UK gets biggest-ever grant from National Institutes of Health to probe links between obesity and cardiovascular disease

The University of Kentucky has received its largest-ever National Institutes of Health grant to explore connections between two of the state's biggest health problems, obesity and cardiovascular disease.

Dr. Lisa Cassis
directs the program.

The university's Center of Biomedical Research Excellence "supports research of promising junior faculty focused on identifying mechanisms linking the epidemic of obesity to a high prevalence of cardiovascular diseases," a UK press release said. The faculty support helps the researchers compete for new NIH grants. In the first phase of the program, 90 percent competed successfully, and they published 500 study reports.

"Research to be executed under the present grant runs the gamut from laboratory research conducted at the cellular level, to bedside translational research conducted in pediatric and adult patients," the release said. "Projects focus on mechanisms for the development of obesity, the influence of obesity on recovery of the heart following a heart attack, obesity-induced inflammation, and how this influences the cardiovascular system, and imaging of heart dynamics and function in obese children."

New guidelines for cholesterol management spark controversy; faulty risk calculator could lead to over-prescribing statins

The American College of Cardiology and the American Heart Association released new guidelines for cholesterol management, a new formula to assess heart attack and stroke risk, and guidelines for lifestyle modifications and weight management to reduce heart attack and stroke risk.

“These guidelines will be helpful to all physicians and their patients, but they will be particularly relevant in Kentucky, where nearly 70 percent of Kentuckians are overweight or obese, we are the third highest state in rates of high blood pressure, five Kentucky counties are among the least active in the U.S. and the incidence of diabetes is above the national average,” Dr. Susan Smyth, director of the Gill Heart Institute at the University of Kentucky, said in an e-mail.

However, some experts have questioned the new guidelines, and the new formula for calculating cardiovascular risk appears to overstate the risk value used to determine who should receive cholesterol-lowering statin drugs.

"There may be no single perfect score that we can use to give statins the 'thumbs up' or 'thumbs down' for our patients without established cardiovascular disease," Smyth said. "Ultimately, physicians have many different tools at their disposal to evaluate CV risk in their patients, and they will review all of the available evidence to make a determination about who may be likely to benefit from statin therapy."

The new guidelines also change how statins should be prescribed. The drugs have been given to lower cholesterol to a specific numerical value, but now it is suggested that moderate to high doses of statins be given to patients who fall within four identified groups of patients who have been determined to get the most benefit from the drug:

• already diagnosed with heart disease or stroke
• with an LDL {"bad" cholesterol) of 190 mg/dL or higher, who may have genetic risk
• aged between 40 and 75, with Type 2 diabetes and high LDL levels, but without heart disease or stroke
• with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75, without heart disease or stroke, but with high LDL levels.  

Instead of focusing strictly on patients' LDL and total cholesterol, the new guidelines suggest physicians treat patients based on their overall risk of heart disease or stroke, of which cholesterol levels are just one part, according to the report.

The guidelines in the report also call for lifestyle modification, including adhering to a heart-healthy diet, which includes vegetables, fruits, whole grains, low-fat dairy, poultry, fish, beans and healthy oils and nuts; 30 to 40 minutes of exercise three to four times a week; avoidance of tobacco products, and maintenance of healthy weight.

The guidelines use a cardiovascular risk calculator that considers age, race, sex, diabetes, smoking habits, blood pressure and low HDL, or "good" cholesterol levels, among other considerations.

But a problem has been identified with the risk calculator, so worrisome that a past president of the College of Cardiology called for a halt to the implementation of the new guidelines, reports Gina Kolata of The New York Times. The calculator appears to overestimate the risk group so greatly, Kolata reports, that it could mistakenly suggest that millions more people should be candidates for statin drugs.

"It's stunning," the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine of the Cleveland Clinic, told Kolata. "We need a pause to further evaluate this approach before it is implemented on a widespread basis."

After an emergency, closed-door meeting on Saturday night, the two organizations that published the guidelines said "that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator," Kolata reports.

Dr Sidney Smith, the executive chairman of the guideline committee, told Kolata that "the association would examine the flaws found in the calculator and determine if changes were needed."

Two Harvard Medical School professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the calculator was not working among the populations it was tested on by the guideline makers a year earlier, during an independent review for the National Institutes of Health's National Heart, Lung, and Blood Institute, which originally developed the guidelines, Kolata reports.

Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University, told Kolata that "the committee thought the researchers had been given these results."

Ridker and Cook evaluated the calculator again after they saw the guidelines and found that it over- predicted risk by 75 to 150 percent, depending on the population, Kolata reports. They wrote in The Lancet, a British medical journal, that the miscalibration be "reconciled and addressed" before implementation, saying: "If real, such systematic overestimation of risk will lead to considerable over-prescription."

Some doctors are concerned that because many people are already "leery of statins, the public would lose its trust in the guidelines or the heart associations," Kolata reports. Currently, it is only obvious that those in the highest risk groups, such as those who have heart attacks, strokes or have diabetes, should take statins, she reports.

Herald-Leader blasts UK for secrecy surrounding children's heart program and its efforts to rebuild it despite nearby competition

The Lexington Herald-Leader blasted the University of Kentucky in an editorial Sunday for "stonewalling questions about the decision to halt pediatric cardiothoracic surgeries and the mysterious sidelining of Dr. Mark Plunkett, the high-profile surgeon UK hired in 2007 to rebuild that program."

Mark Plunkett

The editorial says UK officials implied that "all would be clear" after their examination of the children's heart program, but "nothing is clear" after they issued a 100-page report that "offers no explanation about what went wrong. In fact, Plunkett's name never appears in the report."

But the report does acknowledge two challenges in rebuilding the program: "There are several excellent congenital heart centers in close proximity" to Lexington, and "In some cases we must regain the trust of our referring providers." Dr. Michael Karpf, UK's vice president for health, has been publicly appealing for referrals of all types from hospitals and physicians in Western Kentucky, where UK competes with Vanderbilt University.

Michael Karpf

"After two unsuccessful, no doubt very expensive, efforts to build this program, UK wants to try again," the editorial says. "And it wants to regain trust of referring physicians and families with very sick, very young children despite the fact that it has consistently undermined trust by refusing to answer legitimate questions. UK has in fact agreed to pay a lot of money to avoid a public discussion of what went wrong," keeping Plunkett on the payroll, then paying him $1.5 million for "a vow of silence on both sides."

The editorial concludes, "It is aggravating that UK, a public land-grant institution in a very sick state, is intent on carving out a specialized, expensive health-care niche that's already filled when there are so many needs that are not being met. It is also deeply disturbing that UK's energy and treasure are aimed at maintaining a shroud of secrecy over this program. We still don't know much about what happened in Plunkett's operating rooms but it is clear that UK botched this opportunity to regain the public's trust." (Read more)

Asked to reply, UK spokesman Jay Blanton said, "First, our job is to make sure that Kentuckians have access to the most complex health care. Kentuckians should not have to go outside Kentucky to have access to such high-quality, complex care. . . . If we didn’t have such a program, Kentuckians – particularly those in Eastern Kentucky – will have to leave the state for critically important pediatric care. Moreover, part of the requirements of having a Level 1 trauma center and service for this region is to have an appropriate presence in this critical area of children’s care.

"Second, we’ve been totally forthright. Our standards and expectations – for both transparency and quality – are evidenced by, among other things, our ranking just this month of 12th out of 118 academic medical centers for quality, by University Health Consortium. UHC provides an objective, impartial analysis across a range of quality measures. You don’t rank 12th in the country if you are not putting forward, in a transparent fashion, your numbers and outcomes across an array of metrics and quality measurements."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentuckians can act to protect against heart disease and stroke; half of preventable deaths occur in adults age 65 or younger

By Molly Burchett
Kentucky Health News

Nearly one on three deaths in the U.S. each year is caused by heart disease and stroke. At least 200,000 of these deaths are preventable, and nearly half of those preventable deaths are of people under 65, says a new report.

What can you do to stop heart disease and stroke from killing you? Change your health habits, says the federal Centers for Disease Control and Prevention's "Vital Signs" report. Changes can include quitting smoking, getting more physical activity and using less salt in your diet. Kentucky communities can also take preventive measures by creating healthier living spaces, such as smoke-free zones and safe places to exercise.

While the number of preventable deaths from heart disease and stroke has declined in people 65 to 74, it has remained virtually unchanged in those under 65, says the report. Men, particularly black men, are at a greater risk for dying early from these conditions. Overall, counties in Southern states, including Eastern and some parts of Western Kentucky, have the highest preventable death rates.

Map: Age-adjusted preventable death rates per 100,000 people from CDC "Vital Signs" 

To take action against the heart disease and stroke, risk factors should be considered. Adults in Kentucky have been found to have these risk factors for heart disease and stroke: high blood cholesterol, diabetes, overweight or obesity, not exercising regularly and not eating the suggested amount of fruit and vegetables.

If you have one of more of these risk factors, it is possible to reduce your risk of getting and dying prematurely from heart disease or a stroke. For example, you should work with your doctor on a treatment plan to control your high cholesterol and diabetes, and if you use tobacco, find resources to quit smoking.  It is also important to maintain a healthy diet and a weight, in addition to exercising for 2 hours and 30 minutes every week. (Click here to read more)

Study says obese children (Kentucky's a leader in that) may have quadruple the risk of having high blood pressure as adults

By Molly Burchett
Kentucky Health News

A new study shows that being obese in childhood may quadruple the risk of having high blood pressure risk as an adult, highlighting the need for Kentucky to curb its high rate of childhood obesity.

Eighteen percent of Kentucky high schoolers are obese, tying Mississippi for the highest percentage among the states, says a report by Kentucky's Task Force on Childhood Obesity. In the age range of 10 to 17, Kentucky trails several other states but remains a national leader.

One in three U.S. children and teens are overweight or obese, meaning their body mass index is at least the 85th percentile or at least the 95th percentile for their age and gender, respectively, says the American Heart Association. And, even more children are at-risk of becoming obese adults by the year 2030, says new report from Trust for America’s Health and the Robert Wood Johnson Foundation.

This study adds to concern about the long term impact of childhood obesity by linking it with increased risk for high blood pressure. High blood pressure, if left untreated, can damage the heart and coronary arteries that can ultimately lead to a heart attack, heart disease or congestive heart failure, says the AHA.

The findings, which were presented at the American Heart Association High Blood Pressure Research Scientific Sessions 2013, are also part of the growing body of evidence that heart disease may start in childhood, said Dr. Sara E. Watson, study author and a pediatric endocrinology fellow at Riley Hospital for Children at Indiana University in Indianapolis.

Study researchers tracked the growth and blood pressure of 1,117 healthy adolescents from Indianapolis for 27 years, starting in 1986, finding that 6 percent of normal weight children and 26 percent of obese children had high blood pressure as adults.

“It is important that pediatricians counsel patients on the risk of high blood pressure associated with overweight and obesity, and stress that a healthy diet, including reducing salt intake and exercise, may help reduce this risk,” Watson said. “Interventions to prevent and treat obesity will play an important role in decreasing the significant burden of high blood pressure in adulthood.”

UK's Gill Heart Institute joins Appalachian Regional Healthcare to advance specialty heart care in Eastern Kentucky

Appalachian Regional Healthcare, the Appalachian Heart Center and UK HealthCare’s Gill Heart Institute announced a new collaboration to deliver cardiovascular care to Eastern Kentuckians, which will extend the UK's sub-specialty care footprint and increase access to cardiovascular expertise in the area.

Cardiologists Dr. Vidya Yalamanchi, Dr. Rao Podapati and Dr. Srini R. Appakondu from Hazard's Appalachian Heart Center will team up with UK to provide advanced treatment options not before available in the eastern part of the state.

“We look forward to the opportunity to work closely with the physicians and health care providers at Gill Heart Institute to enhance cardiology services to patients in Eastern Kentucky,” said Dr. Yalamanchi. “This partnership is an example of teamwork that emphasizes a commitment to providing exemplary patient care.”

In addition to the combined efforts in Hazard, UK and ARH have also agreed to jointly administer and manage cardiovascular services at ARH hospitals in Harlan, Whitesburg, McDowell, Hyden and Williamson, W.Va.

 “The goal of this collaboration is to expand the scope of cardiology services provided within our community,” said Joe Grossman, president of ARH. “By providing a range of comprehensive cardiology services, including inpatient and outpatient services to residents of Eastern Kentucky, we hope to improve lives in a region where patients suffer from some of the highest rates of mortality in the nation from heart disease and stroke.”

UK officials have said their hospital must expand its geographical reach to ensure access to quality care for Kentuckians. This collaboration represents a step towards achieving both this goal and the goal of being the hospital destination for sub-specialty care in the state and region.

“This alliance further expands the UK HealthCare mission to improve access to quality health care delivery for all Kentuckians in a cost effective and responsible manner,” Dr. Michael Karpf, UK executive vice president of health affairs, said in the release. “But the real benefit for many patients and their loved ones will be the ability to stay close to home for complex cardiology care.”

Petition drive from parents asks UK Healthcare to release mortality rates for cardiothoracic surgeries on children

More than 250 people have signed a petition asking the University of Kentucky hospital "to make public the mortality rates for pediatric cardiothoracic surgery patients from 2010, 2011 and 2012," Linda Blackford reports for the Lexington Herald-Leader. "All pediatric cardiothoracic surgeries were suspended at UK last fall amid an internal review." UK spokesman Jay Blanton said Monday the investigation is not complete.

"In May, the state attorney general's office issued an opinion that said UK must release mortality rates and other data about the cardiothoracic surgery program to WUKY, the university-owned radio station," Blackford reports. "UK has acknowledged that it calculated mortality rates for the program as part of its investigation, but has refused to release them, citing patient confidentiality laws." The Herald-Leader also requested the information under the Kentucky Open Records Act.

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

The three-year span includes the tenure of ardiothoracic surgeon Dr. Mark Plunkett, who no longer works at UK. Jennifer Allen, whose one-year-old daughter died after having three surgeries performed by Dr. Plunkett, wrote on the petition, "We deserve to know this information, we CAN understand and comprehend this information. It is our right to know and the right of the public!" Allen's daughter suffered from hypoplastic left heart syndrome, where the left side of the heart is underdeveloped and can't pump blood properly. Allen told Blackford she finds it "very suspicious" that UK won't release the information. UK says there were so few surgeries at times that patients' identities could be deduced.

Tabitha Rainey, whose son survived cardiothoracic surgery at UK, before being moved to another hospital, started the petition after being interviewed by CNN, which reported on the issue over the weekend and updated its story today with news of the petition. She said she doesn't accept UK's response that publicly releasing mortality rates would somehow harm patient confidentiality, telling Blackford, "There are no names and no dates, just the data on how many have passed on." (Read more)

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpReadmore here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy, wrto

Seven Ky. communities get grants to reduce risks for chronic diseases among children and 'Invest in Kentucky's Future'

Seven diverse Kentucky communities are getting money to reduce the risk of chronic disease among Kentucky's youth. The initial grants announced Thursday are part of the Foundation for a Healthy Kentucky's new Investing in Kentucky’s Future initiative, a five-year, $3 million program.

“The health of our next generation is at stake,” said Susan Zepeda, CEO and president of the foundation. “Our goal is to help communities make positive changes in policies and service access that will help our children grow into healthy, productive adults. Regardless of the challenges, we want to help communities find new pathways to positive solutions.”

Community groups will use their initial grants to collect and analyze local health data. That analysis will guide development of innovative strategies for effective, sustainable measures to improve children's health. Those communities chosen for the initiative are:

• Clinton County School District, Albany: initial grant of $27,755 for the Clinton County Healthy Hometown Coalition. “We are thrilled that our community was chosen to participate in this important initiative,” Asst. Supt. Paula Little said. “The members of the Healthy Hometown Coalition are committed to helping children grow up in a physical, social, and cultural environment that supports good health habits. With help from the foundation, we can develop our capacity to make a lasting, positive change in our community.”

• Fitness for Life Around Grant County, Williamstown: initial grant of $21,643 for FFLAG and the Northern Kentucky Health Department. “We are pleased and excited to be given the opportunity to work with the Foundation for a Healthy Kentucky,” FFLAG Chairman Jeff Walters said. “We are a small group that has been working on improving the health of our community and we believe we’ve had a positive impact thus far. This grant will accelerate the process and the work that’s been started.”

• Foundation for Appalachian Kentucky, Hazard: initial grant of $32,558 for Perry County Wellness Coalition. “We’ve been working for several years to improve the menu and encourage better eating habits in and out of school,” said Linda Campbell, nutrition director at Perry County Schools. “It’s not as easy as changing a menu or just buying whole wheat bread. We’re changing a culture, and that’s not a simple thing. Working together, as a community, we can really start to make a difference. This grant from the Foundation for a Healthy Kentucky allows us to take the next steps toward helping our kids to become healthier.”

• Green River Area Development District, Owensboro: initial grant of $40,483 for Partnership for a Healthy McLean County. “The Partnership for a Healthy McLean County realizes the impact community organizations, schools, work sites and health care have on the health of families,” said Jiten Shah, executive director of the district. "Obesity is a major factor for many chronic diseases which can begin in childhood and continue into adulthood. "

• Kentucky Heart Foundation Inc., Ashland: initial grant of $19,245 for Healthy Kids, Healthy Communities in Ashland. “Investing in Kentucky’s Future is a perfect fit for the work of the Healthy Kids Coalition and gives us the opportunity to continue to work on policy, system and environmental changes to improve the health of children in Boyd and Greenup counties,” said Laura Patrick, coordinator of Healthy Kids, Healthy communities. “We know that this approach will help sustain change for years to come and what is great about it is that it is sustainable.”

• Kentucky River Community Care, Inc., Jackson: initial grant of $34,156. “This foundation grant will help Breathitt County plan more opportunities for youth and families to participate in healthy lifestyle activities,” said Bridget Turner, KRCC director of clinical services. “We need to develop a strategic plan to specifically address the many barriers that face our children and threaten their future. Education, prevention, behavioral health, physical health, nutrition, employment, substance abuse are a few of the issues that we are trying to deal with in our county.”

• Louisville Metro Department of Public Health and Wellness: initial grant of $34,160. “If we are ever going to realize a healthier future for our citizens, we must improve the health of our young people,” said Dr. LaQuandra Nesbitt, director of the department. “These funds from the Foundation for a Healthy Kentucky will facilitate a coordinated, systemic approach to overcome the health barriers that many of our youth face. The grant will allow us to formulate policies and strategies to improve health that are based on accurate data with buy-in from stakeholders across the community.”

Reducing chronic diseases to improve Kentuckians' health
 
Chronic diseases such as cancer, diabetes and heart disease, are those that last over time, decrease quality of life, increase the risk of early death and occur at higher rates in Kentucky than in surrounding states; substance abuse and some mental illnesses are also chronic diseases.

Kentucky’s children are at greater risk than most for chronic diseases, including high rates of obesity and smoking. When children grow up, they are at an increased risk for heart disease, cancer or stroke, and Kentucky is above the national average in deaths from these diseases.

The Investing in Kentucky's Future initiative will help Kentucky communities confront this cycle of problems. The foundation is encouraging local leaders to identify how best to engage the community in order to have the biggest impact.

“This is the first step in our multi-year approach, which will lead to implementation of permanent solutions for healthier communities,” said Zepeda. “We believe that by working together on the local level, civic leaders with vision can develop innovative strategies to improve the health of our children.”

More than 50 interested organizations responded to the foundation’s request for proposals in October last year, and 22 were invited to submit a full proposal. The foundation’s board of directors approved funding for seven as part of the initiative. Click here to read more about the foundation.

Kids' excessive salty snacks are linked to obesity, high blood pressure; new limits on school vending items may help

As new research shows that America's child-obesity epidemic is linked to eating too many salty snacks,  new federal regulations could ensure that vending-machine snacks in Kentucky's schools are healthier and lower in sodium.

Spurred by children eating too much salt and being too fat, "blood pressure in America's kids and teens has gone sky-high," creating a young generation at risk for serious health problems, including heart disease, stroke, reports Brian Alexander of NBC News.

“Kids eat far too much sodium,” the study's co-author, Dr. Stephen Daniels told NBC. “And they aren’t adding it at the table, and their parents aren’t putting it into food; they’re getting it through processed foods.” The research, published Monday in the journal Hypertension, links this rising blood pressure to children's increasing bod- mass index and sodium intake.

The "Smart Snacks in Schools" nutrition standards, announced last month by the Department of Agriculture, require any food sold in public schools to meet calorie, fat, sugar and sodium limits. The changes shouldn't be very significant for Kentucky students because the state already prohibits vending machine sales during the school day. And, a few existing state regulations, like fat content, are tougher than the federal changes and will remain in place, Sue Bartenfield, nutrition program manager for the Kentucky Department of Education, told Stu Johnson of the Kentucky Public Radio bureau in Frankfort. The new federal limits on calories and sodium are tighter, and the federal law will also keep vending machines shut down for a half-hour after school, Bartenfield told Johnson.

Chief of cardiothoracic surgery and pediatric heart program at UK, suspended from surgeries, takes job in Florida

Dr. Mark Plunkett, the chief University of Kentucky cardiothoracic surgeon whose surgery program was suspended last year for unspecified reasons, has accepted a new job a the University of Florida.

The internal review of UK HealthCare's pediatric cardiothoractic program is ongoing and should be completed in the next few weeks, Michael Karpf, UK's executive vice president for health affairs, told Linda Blackford of the Lexington Herald-Leader.

In December, Brenna Angel, reporter for university radio station WUKY, identified Plunkett as the surgeon at the center of the program review. At the time, Plunkett was on a leave of absence but remained on staff with a $700,000 salary, Angel reported. WUKY requested data under the Kentucky Open Records Act about Plunkett's most recent surgery and his patient mortality rate, but UK denied such requests. Attorney General Jack Conway ruled that UK must release the mortality rates and other data, but UK Has appealed to Fayette Circuit Court, citing privacy rules in the federal Health Insurance Portability and Accountability Act, even though Conway said HIPAA doesn't preempt the Open Records Act, as Angel reported. Angel has since left the station for Lexington city government but the station and the Herald-Leader are defending the appeal.

In addition to being chief of UK's Division of Cardiothoracic Surgery, Plunkett was director of its pediatric cardiac program and a co-director of UK's Gill Heart Institute, says his UK biography. He came to UK in 2007 from the UCLA medical center, where he worked with Karpf. His resignation is effective Aug. 14, UK officials told Blackford.

Floyd County newspaper editor calls on readers to make lifestyle changes to address area's diabetes health crisis

The editor of an Eastern Kentucky newspaper has joined an advocacy group's call for residents in his county to make simple, healthy lifestyle changes, serving as an example of how local newspapers and community members can engage the public to confront poor health status of the area, which is often put on the back-burner despite alarming warning signs.

Recently, the Tri-County Diabetes Partnership declared the rate of diabetes in Floyd, Johnson and Magoffin counties (map) "a crisis of epidemic proportions." The rate in 2002-10, the latest available, was 14 percent.

If the federal Centers for Disease Control and Prevention "saw a similar increase in any other illness, they would probably declare a national emergency,” said J.D. Miller, vice president of medical affairs for Appalachian Regional Healthcare, who chaired the meeting.

The group's statement was an appropriate response to direct public's attention to the imperative of addressing the area's skyrocketing rate of the disease, Ralph Davis of The Floyd County Times wrote in an editorial.

Diabetes will remain a crisis unless we do something about it, said Davis, and "if you have been waiting for a crisis before making healthy lifestyle changes, we’ve got one for you. In fact, we have several," Davis said.

The Central Appalachian region suffers from disproportionate rates of diabetes, cancer and heart disease, and Floyd, Magoffin and Johnson counties have much higher rates of obesity than state and national averages, Davis notes. Floyd County ranks last among the state’s 120 counties in overall health measures, and Johnson and Magoffin counties are ranked 108th and 104th, respectively.

To do something about this problem, Davis calls for concentrated attention by health care providers and government officials, but the problem won't be solved without action from the community and individuals, he says. Simple, healthy lifestyle changes are needed.

"It’s going to require the conscious decision by everyone in the region to do what they can to improve their diet and exercise habits, and to encourage their friends and family to do the same," said Davis.

Calls like Davis's are needed even more in most of the counties that surround the three counties, based on data from the CDC's Behavioral Risk Surveillance System. The counties in dark blue had rates above 14 percent; the highest was Greenup, at 17 percent.

Medically unnecessary procedures are part of culture of disability in Eastern Kentucky, professor writes

St. Joseph London Hospital is taking heat over accusations of performing medically unnecessary cardiac catheterizations and other invasive cardiac procedures, and a look at the health data by a Kentucky physician suggests that the phenomenon is broader and reflects cultural problem in Eastern Kentucky.

An examination of health data by Dr. Peter Hasselbacher, a retired internist and professor emeritus at the University of Louisville, confirmed that St. Joseph London performed a large number of invasive heart procedures for such a relatively small, rural hospital.  Many patients have sued the hospital, alleging unnecessary procedures, notes a story in The Courier-Journal.  And when the hospital came under federal supervision, the frequency of its most commonly performed stent-angioplasty procedure dropped by 37 percent, Hasselbacher reports on his Kentucky Health Policy Institute blog.

As the number of St. Joseph London procedures dropped sharply, there was a more dramatic increase in catheterizations and angioplasties statewide. From 2010 to 2011, the number of the most commonly reported angioplasties in Kentucky increased from 12,803 to 22,688, a 77 percent increase, reports Hasselbracher.

This map showing how many people living in each of Kentucky’s counties underwent a percutaneous transluminal coronary angioplasty (PTCA) in 2010. This is the most common invasive cardiac procedure in Kentucky and is used to prevent and treat heart attacks.

In this map, the darker the shade of blue, the greater percentage of people living in that county had an angioplasty in 2010. The differences among the counties is staggering. It ranges from a low of 42 people per 100,000 in a single year, all the way up to 1,700 per 100,000 – a 40-fold difference. In the counties with the highest rates, between 1 percent  and 2 percent of the county's population underwent the procedure in a single year.

These rates are based on where people live, rather than where they go to the hospital, and the counties with the highest rates are in Appalachia. Hasselbacher calls Eastern Kentucky is "an angioplasty factory" and says the phenomenon can't be be fully explained by the simple fact that people in the region are sicker than those in the rest of the state; he offers another explanation.

"It is my belief that a major, perhaps even the major segment of the economy of Eastern Kentucky revolves around the getting of disability and the keeping of disability" and its government benefits, Hasselbacher writes. "As other industries such as coal and tobacco have faded in importance, the pursuit of disability, medically justified and not, has drained away resources from medical services into an ersatz unemployment and social support program."

Hasselbacher, left, says he doesn't wish to imply that the people of Eastern Kentucky are morally distinguishable from the rest of us, or that their health-care professionals are any less professional. He acknowledges that the region has had an uphill struggle for many years, and it is easy for providers to fall into the trap of wanting to do everything and anything to help patients.

"A culture has evolved in which being sick or just having a diagnosis of being sick is a gateway to economic security for people and professionals alike," Hasselbacher writes. "Some patients, doctors, hospitals, and lawyers wittingly or unwittingly support that process. Doing medially unnecessary diagnostic testing and treatment is part of that culture. It is also good for business." (Read more)   

First major study of diet and strokes links fried, sugary Southern diet, low on fruits and vegetables, to increased risk

Genuine Kentucky fried platter:
Cornbread, fried catfish, fried green
tomatoes, fried apples and fried okra
(Photo from Ramsey's, Lexington)

By Molly Burchett
Kentucky Health News

People with a Southern diet, or one heavy on fried food and sugary drinks like sweet tea and soft drinks, are more likely to suffer a stroke, a new study finds.

It's the first big look at diet and strokes, and researchers say it might help explain people in the nation's "stroke belt" or southern states suffer more of them, reports Marilynn Marchione of The Associated Press.

These findings have important implications for Kentuckians because stroke accounts for 5.5 percent of Kentucky deaths each year and more than 81 percent of Kentucky adults eat fruit and vegetables fewer than 5 times a day, which is a indicator of risk for stroke:

Heart Disease and Stroke Risk Factors from federal Behavioral Risk Factor Surveillance System national survey	Ky.	U.S.
Eat fruits and vegetables less than 5 times/day	81.6	75.6
Overweight or obese	69.1	62.9
No moderate or vigorous physical activity	55.8	50.5
High total blood cholesterol	38.5	37.6
High blood pressure	30.0	27.8
Cigarette smoking	28.2	19.8
Diabetes	9.9	8.0

"We're talking about fried foods, french fries, hamburgers, processed meats, hot dogs," bacon, ham, liver, gizzards and sugary drinks, said the study's leader, Suzanne Judd of the University of Alabama in Birmingham.  For the study, a southern diet also included jerky, red meat, eggs, and whole milk.


Fried foods tend to be eaten with lots of salt, which raises blood pressure and sweet drinks increases risk for diabetes- both are known stroke risk factors, Judd said.

People who ate about six meals a week featuring these sorts of "Southern" foods had a 41 percent higher stroke risk than people who ate that way about once a month, researchers found.

In contrast, people whose diets were high in fruits, vegetables, whole grains and fish had a 29 percent lower stroke risk, reports Marchione.

"It's a very big difference," Judd said. "The message for people in the middle is there's a graded risk" — the likelihood of suffering a stroke rises in proportion to each Southern meal in a week. 

These findings were reported last week at the American Stroke Association conference. The study was launched in 2002 to explore regional variations in stroke risks and reasons for them.

Stroke death rates in Kentucky vary widely among counties. Here's a county map of the rates, from KentuckyHealthFacts.org, which has a county-by county list:

The map shows stroke rates in ranges per 100,000 population from 2003 through 2007. Purple counties had rates above 69; blue counties ranged from 52 to 69; turquoise were 44 to 52; light blue were 31 to 44 (the number that is about the national average), and tan were 18 to 31.

Small steps can prevent Kentucky's No. 1 killer, heart disease

It is now February, which is American Heart Month and a perfect time to remind people that small steps can reduce their risk of heart disease, Kentucky's No. 1 killer.

You may be surprised to hear that almost 80 percent of heart disease is preventable and there are daily things that can be done to keep hearts healthy, according Dr. Martha Grogan, medical editor-in-chief of Mayo Clinic Healthy Heart for Life.

For example, try to move 10 extra minutes each day, Recent research shows a sedentary lifestyle may increase your risk of heart attack almost as much as smoking, said Grogan.

Each day, make an effort to get up from your desk to go talk to a colleague instead of sending an email, or walk around the house as you are talking on the phone, she recommends: “Moving even 10 minutes a day for someone who’s been sedentary may reduce the risk for heart disease by 50 percent.”

Hearts are also hurt when you deprive yourself of sleep, which is a necessity like food and water, said Virend Somers, a Mayo cardiologist and sleep expert. Chronic sleep deprivation can increase the risk of obesity, high blood pressure, heart attack, diabetes and depression.

Healthy habits can reduce a majority of risks for heart attack. "A 53-year-old male smoker with high blood pressure has a 20 percent chance of having a heart attack over the next 10 years. If he stops smoking, his risk drops to 10 percent; if he takes high blood pressure medicine, it falls to 5 percent," says preventive cardiologist Randal Thomas, M.D.

These healthy habits and changes like quitting smoking and taking blood pressure medicine can make a difference in life and death. For more from the Mayo Clinic, click here; for a American Heart Month information from the federal Centers for Disease Control and Prevention, go here.

Children with TVs in their bedrooms are twice as likely to have extra fat, three times greater risk of heart disease and diabetes

Kids who have TVs in their bedrooms are twice as likely to be fat and nearly three times as likely to be at risk for heart disease and diabetes as those who don’t, according to a new study that elevates concerns about health and screen time. The research, published in the American Journal of Preventive Medicine, studied 369 children, 5 to 18, who have TVs in their rooms and watched more than five hours of television a day. They showed dramatic evidence of extra belly fat, bigger waists, greater risk of heart disease and diabetes and elevated triglycerides, or fat in their bloodstream, said Amanda Staiano, a scientist with the Pennington Biomedical Research Center in Baton Rouge, La. (Getty Images photo)

A 2010 study cited by Staiano indicated that 70 percent of American children have a TV in their bedroom. In the Pennington study, 66 percent of the kids had a TV in the room and the precise relationship between TV and health, as measured by height, weight, waist measurements, blood pressures, fat deposits and other exams, revealed the stark disparity between the groups with and without their own TV. (Read more)

One S.C. county serves as incubator for state's efforts to battle weight problems, with some good results

PE teacher Sharon Williams, right,
leads morning exercises before
classes start at Bells Elementary.
(The State photo by Tim Dominick)

With nearly two-thirds of South Carolina deemed overweight or worse, lucky Colleton County got picked to be a test case for doing better. That is, for improving its chances to beat the state's already overwhelming rates of diabetes, heart disease and stroke and for helping to lower the state's $1.2 billion dollar medical bill. Lucky, because in 2010, the county was awarded almost a half million Eat Smart Move More grant by the BlueCross BlueShield of South Carolina Foundation to see if it could promote health eating and more physical exercise countywide. Joey Hollerman of The State newspaper in Columbia, S.C., reports that "the results have been striking," though he notes that changing obesity numbers is "like turning an aircraft carrier, it's a slow process." Mostly, he's talking about attitude and perseverance.

How does the county-wide program work on a daily basis? First, of course, you have to have buy-in, which this county did. Hollerman explains that now when children arrive at Bells Elementary School in the county seat of Walterboro, "they go straight to the gym and walk laps before heading to classrooms. Worshipers at Power of Faith Delivery Ministry harvest collards as well as souls, and fried chicken is discouraged at church dinners. The local farmers market has a sparkling new home and a system set up to accept cards from the Supplemental Nutrition Assistance Program." The Let’s Go, Eat Smart program and exercise programs are posted in schools, workplaces, grocery stores and churches.

So how, if the numbers aren't clear yet, how to measure if it's working? Well, only one fried chicken basket showed up at a recent church supper and the member who brought it ended up apologizing for her breach. On the day the reporter visited only the elementary school only one child in the entire first grade tried to slip through without selecting a fruit or vegetable. He was sent back and grabbed a plastic container of grapes from the Go (instead of the Slow or Whoa) food options, Hollerman reports. There are also anecdotes galore, including those of children, once on insulin, who are now fine without it.

South Carolin's BlueCross BlueShield recently awarded another grant to Eat Smart Move More, in part to continue the work in Colleton County but also to for expand it to other communities. (Read more)

UK, ARH planning efforts against high rate of heart-disease deaths and limited availability of proper food in Perry County

The death rate from heart disease is nearly twice as high in Perry County (Wikipedia map) as in Kentucky as a whole, so there's no better time than now to announce that the University of Kentucky Medical Center is close to finalizing a three-year agreement with Hazard Appalachian Regional Healthcare Medical Center to provide continuing care, outreach and education to local physicians and county residents, including more and better information about heart-healthy food choices. Bailey Richards of the Hazard Herald reports that this last task is daunting, particularly since availability of good food is an issue in remote parts of the county.

Richards writes that a 2011 study of the heart-healthy food options in Perry County "showed that the area severely lacks low-fat and low-sodium options." Kevin Luley, a registered nurse at the UK Medical Center and winner of the "Heart Health in Rural Kentucky" grant, surveyed all of the restaurants and grocery stores in Perry County and found that most do not have many off-the-shelf options for a healthy diet. Of all of the items available at the restaurants in Perry County, fewer than 6 percent were considered healthy. (Residents can consult their own smartphones for that information. It should also be posted or available upon request.) Of a standard list of produce items, on average only 60 percent were found at the local grocery stores, Luley found. (Read more)

U of L doctor tells American Heart Association that cardiac stem-cell research shows a lot of promise

Dr. Roberto Bolli

Promising results are coming from research that uses patients’ own cardiac stem cells to heal their hearts, a Louisville doctor told colleagues this week at an American Heart Association meeting in Los Angeles.

Laura Ungar of The Courier-Journal reports that Dr. Roberto Bolli, lead author of the clinical trial and chief of cardiovascular medicine and director of the Institute of Molecular Cardiology at the University of Louisville, said cardiac stems cells may someday be used to treat heart failure caused by muscle scarring after a heart attack.

Bolli, who partnered with Dr. Piero Anversa of Brigham and Women’s Hospital in Boston on the research, explained that their research showed that hearts in patients treated with their stem cells had greater pumping power, and benefits continued to increase as long as two years after receiving the cells.  Heart failure afflicts about 6.6 million Americans. (Read more)

Cardiologist: Kentucky needs better way to get heart attack patients to dedicated catheterization centers in time

Because cardiovascular disease kills more Kentuckians than anything else, and because what mostly kills them is a heart attack, and because if you can get help within 90 minutes of that heart attack your chances improve dramatically, this state needs a vastly improved way to get heart attack patients to the right hospital in a short amount of time. So explains Dr. William Dillon, an interventional cardiologist in Louisville, who writes an guest column in the In The Prime health blog of The Courier-Journal. He punctuates his point with a graph, right, that shows that Kentucky now ranks 49th of 50 states in acute myocardial infarction (AMI) deaths. AMI is doctor-speak for heart attacks. (American Heart Association graph)

Dillon's medically reasoned plea is for a more systematic regional network -- like one that have saved lives in North Carolina -- is "to transfer AMI patients to dedicated (heart catheterization lab) centers throughout the state." But Dillon also knows that many Kentuckians are not listening to their bodies as closely as they might. He writes that "another source of delay in AMI treatment is that, on average, patients wait more than 90 minutes before seeking medical attention. Furthermore, 50 percent of AMI patients drive to a hospital or clinic without calling EMS. Every year, a significant number of these patients needlessly die en route to the hospital." He adds then that health education -- in this case, early notification of needing EMS help -- is an important component in saving Kentuckians' lives. (Read more)

Study: Smoke-free workplace leads to fewer heart attacks

Mayo Clinic researchers have found a 33 percent drop in heart attack rates in a Minnesota county after public smoking bans were enacted. This, while rates of hypertension, diabetes, high cholesterol and obesity remained the same or even increased after the ban was put in place, reports The New York Times. The conclusion: “I think the bottom line is this should turn the page on the chapter discussing whether or not secondhand smoke is a risk factor for heart attacks,” said Dr. Richard D. Hurt, an author of the study and a professor of medicine at the Mayo Clinic in Rochester, Minn.

The study, published in Archives of Internal Medicine, was conducted in Minnesota's Olmstead County where medical records were examined 18 months before the county's 2002 public ban went into effect and 18 months after it extended the ban to all workplaces in 2007. (Read more)