Dr. Alessi revisits his American Heart Month conversation with UConn Health cardiologist Dr. Peter Schulman, drilling down on advances in prevention, treatment, and management of heart disease, heart attack, and heart failure, how they've changed over the years, and further changes potentially on the horizon.
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Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your personal physician.
I’m your host, Dr. Anthony Alessi, and it’s great to be with you on what has become known as our deep dive. And this particular episode of our deep dive is dedicated to a show we did with Dr. Peter Schulman last week. As you’ll recall, Dr. Schulman is a cardiologist and professor of medicine here at the University of Connecticut, where he has practiced for 44 years, and he has been a cardiologist for longer than that.
But before we get to Dr. Schulman, I want to go back to something that was discussed in a previous episode with Dr. Juthani, and that was the use of messenger RNA. We’re hearing a lot about that this week, because the Food and Drug Administration refused to review a flu vaccine that is based on messenger RNA, that’s put out by the Moderna company. And they really haven’t given good reason for why they have refused to review this.
Now, let’s take a step back, because we know that the current administration has stopped research to the degree of $500 million cut, just on the topic of messenger RNA. And that’s because there is misinformation out there -- I almost think it’s disinformation, but it’s misinformation -- that messenger RNA, somehow changes a cell structure, and that’s not the case at all. Dr. Juthani used a good example of it, but I’m going to go a step further.
Messenger RNA is just that. It’s a messenger. It brings a message to a cell. Think about it this way: If you were to order food from Uber Eats or DoorDash, right, that food is brought to your door by a messenger, he leaves the food and then leaves your premises.
Think of messenger RNA as just being that messenger. He doesn’t come in your house and start telling you how to rearrange your furniture. He just brings the message about what it is your body needs to be fighting, in this case, the flu.
Now, one of our problems is that we keep coming up a little bit off target when it comes to influenza, and Dr. Juthani explained that it’s because we have to decide in February. So right now in February, we’re deciding what flu we’re going to be fighting in the fall. We base that on information that we get from the southern hemisphere with the flu. That is the flu strain that is most prominent there. It takes a long time because you grow it in eggs and that’s how you produce the vaccine messenger RNA.
And thanks to Operation Warp Speed, we are now able to come up with a vaccine in a much shorter period of time. So let’s think about it. If we could do it in a shorter period of time, we will have a better idea of what our target is. For influenza that year. So now we’re talking about instead of February, possibly doing it in May or June when we have a better idea of the target and a better chance of hitting it. So again, I want to emphasize the fact that messenger RNA is purely a messenger and it’s not changing your cell structure in any way.
But let’s get to our discussion with Dr. Schulman, which we put out on the airwaves on February 9, and that is, we wanted to get him on because this is American Heart Month. That’s something that was started in 1964 by Lyndon Johnson, and they did it to coincide with Valentine’s Day and the heart. And I guess, many of you listeners are probably my age or thereabouts. And remember, the one thing about the heart I remember is, Dr. Christian Barnard, right? Dr. Barnard, on December 3, 1967, he performed the first human heart transplant into a fellow by the name of Louis Washkansky in South Africa. Now it only lasted 18 days and, and that was ostensibly because we didn’t really have immune-suppressant drugs that would avoid this rejection of the heart. But it suddenly really brought to light that great things were possible.
And indeed, great things have developed since 1964. In a recent study -- and this is because I like to know, are we getting our money’s worth out of something, right? So we’ve made changes in our lives, changes in our lifestyle that Dr. Schulman talks about, right? A better diet, stop smoking, exercise regularly, and, and taking newer medications, but has it made a difference? And it’s interesting because a recent study published looked at heart disease mortality, so everybody who died of any heart disease from 1970 to 2022, and those deaths are down by 66%, the biggest drop being in ischemic heart disease, the typical heart attack from a clogged artery. That dropped from 91% of the overall deaths to only 53%. But what we have also seen is an increase in heart failure, where the heart, as Dr. Schulman again explained very clearly, the pump of the heart begins to fail. And a lot of that is because we’re getting older. So there are newer medications to really work on that because heart failure was up 146% since 1970. So again, we really want to emphasize that we’re making great strides, but now we are redirecting our efforts to a large extent.
The other things we talked about that were really most striking, we had a question from Bob about taking aspirin -- and again, if you have questions for me or things you want to address on the show, you can go to healthyrounds@uchc.edu -- and this was a question about aspirin. At first everybody thought everybody should be taking a baby aspirin as you got older. But again, it’s something you need to discuss with your physician because there are certain risks to doing that.
But the other thing we talked about was cardiac arrest. We’ve gone through great efforts to have programs to teach people CPR and how to use these automatic external defibrillators, the AEDs, and these are very important devices if we’re going to save lives. But once again, I asked him, has it been worthwhile?
And what was interesting to me, that 90% of deaths from heart attack occur before getting to the hospital. But when we looked at CPR and AEDs, we looked at the survival being about 25 to 35%. So again, if you have. A cardiac arrest where your heart stops outside the hospital, you still only have a 30% chance of survival. But again, we do know that the quicker you have CPR or use an A ED, your chances of survival are better.
But when you address the issue of, am I having a heart attack? Everybody has come up against this, and we hear about this all the time: I’m not sure if it’s indigestion. I’m not sure if it’s a heart attack. Dr. Schulman made it very clear that cardiologists don’t mind a false alarm here because 90% of the deaths from heart attack -- so everybody who dies from a heart attack, 90% of those -- occur before getting to the hospital. So it’s important, I think if there’s one message to take away from this podcast, it’s that if you believe you are having symptoms of a heart attack, the typical ones crushing chest pain, pain radiating from your chest to your jaw, to your left arm, or both arms. Any of those signs, especially the crushing chest pain, shortness of breath, get to an emergency room, it will certainly in many cases, be lifesaving.
One of the best parts of all our shows I enjoy is when we ask our guests. What will we imagine in the future, 40 years from now? What is the treatment of heart disease going to look like? And it was so interesting hearing from Dr. Schulman, because he talked about rebuilding the heart. Because we talked about that heart failure number having gone up. How do we rebuild the heart? And that’s where he thinks the greatest strides are going to be made, either by using stem cells that can be used for growing new heart muscle, or devices that can be placed in the heart, even just through the groin, that would again help the heart to pump more efficiently.
Well, anyhow, I think that’s about it from my end here. I really enjoyed Dr. Schulman and all the information he was happy to share with us, and I hope you’re enjoying this deep dive as we do them, and the guests as we come up with them.
Next week, I’m excited because we taped an interview with my guest, who will be Commissioner Andrea Barton Reeves. She is the commissioner for the Connecticut Department of Social Services, and we had a lively discussion about Medicaid, the people who are on Medicaid, and a lot of, again, misinformation that’s out there about the Medicaid program and SNAP programs here in the state of Connecticut.
If you have any questions or ideas for future programs, as I always mention, reach out to me at healthyrounds@uchc.edu. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for our podcast, and Tessa Rickart is in charge of social media for the Healthy Rounds podcast.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.
