Duke Research Blog

Following the people and events that make up the research community at Duke.

Category: Cardiology (Page 2 of 3)

Cooking up a new approach to heart disease in rural China

By Ashley Mooney

As cardiovascular disease becomes more prevalent in China, researchers look to change cooking practices that may be putting people at higher risk.

Currently, the top two causes of death in China are cardiovascular disease and chronic obstructive pulmonary disease, meaning that cardiovascular interventions will become increasingly important in public health, Assistant McGill University professor Jill Baumgartner said in a March 21 lecture. Environmental pollution from industry, increasing vehicle pollution, tobacco smoke and biomass usage have contributed to China’s shift in disease burden.

Typical gasifiers in China. Slide created by , photo taken by Ashley Mooney.

Typical gasifiers in China. Slide created by Jill Baumgartner, photo taken by Ashley Mooney.

“There’s been massive changes in China since the 1970s, they’ve brought in economic and social reforms. You see these massive increases in [gross domestic product] per capita as well as life expectancy,” she said. “[As a result], there’s been this shift from nutritional or infectious disease-related deaths in China… to chronic diseases.”

Many across the globe use gasifier stoves to cook, which use wood or coal as fuel and emit more carbon monoxide than electric alternatives. These emissions are not only harmful to the environment, but chronic exposure can lead to an increase in systolic blood pressure—a marker for increased risk of cardiovascular disease.

“Globally, about half the world’s population is using biomass and coal as their primary energy source,” Baumgartner said. “In China it’s just under 50 percent of the population.”

Baumgartner primarily studied women who have never smoked cigarettes in Yunnan, a southern province of China. Culturally, women from this area rarely smoke, while men often do, she said. The women are also the primary cooks for the family, meaning they spend the most time near biomass-burning stoves and space heaters and are ideal study subjects for the effects of the biomass without the confounds of smoking.

By measuring particulate matter, black carbon and water-soluble organic carbon, Baumgartner determined women’s seasonal exposure to biomass and its effect on their blood pressure. Black carbon is associated with regional climate warming and is used as an indicator of combustion particulate matter and water-soluble organic carbon is an indicator of biomass particulate matter.

“When we think about climate change and other greenhouse gasses, the effects are going to be really long term,” Baumgartner said. “But black carbon is unique because if you turn off black carbon, it’s kind of like turning off the tap. So you stop black carbon from entering the atmosphere and the warming effect decreases in weeks.”

While Baumgartner’s research initially looked at only the effects of biomass burning on cardiovascular health, she is transitioning to work on interventions. Since the beginning of her work in Yunnan, engineers have built a biomass-pellet manufacturing site, which provides more efficient and less toxic fuel for locals.

Baumgartner said interventions leading to a 8mm Hg decrease in systolic blood pressure could translate to a 29 percent decrease in coronary heart disease and 38 percent decrease in the onset of strokes.

Beers with Bob — Without Beer

By Nonie Arora

My living group, Round Table, had the opportunity to meet up with Dr. Bob Lefkowitz in his office for “Beers with Bob without Beer.” Arnab Chatterjee, a Pratt sophomore and one of our members, works in his research lab and arranged the meet-up…and later dropped the beer from our plans.

We enjoyed being immersed  in Dr. Lefkowitz’s office. We saw the jersey, hanging from the “rafters”, that Coach K presented to him last year amidst cheers of “He’s so smart” from the Cameron Crazies. 

He showed us a video – three times – of the first pitch he threw out for the Durham Bulls baseball game.

Dr. Lefkowitz’s biggest piece of advice to us all was to eat a square of chocolate every day. He jokingly attributes part of his Nobel prize to the threshold effect of upping his chocolate consumption from two squares a week to one a day just two months before receiving the call from Stockholm. That’s one recipe for success that I can get behind! 

Round Table meets with Dr. Bob Lefkowitz. (Nonie’s just to the left of Bob in red top.)

 

5 Dukies On List of World’s Top Biomedical Scientists

A recent paper in the European Journal of Clinical Investigation identified 400 of the world’s most influential researchers in biomedicine—and five hail from Duke University. The authors used citation data spanning 15 years (1996-2011) from Scopus, a database of peer-reviewed literature, to pinpoint researchers with high degrees of productivity and impact. Get to know the Duke researchers:

califf2

 

Robert M. Califf is a global leader in treating cardiovascular disease and has a long history at Duke, where he completed both his undergraduate degree and his MD.  Califf serves as vice chancellor for clinical and translational research and directs the Duke Translational Medicine Institute. You can read Dr. Califf’s blog here.

 

caron

 

Marc G. Caron is the James B. Duke Professor of Cell Biology in the School of Medicine, as well as a member of the Duke Institute for Brain Sciences. He studies how neurotransmitters, chemical messengers like dopamine and serotonin, regulate behavior and play a role in diseases like schizophrenia and depression.

 

leftkowitz-lrg

 

Robert J. Lefkowitz was awarded the 2012 Nobel Prize in Chemistry for his work discovering and describing a large family of proteins, known as the G-protein coupled receptors, that regulate cellular responses to outside molecules. His work underlies a third to a half of all prescription drugs today. Lefkowitz is a professor of biochemistry, chemistry, medicine, and pathology at Duke.

 

terrie_moffitt

 

Terrie E. Moffitt is a psychologist and the director of two longitudinal studies—one of 1000 New Zealand families and one of over 1000 British families with twins, which she uses to investigate how antisocial and criminal behaviors arise in individuals. She is the Nannerl O. Keohane university professor of psychology and neuroscience at Duke.

 

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Eric D. Peterson is a cardiologist specializing in acute coronary systems and geriatric cardiology with nearly 700 peer-reviewed biomedical papers to his credit. He is the director of the Duke Clinical Research Institute and a professor of medicine at Duke University Medical Center.

Igniting U.S. health care’s ‘escape fire’

The film Escape Fire explores what's fanning the flames of the health care debate. Credit: escapefiremove.com

By Ashley Yeager

Imagine lighting a match to protect yourself from the flames of a fire.

It’s probably not the first thing you would think to do to stop from being burnt. But when there’s no other escape, the technique works. In 1949, Robert Wagner Dodge became living proof when he lived through the Mann Gulch fire by setting his surroundings on fire.

Now, his actions have become a metaphor for drastic ways government and industry should change U.S. health care before it too burns everything in its path.

Escape Fire: The Fight to Rescue American Healthcare showcases the health care system’s metaphorical blaze. The award-winning documentary, described as the “Inconvenient Truth” of the health care debate, opens nationwide in October. But members of the Duke community saw it for free on Wed., Sept. 19. They were also able to participate in a post-film panel discussion, which fleshed out a few potential escape fires for the health care industry.

“I think working with one patient at a time can help everyone become healthier,” said Annie Nedrow, a primary care physician and the associate director of Duke Integrative Medicine, which sponsored the event. But as the film points out, the current system rewards doctors for the number of patients they see, not the amount of time they spend with each person or the plans they may develop to help that patient prevent and manage disease.

Ironically, almost 75 percent of health care costs are spent on preventable diseases. The film, directed by Matthew Heineman and Susan Froemke, illustrates this statistic through anecdotes, where a band-aide, pill or even invasive surgery, such as inserting a stent to relieve heart blockages, provides immediate relief but does nothing to address the underlying causes of illnesses – typically diet and lifestyle.

Preventable diseases are 75% of our health care costs. Credit: escapefiremovie.com

“There’s got to be a shift in our culture, one where we actually have access to safe parks to exercise, healthy food, and the time to eat it,” said Adam Perlman, Duke Integrative Medicine’s executive director. He also agreed with Nedrow that a new system should invest more in primary care and health promotion, rather than disease treatment.

To set an example and test the feasibility of such a system, Duke Integrative Medicine has opened a primary care practice that limits the number of patients each physician sees so the doctors can spend more time with each patient and create a more holistic approach to that person’s health.

Perlman said that health coaching could be another important aspect of correcting the healthcare system. He explained that doctor X might tell a patient to lower his blood sugar, doctor Y then tells him to lower his blood pressure, and all the patient really wants to do is dance at his daughter’s wedding. “A health coach helps the patient reach those bigger goals by connecting the dots and helps them execute the plan to get there,” he said.

The film and remarks prompted many audience members to question what it would take to change the current system. Nedrow, who said she has been inspired by books on creativity and innovation, suggested that it was dialogues like the one they were having that could ignite change to repair the broken model of health care or create a new system.

More innovation, however, may mean that more people need to step into the fire and strike a match, rather than run and try to dodge the flames.

CSI-House teams could make better medical diagnoses

By Ashley Yeager

Comparing a child's DNA to his parents' could help with identification of hard-to-diagnose genetic diseases. Credit: Henrik Jonsson/iStockphoto

Dr. Gregory House, star of House, M.D., and the lab techs on CSI never fail at their jobs. But that’s Hollywood. In real life, diagnosing illnesses and sequencing DNA isn’t so straightforward. It doesn’t always lead to a happy ending either, especially for children who are sick but can’t be diagnosed, even by gifted, real-life doctors.

That’s exactly why geneticist David Goldstein has teamed with pediatrician Vandana Shashi to combine a little House and CSI to identify apparent genetic diseases and quickly end some families’ diagnostic odysseys.

So far, the team has provided likely genetic diagnoses in six of 12 children it has worked with, said Goldstein at a Cardiovascular Research Center Seminar Series talk on June 27.

The children were referred to Shashi for a pilot study where she would record their symptoms, or phenotypic behavior, much like House. Then, Goldstein and his team at the Center for Human Genome Variation collected DNA samples from the children and both of their biological parents.

Using next-generation genetic sequencers, as well as traditional DNA scanners, Goldstein and his team looked for genetic variations between the children’s and parents’ complete genome. Like looking at DNA to identify a criminal, Goldstein and his genetics team are scouring the sequences for genetic fingerprints of the diseases disrupting the children’s lives.

Once variations were identified, the entire team looked for known diseases with similar gene mutations and symptoms. Goldstein explained that the study not only pinpointed the undiagnosed congenital diseases in some patients but also presented new genes that could also be linked to the illnesses. The study’s success has led to the creation of the Genome Sequencing Clinic.

The clinic will begin to help the families of the 50,000 children (out of the four million) born each year in the US with difficult-to-diagnose genetic diseases. These types of studies will likely be the “earliest drivers for large-scale genetic sequencing,” Goldstein said.

But, he cautioned, “there’s a whole lot of junk,” or variation, in DNA. Every genome has the narrative potential for devastating diseases, and that means that House-CSI teams, like Shashi and Goldstein’s, need to be extremely careful when making diagnoses, especially if the results will influence treatment, he said.

Citation: Clinical application of exome sequencing in undiagnosed genetic conditions. Need, A. et. al. 2012. J. Med Genet. 49:6 353-361. doi:10.1136/jmedgenet-2012-100819

New Blogger Nonie: Joining the Team

By Nonie Arora

Hello there,

This is Nonie Arora, a freshman A.B. Duke Scholar from Novi, MI. I am excited to join the Duke Research Blog team.

I’ve been involved in research since my freshman year of high school. Back then, I was obsessed with the concept of “superbugs” and antibacterial resistance. I ordered E. coli out of a catalog with my chemistry teacher and tested its resistance to common household substances, like soap and bleach. My research interests evolved as I started working in a lab at the Wayne State University Medical School. For three years, I studied genes in a yeast, C. albicans, that contribute to antifungal drug resistance.

My research took me to different science fairs, such as the International Science & Engineering Fair (ISEF) and the Intel Science Talent Search. At ISEF, being in a hall with 1500 other students from around the world – who were all enthusiastic about research – was incredibly motivating. I was eager for more research exposure. The wide variety of research present at Duke, from basic science to behavioral economics to clinical trials, is incredible. Being able to interact with renowned faculty as a freshman is a privilege.

Last semester, I was part of the Genomics FOCUS program and took classes with Hunt Willard and Bob Cook-Deegan. The captivating teaching styles of my professors coupled with a better understanding of how science affects society increased my passion for genomics. This semester, I am working in the Kontos lab studying protein interactions that may explain how endothelial cells maintain a resting state, which is relevant to cardiovascular disease.

Outside of research, I like to run, read the New York Times, and devour law thrillers. When I have the time, I indulge in watching The Big Bang Theory, House, and the Good Wife. At home, I enjoy spending time with my parents and my 11-year old sister. It’s probably easier to answer some of the questions that my professors propose than the ones she does!

I look forward to contributing my perspective on research at Duke.

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