebody who smokes one to two packs a day. It’s kind of an on/off thing. . . . The cancer risk is more related to duration of smoking and burden, but the cardiovascular risk is really related to whether you smoke at all. So if you’ve cut out 95% of your tobacco cigarettes, that’s good, but it’s not going to give you nearly the benefit as completely stopping smoking.” There probably is going to be some cardiovascular harm from using electronic cigarettes, but it’s probably orders of magnitude less than tobacco cigarettes. Holly R. Middlekauff The long-term cardiovascular effects of vaping are still unknown, said Middlekauff. Her own research, along with other studies, has shown that e-cigarettes can cause physiologic changes that might up the risk of a person developing cardiovascular disease. Still, if e-cigarettes can indeed help people quit smoking—as has been suggested by earlier research, including the randomized E3 trial—then the risks might be outweighed by the health gains, she suggested. “There probably is going to be some cardiovascular harm from using electronic cigarettes, but it’s probably orders of magnitude less than tobacco cigarettes. We know that those are bad for you, those kill you—they kill half the people that use them, yet people still use them because it’s such a powerful addiction,” Middlekauff said. From Tobacco to E-Cigarettes Led by Xin Wen, MD (Jiamusi University), the researchers analyzed data on 30,465 adults with CVD who responded to the National Health Interview Survey between 2014 and 2020. The mean age was 65 years, and 47.8% were women. Most of the participants (84.7%) self-identified as white, while 4.9% self-identified as Black, 4.9% as Hispanic, and 1.6% as Asian. Among these patients with a history of cardiovascular disease, current use of e-cigarettes decreased initially, with the weighted prevalence dropping from 5.2% in 2014 to 3.1% in 2019. However, it then rebounded back to 5.2% in 2020. E-cigarette use decreased over the years for those ages 60 or older (dropping from 2.9% in 2014 to 0.9% in 2020) but held steady for those younger than 60 (at 6.2% in 2014 and 7.2% in 2020). Before 2018, men were more apt to use e-cigarettes than were women, though this was no longer the case in 2019 and 2020, by which time 2.9% of men and 8.3% of women reported vaping. People with CVD who had quit smoking conventional cigarettes were, over the years, increasingly more likely to use e-cigarettes (rising from 3.2% in 2015 to 10.1% in 2020). Adjusted for age, sex, region, race/ethnicity, education, and household income, several factors predicted higher or lower odds of e-cigarette use. Predictors of E-Cigarette Use in Patients With CVD Adjusted OR (95% CI) Age (vs ≥ 60 Years) 18-39 Years 40-59 Years 5.2 (4.0-6.7) 3.2 (2.6-4.1) Race/Ethnicity (vs White) Asian Black 0.3 (0.2-0.4) 0.3 (0.3-0.5) Education Level (vs ≥ College) < High School 1.6 (1.2-2.1) Household Income (vs High) Middle Low 1.7 (1.4-2.5) 2.2 (1.6-2.8) Smoking Status (vs Current) Former, Quit ≤ 1 Year Former, Quit > 4 Years Never 1.8 (1.2-2.7) 0.2 (0.2-0.3) 0.1 (0.1-0.2) Failed Attempt to Quit ≤ 1 Year 2.0 (1.5-2.6) “More attention should be paid to young people, women, and

August 16, 2023 — A new American Heart Association (AHA) scientific statement highlights evidence that supports shared decision-making, a term that describes the process of ensuring patients have the knowledge and tools to make decisions about their health in collaboration with their professional health care team. The statement was published August 14 in the American Heart Association’s flagship, peer-reviewed journal Circulation. More than 100 trials have demonstrated that shared decision-making improves patient’s understanding, acceptance and satisfaction with their health care, yet adequate levels of shared decision-making occur in as few as 10% of face-to-face consultations across a variety of health care specialties. The statement details the key components of shared decision-making: – clearly communicated, unbiased evidence about risks, benefits and reasonable alternatives to treatment; – clinical expertise provided in a way that is relevant to the patient; and – inclusion of the patient’s values, goals and preferences in the decision process. The statement presents models of shared decision-making and ways to measure it in research, in addition to strategies to promote its use. Potential solutions to increase shared decision-making in cardiovascular care include reimbursement for consultations, team-based care, integrating decision aids in electronic records, and training clinicians on communication skills that support shared decision-making more effectively and are sensitive to the cultural, racial, ethnic and language considerations for each patient. The abstract offers the following: “Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues.” “Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions,” noted the authors, writing that the scientific statement “shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities.” It further added: “Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.” This statement was prepared by the writing group committee on behalf of ten American Heart Association Councils and, according to the American Heart Association statement, include: Dennison Himmelfarb CR, Beckie TM, Allen LA, Commodore-Mensah Y, Davidson PM, Lin G, Lutz B, Spatz ES; on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Quality of Care and Outcomes Research; Council on Hypertension; Council on the Kidney in Cardiovascular Disease; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; Council on Epidemiology and Prevention; and Stroke Council. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. This new statement was approved by the American Heart Association Science Advisory and Coordinating Committee on May 1, 2023, and the American Heart Association Executive Committee on May 17, 2023. More information: www.heart.org Reference: Shared decision-making and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2023;148:e•••–e•••. doi: 10.1161/CIR.0000000000001162

AI automation will save significant amounts of exam and post-processing time for sonographers and the cardiologists. If the tedious and time-consuming work of drawing lines and making measurements can be removed, he said the humans can spend more time interacting with their patients rather than with the machine. Most of the FDA-cleared AI algorithms in echo are for the automation of measurements. Many of these are already available on current ultrasound systems to help automate ejection fractions, assessing all the measurements needed for structural heart assessments, strain, and others. Other deep learning algorithms can help act as a second set of eyes to help diagnose patients with specific conditions, including aortic stenosis, heart failure and amyloidosis. “These applications are very useful in echocardiography to automate the process and create more time for us to do more higher-caliber activity,” he said. By training AI to always take measurements from ideal planes and anatomic landmarks, it can make measurements much more reproducible and help eliminate variability between sonographers. GPT AI may significantly change cardiac imaging “The second inflection point that I am really excited about is the development of GPT,” Sangupta said. He explained these algorithms basically connect the language in the body of the reports and in the electronic medical records for new ways of communication between physicians. GPT in the future might also begin connecting the physicians and the patients to the images. Sangupta said the new frontier is going to be the ability to train GPT models to create effortless reports and communicate clinical information to referring physicians. GPT is also being developed to look at clinical reports and other patient information to instantly create a layman’s language version of exam reports that are more patient friendly and easier to understand. “It will give them the ability to understand what is in their reports and their records. There is no doubt that communication piece is lacking right now. This will give them the ability to digest and understand the report so they can have a decision-making capability,” Sangupta explained. GPT AI also might be able to provide additional relief for clinicians who are feeling burned out with the amount of work that is required. Sangupta said it is still in the early days of GPT development, so the technology is not ready yet for regular use in patient care. There are also many questions about where the algorithms are pulling their data and how they reach conclusions. “There is a great deal of uncertainty, but there is also a great deal of opportunity,” he explained. “But we need to embrace this because this change is imminent.” This change is also necessary to enable moving patient care forward and to address burnout. “I believe a lot of physicians experience burnout because of the additional work they have to do with the electronic medical record, which is not really rewarding. So the whole idea of being able to create more free time so doctors can do what they like and do best, which is talk to the patients. Everything else can be put into the EMR using ChatGPT, and that is absolutely needed,” he said. Why human clinicians will not be replaced by AI or GPT technology Sangupta is certain there is no way a clinician can be replaced by GPT technology anytime soon because the technology is just not as capable as human brain or understanding context in the human world. “The human level competency of GPT is still very underdeveloped. Even if these models are able to become more generalizable and precise, they lack the human element of intelligence, which has several layers. There is contextual information that is clearer and easier for the human mind to digest, versus a ChatGPT,” Sangupta explained. Often the diagnosis or treatment of a patient is based on a doctor’s intuition and clinical judgement. And this is hard for programs to replicate and that is where clinical expertise, for now, is still a human trait required for patient care. “It also comes down to empathy and why we took the Hippocratic Oath, to make patients feel better. ChatGPT does not have feelings, so it does not have these sets of information to drive what is good for patient care, and that is where human doctors need to focus on,” Sangupta said. What he said will happen is that clinicians will have new tools for exploring the unknown components of the images with the ability to see far better than the human eye. He also said this new AI will be able to parse out large amounts of data and distill it for easier human consumption.

Exposure to environmental chemicals, including those in common plastic products, has been linked with an increased risk of cardiovascular disease, or CVD, the leading cause of death worldwide. According to the World Health Organization, 17.9 million people died from CVDs in 2019. Changcheng Zhou, a professor of biomedical sciences in the School of Medicine at the University of California, Riverside, has received an eight-year award of nearly $6.8 million from the Revolutionizing Innovative, Visionary Environmental Health Research (RIVER) program of the National Institute of Environmental Health Sciences, or NIEHS, to investigate how interactions between genes and endocrine disrupting chemicals, or EDCs, may increase CVD risk. Only five scientists, including Zhou, received RIVER grants this year. The grant “rewards outstanding environmental health sciences researchers who demonstrate a broad vision and potential for continuing their impactful research with increased scientific flexibility, stability in funding, and administrative efficiency.” EDCs mimic, block, or interfere with the body’s hormones. They can affect reproduction and the functioning of the immune and nervous systems. They are also known to increase cancer risk. Examples are human-made chemicals used as industrial solvents/lubricants and their byproducts, as well as some plastics, pesticides, fungicides, and pharmaceutical agents. Other examples are some natural chemicals, such as phytoestrogens (estrogen-like compounds derived from plants), found in human and animal food. How exposure to EDCs and other environmental chemicals influences CVD risk is not well understood. Recent large-scale studies found a link between exposure to EDCs and atherosclerosis, the gradual buildup of plaque — fats, cholesterol, and other substances — in and on the artery walls, resulting in the hardening and narrowing of the arteries. Treatment for atherosclerosis typically includes lifestyle changes, medicine, and surgery. “I am humbled and honored to receive the NIEHS RIVER grant, which provides the flexible and long-term support my research program needs to conduct innovative and impactful research in an area of crucial importance to the NIEHS mission,” Zhou said. “We expect the research this grant supports will contribute to the understanding of gene-EDC interactions in predisposing individuals and their children to CVD. We will explore how chemicals in common plastics and household products can act as EDCs, singly and in mixtures, and whether microplastics can act as Trojan horses, ferrying EDCs into the body to develop atherosclerosis.” Zhou’s prior work showed many EDCs activate a sensor in cells, called the pregnane X receptor, or PXR, which detects foreign chemicals and substances and helps regulate atherosclerosis development. The new funding will allow Zhou to study the mechanisms that allow EDCs to affect PXR in cells, leading to atherosclerosis. “Using a mouse model, we will look particularly at circulating cholesterol and ceramide lipids and how PXR regulates them to affect atherosclerosis development,” Zhou said. “We will also explore whether male mice’s exposure to EDCs can cause PXR to alter their sperm in a way that increases CVD risk in their offspring. We hope this research will help establish a novel therapeutic target for chemical-induced CVD.” Zhou’s lab was the first to reveal the novel function of PXR in the regulation of atherosclerosis development and showed in mouse models that widely used EDCs increase atherosclerosis through PXR signaling. Zhou’s scientific training in molecular biology, toxicology, pharmacology, and cardiovascular research uniquely positions him to investigate how gene-EDC interactions affect atherosclerosis development. “Influences of the chemical environment on human health have become the subject of intense interest but very few studies in the EDC research field have focused on atherosclerosis development,” Zhou said. “Besides establishing a novel therapeutic target for chemical-induced cardiovascular disease, our findings from this research have the potential to revolutionize our understanding of the etiology of many chronic human diseases originating from chemical-elicited intergenerational effects.”