Chief Message: Summer Reading Program

Hope you are all well.  Our Duke Heart Pulse may look different over the next 3 -4 weeks.

The reason for this is that some of you may know that Tracey Koepke, communications director for Duke Heart, was diagnosed with breast cancer in November. She has an excellent care team at DCI, has done well through the first phase of her treatment, and is recovering from the next phase – a surgery.  She has been amazing in supporting our teams – and we are supporting her and making sure she knows our thoughts are with her as she works to recover.  She is comfortable with my sharing of this information – so keep her in your thoughts and if you get a chance send her a brief note.

While she is out of office (anticipated from till mid July), I have been thinking how to share more with our community.  Given the summer time – my sense was to share detailed but concise reviews of things that I am reading – scientific and otherwise, a “summer reading list” if you will.  The intention is to provide some thoughts and hopefully stir discussion amongst our community on topics of interest.  This weekend I have been on call for our cath lab – so as with several cases and the energy of working with our teams and fellows near the end of their year of training – I wanted to share some thoughts on a book I recently read.

So first – the book that I wish to have you all consider is Super Agers by Eric Topol.  As with everything Eric Topol does – it is a factual, easy to read, and informative book on some key themes that I believe will play a bigger role in all of medicine.

First, Eric Topol is a well known cardiologist (with many ties to Duke Faculty) and a history of working on some of our initial clinical trials in cardiovascular medicine, coronary revascularization – as I contemplate where we are with acute MI care this weekend and work with our team at Duke to carry out many of the lessons that Drs. Topol, Califf, Stack, Phillips, Granger, Ohman, Newby, Mark, and countless others have taught us.  He is currently the founder and directly of the Scripps Research Translational Institute and still practices cardiology.   He is also know as a digital health expert and broad thinker. He was previously also Director of the Cleveland Clinic Heart and Vascular Institute.

The concept for Super Agers he notes came from a study he performed on a cohort of 80 year old and above people with no medications and no signs of systemic disease.  They did whole genome sequencing looking for the key genomics as their first hypothesis on what will be different for these people.  And found that they are mostly healthy based on a serious of environmental and behavioral findings – and there was nothing in the genome sequences they could find to distinguish these peoples good aging.

These “Super Agers”—individuals who not only live longer but also maintain remarkable cognitive abilities, physical health, and emotional resilience well into their later years seem to have several findings.  As noted – the answer is not in their genes.  In fact, many had family members with many more clinical issues.

Fundamentally, Topal notes the big three (Cardiovascular disease, Cancer, and Neurodegenerative disease) are the keys to work on achieve Super Aging.  In fact, he notes that all of these conditions often “inclubate” for 10- 20 years before clinically manifesting.  Herein lies the greates opportunity with new science, technology – when added to routine daily behaviors.

Some Key Themes from the book:

1. Defining Super Agers:
   • Topol defines Super Agers as those who exhibit exceptional cognitive abilities and emotional well-being in their later years (above 80). They often outperform their peers in memory tests and maintain strong social connections.
2. Biological and Environmental Factors:
   • The book explores the interplay between genetics, lifestyle choices, and environmental influences on aging. Topol emphasizes the importance of diet, exercise, social interaction, and mental stimulation in promoting healthy aging.
3. The Role of Technology:
   • Topol is a strong advocate for the integration of technology in healthcare. He discusses how digital health tools, such as wearable devices and telemedicine, can empower individuals to take charge of their health and monitor their well-being.
   • He highlights how the confluence of AI, omics, Lifestyle +plus (resistance / muscle training / diet / GLP-1), cells, and drugs and vaccines will lead to many more super agers.
4. Neuroscience of Aging:
   • The author examines advances in neuroscience that shed light on how the brain changes with age. He discusses neuroplasticity and the potential for the brain to adapt and grow, even in older adults.
5. Real-life Examples:
   • The book is enriched with stories of Super Agers and insights from researchers in the field of gerontology. Many of these story serve to help understand the work.  Importantly – many of the chapters have great tables and all have references.
   • Topol provides actionable recommendations for readers to enhance their cognitive and physical health. This includes adopting a Mediterranean diet, engaging in regular physical activity, maintaining social relationships, and pursuing lifelong learning.

Key Biologic Insights:

As is often the case with Eric Topol – he has summarized an amazing amount of information.  He covers the GLP-1 and Gut-Brain axis, the biology of aging and three peaks for proteins that work to age, he covers gene editing and beyond, and ends with providing the overall impact of high computational biology and Agentic AI.  These parts of the book provide what is likely the processes that we all will see explored to make breakthrough or continue those in diagnosis, immune reprogramming, and measures of biologic age.  The book provides over 300 references.

My Take Home Message:

This is one of the next big frontiers for us to consider and conquer in how we move from caring for patients with existing and clinical disease to true prevention of cardiovascular, cancer, and neurodegenerative disease. Many of the process and underpinnings are similar, the technology and data for individual personalization are upon us.  Hopefully we can all play a part in building trust in the scientific community and process to ensure these breakthrough reach all in our community.

The book is worth a read if you have the time and interest.   Now for me –  back to call with our great interventional fellow and team to ensure we can help those with urgent needs while we strive for a better world of prediction and care.  Hope you all have a good week and I am open to any other summer reading suggestions from our Duke Heart Community.