Stories about: cardiovascular disease

Mitigating blood vessel damage from heart attack, stroke

Mouse hearts showing the impact of a therapeutic protein fusion on blood vessel health
Imaging of mouse hearts reveals widespread tissue damage (light-colored areas) after heart attack. At far right, however, mice that were treated with an engineered, optimized ApoM protein containing S1P have better tissue recovery than untreated mice (left) and mice that were given an inactive “dud” ApoM treatment (center). Credit: Hla lab/Boston Children’s Hospital

The average human has 60,000 miles of blood vessels coursing through their body. There are a number of mechanisms the body uses to keep that vast vascular network healthy, including a tiny fat molecule, a lipid called S1P, that plays a particularly important role.

S1P receptors dot the surface of the endothelium, a layer of cells that line the inside of all the body’s blood cells. Together, these so-called endothelial cells form a barrier between the body’s circulating blood and surrounding tissue. When S1P molecules activate their receptors, it suppresses endothelial inflammation and generally helps regulate cardiovascular health.

Now, researchers led by Timothy Hla, PhD, from the Boston Children’s Hospital Vascular Biology Program, report a novel therapeutic fusion that could trigger increased S1P receptor activity and recover blood vessel health following the onset of hypertension, atherosclerosis, stroke, heart attack and other cardiovascular diseases.

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What can pulse pressure teach us about pediatric obesity?

pulse pressure
Subtract 68 from 100 to get a pulse pressure of 42 (Wikiphoto/Creative Commons)

Second in a two-part series on cardiovascular prevention in children. Read part 1.

Carrying too much weight is tough on the body. The dramatic rise of obesity in recent years means more and more people are confronting increased cardiovascular risk due to changes in their blood vessels, cholesterol levels, blood pressure, and blood sugar. And the problem isn’t limited to adults: Today, there are more than three times as many obese children in the U.S. than there were in the early 1970s.

However, not every person with excess weight has cardiac risk factors, and not everyone with cardiac risk factors carries excess weight. So what is the relationship between childhood obesity and cardiac risk factors later in life? What links excess weight to its consequences?

Justin Zachariah, MD, MPH, a cardiologist at Boston Children’s Hospital, was inspired to investigate these “risk factors of risk factors” when he observed a pattern in his pediatric preventive cardiology clinic. He noticed that many of his patients who were carrying excess weight did not have very high blood pressure, or hypertension.

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Ambulatory BP monitoring for all kids with suspected hypertension? Model could lower screening costs

Blood pressure taken in child-shutterstock_181679828First of a two-part series on cardiovascular prevention in children. Read part two.

As childhood obesity has increased over the past 30 years, so has pediatric hypertension, which now affects one in 20 children. However, 48 percent of children with high blood pressure (BP) are of normal weight; other risk factors include low birth weight, which has also increased in the past 30 years (more recently dipping slightly to about 8 percent of births).

While children with hypertension rarely develop diseases that adults do, such as myocardial infarction, heart failure and stroke, they are at risk for adult hypertension and early symptoms of heart disease. “Attacking pediatric hypertension is the next frontier in cardiovascular disease prevention,” says Justin Zachariah, MD, MPH, of the Department of Cardiology at Boston Children’s Hospital.

The Affordable Care Act’s mandate to identify elevated BP in children is expected to increase referrals for screening. But diagnosing pediatric hypertension through BP screening in the clinic can be problematic. In a recent study, Zachariah found that ambulatory BP monitoring (ABPM) with a take-home device is both effective and cost-effective—especially when done from the get-go.

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Guidelines urging more cholesterol screening do not result in more kids on drugs

heart_screening cropped ShutterstockDespite recent national pediatric guidelines recommending identification and treatment of children with familial hypercholesterolemia, the use of lipid-lowering treatment has been flat over the past decade in real-world pediatric practice, finds a large multicenter study.

Justin Zachariah, MD, MPH, a pediatric cardiologist at Boston Children’s Hospital, presented the findings this week at the 2013 American Heart Association (AHA) Scientific Sessions. He believes they dispel some critiques of the recent guidelines, particularly concerns that more screening would result in overmedicating the pediatric population.

Extending beyond 2008 recommendations from the American Academy of Pediatrics, the 2011 National Heart, Lung and Blood Institute’s pediatric guidelines call for universal lipid screening and medical treatment for children at highest risk for early cardiovascular disease. One such high-risk condition is familial hypercholesterolemia, a genetic disorder characterized by high blood cholesterol levels, specifically very high levels of low-density lipoprotein (LDL, or “bad” cholesterol) and early coronary events.

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Blood pressure, cancer and EETs: Too much of a good thing?

Medicine is a balancing act; how much of a drug is too much? A group of compounds called EETs provide a clear example of the possible dangers of giving patients too much of a good thing. (chris grabert/Flickr)

Usually when your doctor talks to you about lipids, he or she is talking about cholesterol (be it the good or bad kind). But cholesterol is only one kind of lipid. There are millions of these fatty molecules working in everyone’s body right now.

One family of lipids, known as EETs (or epoxyeicosatrienoic acids), is produced by the endothelial cells that line blood vessels, where they help control inflammation and the response to injury. Because EETs are also potent regulators of blood pressure, pharmaceutical companies are looking intently at compounds that raise bloodstream EET levels as a way of managing the cardiovascular aspects of more than 20 conditions, ranging from diabetes and stroke to kidney and eye diseases; some are currently in clinical trials.

There may be a catch, however: Some studies suggest that EETs promote angiogenesis, or blood vessel formation, and that the enzymes that process EETs have a relationship to cancer.

Dipak Panigrahy and Mark Kieran of Children’s Vascular Biology Program and the Dana-Farber/Children’s Hospital Cancer Center wanted to understand this relationship better: Could boosting EETs be dangerous?

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Heart disease in childhood cancer survivors: Helping keep their hearts healthy

Survivors of childhood cancers may walk around with treatment-related heart damage for decades without knowing it. Ming Hui Chen wants to help these survivors keep their hearts healthy. (qthomasbower/Flickr)

Our success at treating children with cancer has steadily improved in the 40 years since President Nixon announced the War on Cancer. At the time, 3 in 10 children survived a diagnosis of cancer; now upwards of 8 in 10 do. The U.S. alone is home to an estimated 328,000 childhood cancer survivors today.

But as these survivors age, they can experience late effects, long-term medical complications of the very treatments that saved their lives. In fact, 30 years out, survivors are at more risk of dying from treatment-related illness than from cancer recurrence.

Perhaps the most insidious late effect – and the leading cause of non-cancer death at the 30-year mark – is cardiovascular disease.

Treatment-related heart damage can take decades to appear. This long latency means that a woman treated for cancer at age 6 could face a heart attack when she’s 36. And she might never see it coming. “A survivor can walk around for years with minimal symptoms while their cardiovascular disease silently progresses,” says Ming Hui Chen, an adult cardiologist at Children’s Hospital Boston.

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Battling rising hypertension in children: 5 tools

FDR (here signing the Declaration of War against Japan, 1941) died from a stroke caused by years of hypertension. Millions of U.S. children could meet the same fate – unless we act now.

While many of us recall that President Franklin Delano Roosevelt had polio, few remember that he died in 1945 from another cause: stroke. The sentiment of his physician — that it “had come out of the clear sky” — reflected the prevailing view that heart attack and stroke were bolts from the blue that doctors could act on only after the event.

But a few mavericks challenged this “salvage” paradigm, establishing the Framingham Heart Study in 1948 to identify predictors of cardiovascular events. One leading maverick, Dr. William Kannel, who passed away last month, coined the term “risk factors” to describe these predictors. Acting on the insight that controlling risk factors could prevent cardiovascular disease saved the lives of more than 150,000 Americans from heart disease alone between 1980 and 2000.

Judging by the surviving medical records, Roosevelt’s stroke may have been preventable with treatment for one such risk factor, hypertension. How different would the world have been had his persistent high blood pressure been treated?

The world is different now, not all for the better. High blood pressure has been attacking more and more children over the last 30 years,

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Putting technology to work to get kids exercising

Obesity among children is on the rise, but just telling them to out and get more exercise doesn’t work well. Tracy Curran hopes technology and counseling can help. (Photo: Wagner T. Cassimiro "Aranha"/Flickr)

[Ed. Note: This is the second in a series about Children’s Hospital Boston staff who received Patient Services Research Grants in 2011. This grant program engages the professional staff in the Department of Patient Services in high quality pediatric research with the ultimate goal of improving child health]

We all look at babies and fall in love with their chubby little legs and paunchy bellies. (When my younger son was a baby, a friend often jokingly threatened to “eat him like a marshmallow.”)

Cute as it is in babies, though, children can’t afford to have that cushioning as they get older. Obesity threatens the future health of a whole generation of children, putting them at risk for a host of long-term health problems like high blood pressure, type 2 diabetes (increasingly starting in childhood) and cardiovascular disease. This is on top of more immediate problems like sleep apnea, asthma, low self-esteem, depression, fatty liver disease (which can turn into cirrhosis) and joint pain.

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