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Many traditional cancer treatments, such as chemotherapy and radiation, effectively destroy cancer cells but often lead to severe side effects that leave patients feeling even more sick.

Two University of Washington researchers are developing treatments that aim to simultaneously treat cancer and improve patients’ quality of life. Miqin Zhang, UW professor of materials science and engineering and of neurological surgery in the UW School of Medicine, develops tiny systems that deliver cancer treatment specifically to cancer cells. Dr. Avik Som, UW assistant professor of materials science and engineering and of radiology in the UW School of Medicine, uses interventional radiology to precisely deliver cancer treatment to the body.

Both Zhang and Som are studying a cancer treatment method called immunotherapy, where a patient’s own immune cells are trained to target and destroy cancer cells. The two researchers are now collaborating with the goal of getting their therapeutics into the clinic.

For World Cancer Day, UW News asked Zhang and Som to discuss their novel materials and how these materials can treat both the cancer and the patient.

Tell us about your research in this area. 

Miqin Zhang: One of our key research areas is developing biocompatible nanoplatforms for cancer diagnosis, treatment and therapy-response monitoring. For example, one of our recent advances is using tiny particles called nanoparticles to deliver immunotherapies or vaccines in preclinical animal models. The payloads from these nanoparticles activate immune cells to eradicate drug-resistant solid tumors and metastases.

In general, our nanoplatforms provide tumor specificity in two unique ways:

• The nanoparticles can carry diverse payloads — including chemotherapeutics and genetic materials — to address tumor heterogeneity
• We can use different methods to trigger our nanoparticles to release their payloads, such as changing the temperature or pH. Other methods include using enzymes or magnetic fields.

Our systems are designed for versatility and can work in tandem with various tumor-targeting and therapeutic agents.

Avik Som: I am a physician-scientist with clinical training in interventional radiology, with a specific focus in interventional oncology. In this field we often deliver therapy directly to single lesions using small needles and wires. This eliminates the need for invasive surgery in patients who are often too sick for surgery.

My research expertise has focused on developing novel drug delivery materials and techniques for interventional radiologists to use, including in the field of immunotherapy. Interventional radiologists have long succeeded at delivering therapy highly precisely within the body. Using the best of material science, my lab looks at changing what we’re delivering to heal our patients of both their cancer and the underlying ravages that the cancer has caused.

How can your materials both extend patients’ lives and improve their quality of life?

MZ: Our new nanoparticle materials promise more effective and less harmful treatments in a variety of ways. First, the nanoparticles target cancer cells specifically, which minimizes side effects and enables controlled drug release to maintain therapeutic levels without toxicity spikes.

Next, we design these nanoparticles using biocompatible materials, such as iron oxide and chitosan coatings, which reduce immune-response reactions and make the nanoparticles more compatible with long-term use.

Cancer’s complex and variable nature means that treatments that are effective for one patient might not work for another, which makes it difficult to create one-size-fits-all solutions. But our nanoparticles support personalized medicine because we can target specific mutated genes in individual patients. Furthermore, we can develop nanoparticles that are multifunctional. For example, a single nanoparticle can have capabilities that enable both monitoring as well as treatment.

AS: The concepts of extending patients’ lives and improving their quality of life have effectively been done in parallel for years. For example, the UW has extensive history and expertise in tissue engineering. But it usually isn’t combined with cancer care because the two goals often feel contradictory: Tissue engineering results from inducing cell growth, while historically cancer therapy has directly focused on killing cells. So the fields have diverged.

But we can design novel materials to do both: One material can use different release rates to stagger the anti-cancer versus tissue-engineering effects. For example, we can use interventional radiology to implant a material directly into a tumor. The material can have an initial burst of drug release that has an anti-cancer effect. And then, after killing the tumor, the residual material can release factors that recruit normal cells to fill in the gap where the cancer was.

Alternatively, as radiologists, we can see where cancer is and isn’t. It is therefore possible to selectively deliver anti-cancer agents to the cancer, while simultaneously delivering pro-tissue engineering agents to normal tissue.

Are any of these treatments currently available in the clinic?

MZ: The process of getting a treatment like this approved is complex and resource-intensive, because it requires extensive research, clinical trials and regulatory approvals. To reduce clinical trial costs, our nanoparticle platform is adaptable for multiple genetic therapies, which offers regulatory advantages and paves the way for FDA approval.

Right now, our nanoparticles are still at the basic research stage and have not yet entered clinical trials. They have, however, demonstrated their efficacy in various pre-clinical animal models. We are now prepared to engage with venture capitalists and major pharmaceutical companies to advance our nanoparticles into clinical trials.

AS: Our research is also still in the basic stage for the moment. We need to determine the best type of material and safest way to deliver it into patients through rigorous pre-clinical testing.

That being said, at the Fred Hutch Cancer Center and UW Medicine, we are leading an intratumoral therapy group that is ramping up clinical trials for patients using therapies that are in development around the country. In addition, we are working on bringing on more minimally invasive tissue engineering trials to the clinic soon.

What part of this collaboration is the most exciting to you?

AS: I was fortunate to meet Miqin during my interview at UW, and we struck up a vibrant conversation. Miqin has been a leader in the fields of biomaterials and drug delivery, and she is an ideal mentor to help me with my goal of bringing these advances to the clinic.

MZ: I have more than 15 years of experience in cancer research, and I strongly believe that interventional radiology is transforming cancer care by offering minimally invasive, precise treatment options that reduce side effects and improve patient outcomes. I am thrilled to collaborate with Avik so that we can apply our advanced materials and his innovative approaches to enhance interventional radiology for cancer treatment and tissue growth in a way that minimizes side effects and improves patients’ quality of life.

Zhang’s research is funded by the Kuni Foundation and the National Institutes of Health. Zhang is also a faculty researcher with the UW Institute for Nano-Engineered Systems and the Molecular Engineering and Sciences Institute. Som’s research has been funded by the Radiologic Society of North America and the National Institutes of Health.

For more information, contact Zhang at mzhang@uw.edu and Som at aviksom@uw.edu.

The vast majority of earthquakes strike inside the Ring of Fire, a string of volcanoes and tectonic activity that wraps around the coastlines of the Pacific Ocean. But when an earthquake hits, the areas that experience the strongest shaking aren’t always the places that suffer the greatest damage.

Take the massive Chi-Chi earthquake, which caused extensive damage in Taiwan in the fall of 1999 and killed more than 2,400 people. The distribution of damage followed an uneven pattern: Deaths caused by the earthquake were concentrated not in densely populated city centers, but in those cities’ suburbs and outer fringes. A similar pattern has occurred following earthquakes in China, Chile and Nepal.

More than two decades later, researchers at the University of Washington have identified a hidden factor behind what they call ‘suburban syndrome’ — migration. Workers from small, rural communities often move into the outer edges of cities, which offer greater economic opportunities but often have low-quality housing that is likely to suffer greater damage during an earthquake. The risk grows even more when migrants come from low-income or tribal villages.

The findings, published in December in the journal Natural Hazards and Earth System Sciences, suggest that emergency management organizations should pay greater attention to migration and housing quality when developing disaster mitigation and response plans.

UW News spoke with lead author Tzu-Hsin Karen Chen, an assistant professor of environmental & occupational health sciences and of urban planning, to discuss ‘suburban syndrome,’ how migration can amplify disparities in a disaster’s impact, and what U.S. officials can learn from a Taiwanese disaster.

Your work on this study builds on an existing model that assesses earthquake risk by considering migration patterns and the movement of vulnerable populations. What does the existing model miss, and why is it important to fill those gaps?  

Tzu-Hsin Karen Chen: This risk-assessment model has been used by many organizations internationally and in the United States. For example, FEMA uses a similar risk model to assess populations exposed to hazards, vulnerabilities and potential disaster impacts. They typically do a comprehensive risk assessment geographically within states and counties, identify areas with potential larger impacts, and then draft a preparedness plan.

In United States, temporary domestic migrants and undocumented immigrants don’t always officially register in government systems. One common reason is the fear of deportation or other legal repercussions. And so, when a government agency like FEMA allocates resources for disaster preparedness or recovery, relying on registered population data can lead to an underestimate of the support required in certain areas.

In Taiwan, our study case, many migrant workers moving from rural to urban areas don’t update their registered residence. They still have their registration back in their hometown, like in a tribal area. It just doesn’t make sense to re-register, because they might have multiple jobs within a single year in different places. To minimize expenses, some workers look for the lowest possible rent, and their rental housing might not be officially registered either. Those could be informal housing structures, like a metal floor added on top of a concrete building, which don’t comply with safety regulations. The informality of this process can help lower their cost of living, but can also leave them more vulnerable to disasters.

How did you get started in this research? 

TKC: I’ll share my personal story, but I also want to acknowledge my co-authors for their years of work in risk assessments. For me, it started back in 2010, when I volunteered in a tribal area of Taiwan teaching computer skills. This provided bigger lessons for me than anything I could’ve taught them. I learned how teenagers often move from their tribal areas downhill to nearby cities to take construction jobs during the off-crop seasons. Those jobs pay more than farm work, but they’re also very physically demanding and often lack worker protections like job security and health insurance. Seeing that put a seed in my mind. 

When I was a master’s student, a team from the National Earthquake Center and Academia Sinica in Taiwan was working on a risk assessment of the Chi-Chi earthquake using the exposure, vulnerability and hazard framework. They had already published a fundamental risk assessment, and reached out to me to develop an extended study by incorporating spatial statistics. That collaboration eventually evolved into the study in this paper. 

The COVID-19 pandemic also shaped this study. I came across news about how migrant workers were stuck in urban fringe areas of India. Because of the lockdown, they weren’t able to continue their work, and their crowded living conditions left them at even greater risk during the pandemic. I started to wonder: How can we shift from a pure statistical model to something more meaningful? How can we bring migration into the center of the discussion? 

The final push came from colleagues’ work at the UW. I’ve noticed initiatives for undocumented students and research efforts around environmental justice and health equity. For example, my co-author Diana Ceballos’s research on migrant worker’s health was particularly motivating. We read and wrote back and forth to refine the framing and discussion in this paper.  

How did you incorporate migration data into a larger earthquake-risk model, and what did you find?

TKC: At the time of the Chi-Chi earthquake in the late 1990s, we didn’t have any detailed migration data. Today, new research uses mobile phone signals to track people, but such data wasn’t available back then. So we adapted the radiation model — a model widely used to predict human migration — to estimate migration flow and used it as a new way to estimate migrants from low-income and tribal areas. This provided new variables to incorporate into the large risk model. 

Most of our findings are supportive of previous studies, where we can see, logically, if there’s stronger ground movement, there are likely to be more fatalities. That’s a very straightforward way of thinking of how disasters can happen. However, it’s not just a physical story. We also confirm that in areas where incomes are lower, there are more fatalities. Income is a known risk factor in the vulnerability theory. What’s unique in this study is that we tested whether an increase in migration flows leads to an increase in fatalities, and we found that to be true. 

Tell me about the migration model. What is it estimating? 

TKC: We applied the radiation model and adapted it to measure different migration populations. The fundamental idea of the radiation model comes from a simple model called the gravity model. In this context, gravity refers to the idea that larger populations have a stronger “pull” on people in nearby communities. The model assumes that, for a place, the number of people who want to migrate to nearby cities depends on the population size of those cities. Larger cities tend to attract more people.  

If the distance is too far, then it costs too much to travel, so the model will predict fewer migrants. But if the city is closer, or even far away but has a very large population, it becomes a more attractive destination, leading to greater migration flow.  

The radiation model builds on these principles and adds another layer. It considers competitors along the way. In other words, migration flow may also be influenced by other cities or opportunities that lie between the starting point and the destination. 

At first glance, it seems obvious that greater migration would lead to higher fatalities in a given area, just because there are more people present when disaster strikes. Is that the primary driver, or are there other factors at play?  

TKC: Logically, if there are more people, and the percentage of fatalities is equal, then there should be more people dying from a specific event. But we found it’s not just about population numbers. There are two additional factors: When migrant workers are from areas with lower incomes, or when they are from tribal areas, those factors significantly contribute to higher fatalities in the places they migrate to. 

Our hypothesis is that it’s about housing safety. Migrant workers tend to move to cities, and when cities are more expensive, affluent workers might be able to secure housing that offers better protection against disasters. However, workers from tribal or low-income areas tend to settle in urban fringe zones where affordable housing options might not meet safety standards, making them more vulnerable to earthquakes.

Why did you choose to study this earthquake from 1999 in particular?  

TKC: The research team that invited me to work on this project was interested in the Chi-Chi earthquake, partly because it was one of the most disastrous in Taiwan’s history. And even 20 years later, there’s still a conference focused on the Chi-Chi earthquake that brings domestic and international researchers to talk about it.

How widely applicable are your findings? Could they help us better understand hazards in other earthquake-prone areas of the world, like, say, the Pacific Northwest?  

TKC: It’s important to consider this risk assessment as a tool for preparedness for future hazards. When the next earthquake occurs, migrant communities will likely face elevated impacts if housing safety policies do not improve.

I believe the migration component is universally important, even outside Taiwan. There has always been a paradox, a structural dilemma of disaster governance: Because migrants are often invisible, they suffer from little support. But making them visible can sometimes lead to exclusion and discrimination. This model represents migrants in a geographic sense rather than identifying every person individually through government surveillance, which could address this challenge. By protecting anonymity while still accounting for migrant populations, the model might help ensure their needs are considered in housing safety and resource allocation.

Co-authors on this study include Diana Ceballos of the UW Department of Environmental & Occupational Health Sciences; Kuan-Hui Elaine Lin of National Taiwan Normal University, Thung-Hong Lin of Academia Sinica in Taiwan; and Gee-Yu Liu and Chin-Hsun Yeh of the National Center for Research on Earthquake Engineering in Taiwan.

For more information, contact Chen at kthchen@uw.edu.

In most doctors’ offices these days, you’ll find a pattern: Everybody’s Googling, all the time. Physicians search for clues to a diagnosis, or for reminders on the best treatment plans. Patients scour WebMD, tapping in their symptoms and doomscrolling a long list of possible problems.  

But those constant searches leave something to be desired. Doctors don’t have the time to sift through pages of results, and patients don’t have the knowledge to digest medical research. Everybody has trouble finding the most reliable information.  

Optimists believe artificial intelligence could help solve those problems, but the bots might not be ready for prime time. In a recent paper, Dr. Gary Franklin, a University of Washington research professor of environmental & occupational health sciences and of neurology in the UW School of Medicine, described a troubling experience with Google’s Gemini chatbot. When Franklin asked Gemini for information on the outcomes of a specific procedure – a decompressive brachial plexus surgery – the bot gave a detailed answer that cited two medical studies, neither of which existed.  

Franklin wrote that it’s “buyer beware when it comes to using AI Chatbots for the purposes of extracting accurate scientific information or evidence-based guidance.” He recommended that AI experts develop specialized chatbots that pull information only from verified sources.  

One expert working toward a solution is Lucy Lu Wang, a UW assistant professor in the Information School who focuses on making AI better at understanding and relaying scientific information. Wang has developed tools to extract important information from medical research papers, verify scientific claims, and make scientific images accessible to blind and low-vision readers. 

UW News sat down with Franklin and Wang to discuss how AI could enhance health care, what’s standing in the way, and whether there’s a downside to democratizing medical research.  

Each of you has studied the possibilities and perils of AI in health care, including the experiences of patients who ask chatbots for medical information. In a best-case scenario, how do you envision AI being used in health and medicine? 

Gary Franklin: Doctors use Google a lot, but they also rely on services like UpToDate, which provide really great summaries of medical information and research. Most doctors have zero time and just want to be able to read something very quickly that is well documented. So from a physician’s perspective trying to find truthful answers, trying to make my practice more efficient, trying to coordinate things better — if this technology could meaningfully contribute to any of those things, then it would be unbelievably great. 

I’m not sure how much doctors will use AI, but for many years, patients have been coming in with questions about what they found on the internet, like on WebMD. AI is just the next step of patients doing this, getting some guidance about what to do with the advice they’re getting. As an example, if a patient sees a surgeon who’s overly aggressive and says they need a big procedure, the patient could ask an AI tool what the broader literature might recommend. And I have concerns about that. 

Lucy Lu Wang: I’ll take this question from the clinician’s perspective, and then from the patient’s perspective.  

From the clinician’s perspective, I agree with what Gary said. Clinicians want to look up information very quickly because they’re so taxed and there’s limited time to treat patients. And you can imagine if the tools that we have, these chatbots, were actually very good at searching for information and very good at citing accurately, that they could become a better replacement for a type of tool like UpToDate, right? Because UpToDate is good, it’s human-curated, but it doesn’t always contain the most fine-grained information you might be looking for. 

These tools could also potentially help clinicians with patient communication, because there’s not always enough time to follow up or explain things in a way that patients can understand. It’s an add-on part of the job for clinicians, and that’s where I think language models and these tools, in an ideal world, could be really beneficial. 

Lastly, on the patient’s side, it would be really amazing to develop these tools that help with patient education and help increase the overall health literacy of the population, beyond what WebMD or Google does. These tools could engage patients with their own health and health care more than before.  

Zooming out from the individual to the systemic, do you see any ways AI could make health systems as a whole function more smoothly? 

GF: One thing I’m curious about is whether these tools can be used to help with coordination across the health care system and between physicians. It’s horrible. There was a book called “Crossing the Quality Chasm” that argued the main problem in American medicine is poor coordination across specialties, or between primary care and anybody else. It’s still horrible, because there’s no function in the medical field that actually does that. So that’s another question: Is there a role here for this kind of technology in coordinating health care? 

LLW: There’s been a lot of work on tools that can summarize a patient’s medical history in their clinical notes, and that could be one way to perform this kind of communication between specialties. There’s another component, too: If patients can directly interact with the system, we can construct a better timeline of the patient’s experiences and how that relates to their clinical medical care. 

We’ve done qualitative research with health care seekers that suggests there are lots of types of questions that people are less willing to ask their clinical provider, but much more willing to put into one of these models. So the models themselves are potentially addressing unmet needs that patients aren’t willing to directly share with their doctors. 

What’s standing in the way of these best-case scenarios?  

LLW: I think there are both technical challenges and socio-technical challenges. In terms of technical challenges, a lot of these models’ training doesn’t currently make them effective for tasks like scientific search and summarization.  

First, these current chatbots are mostly trained to be general-purpose tools, so they’re meant to be OK at everything, but not great at anything. And I think there will be more targeted development towards these more specific tasks, things like scientific search with citations that Gary mentioned before. The current training methods tend to produce models that are instruction-following, and have a very large positive response bias in their outputs. That can lead to things like generating answers with citations that support the answer, even if those citations don’t exist in the real world. These models are also trained to be overconfident in their responses. If the way the model communicates is positive and overconfident, then it’s going to lead to lots of problems in a domain like health care.  

And then, of course, there’s socio-technical problems, like, maybe these models should be developed with the specific goal of supporting scientific search. People are, in fact, working toward these things and have demonstrated good preliminary results. 

GF: So are the folks in your field pretty confident that that can be overcome in a fairly short time? 

LLW: I think the citation problem has already been overcome in research demonstration cases. If we, for example, hook up an LLM to PubMed search and allow it only to cite conclusions based on articles that are indexed in PubMed, then actually the models are very faithful to citations that are retrieved from that search engine. But if you use Gemini and ChatGPT, those are not always hooked up to those research databases.  

GF: The problem is that a person trying to search using those tools doesn’t know that. 

LLW: Right, that’s a problem. People tend to trust these things because, as an example, we now have AI-generated answers at the top of Google search, and people have historically trusted Google search to only index documents that people have written, maybe putting the ones that are more trustworthy at the top. But that AI-generated response can be full of misinformation. What’s happening is that some people are losing trust in traditional search as a consequence. It’s going to be hard to build back that trust, even if we improve the technology. 

We’re really at the beginning of this technology. It took a long time for us to develop meaningful resources on the internet — things like Wikipedia or PubMed. Right now, these chatbots are general-purpose tools, but there are already starting to be mixtures of models underneath. And in the future, they’re going to get better at routing people’s queries to the correct expert models, whether that’s to the model hooked up to PubMed or to trusted documents published by various associates related to health care. And I think that’s likely where we’re headed in the next couple of years.  

Trust and reliability issues aside, are there any potential downsides to deploying these tools widely? I can see a potential problem with people using chatbots to self-diagnose when it might be preferable to see a provider. 

LLW: You think of a resource like WebMD: Was that a net positive or net negative? Before its existence, patients really did have a hard time finding any information at all. And of course, there’s limited face time with clinicians where people actually get to ask those questions. So for every patient who wrongly self-diagnoses on WebMD, there are probably also hundreds of patients who found a quick answer to a question. I think that with these models, it’s going to be similar. They’re going to help address some of the gaps in clinical care where we don’t currently have enough resources.  

For more information or to reach the researchers, email Alden Woods at acwoods@uw.edu. 

When University of Washington President Ana Mari Cauce launched the Population Health Initiative in 2016, she spoke in soaring, ambitious terms. “We have an unprecedented opportunity to help people live longer, healthier, more productive lives – here and around the world,” she said. UW researchers have leapt at that opportunity, forging connections across the university, working side by side with community partners and breaking down traditional barriers to improving public health.  

In just eight years, the Initiative has funded 227 innovative, interdisciplinary projects. Many are focused right here in Western Washington, where projects have helped improve transportation accessibility in South Seattle, identified soil contaminants in community gardens in the Duwamish Valley, and improved how community leaders along the Okanogan River communicate the public health risks of wildfire smoke. Other projects have reached across the globe, targeting health disparities in Somalia, Peru, Brazil and more.  

“In this relatively short period of time, we’ve demonstrated the power that accrues when faculty and staff across the various areas of our campuses are working together and also exposing students to the cutting-edge work of tackling grand challenges,” Cauce said in her most recent campus address. 

And they’re just getting started. Many PHI-funded projects are still in their earliest stages, leveraging initial funding to show proof-of-concept for their ideas and setting the stage for future work. Fourteen projects so far have received much larger grants to empower researchers and community partners to expand successful projects and scale up for greater impact. 

With the Initiative now a third of the way into its 25-year vision, UW News checked in with three projects that recently received funding to scale their efforts. 

Spotting potential memory health issues in rural Washington

Diagnosing memory health issues in the best of circumstances is extraordinarily difficult. Patients typically make multiple visits to their doctor and take a rash of tests, many of which can produce flawed results — people who take the same test more than once, for example, will often score higher, potentially masking memory loss.  

It’s even harder in rural America, which has a severe shortage of neurologists. Patients seeking memory care might have to make a long, expensive trip to a major city, which leads many people to wait until a problem becomes apparent. By then, it’s often too late — modern treatments can slow the progress of memory loss, but there’s no way to regain what’s been lost. 

“So, how do you catch it early?” said Andrea Stocco, a UW associate professor of psychology. “We give people an app to have them check for themselves.”  

Stocco and Dr. Thomas Grabowski, director of the UW Alzheimer’s Disease Research Center, together with Hedderik van Rijn of the University of Groningen in the Netherlands, led the development of an online program that can measure a person’s memory and predict their risk of memory disorders. Like a flash-card app that helps students cram for a test, the program shows pictures and asks the user to recall what they saw a few minutes earlier. The app records how quickly and accurately the user responds to each question and makes the next one a little easier or more difficult.  

Researchers have long understood that a person’s ability to recall a specific memory tends to fade over time. This is called the “forgetting curve.” In previous work, Stocco and van Rijn found that they could measure individual differences in the slopes of such curves.  The app works by comparing a person’s responses to an internal model of forgetting and adjusting the slope of the model until it matches the responses. The resulting slope can be used to estimate the likelihood that their memory is fading faster than normal.  

By taking the test regularly, a person can track their memory’s decline over time. But preliminary tests, Stocco said, have shown that even a single use can spot a potential problem. 

“Just by looking at a single lesson, based on the result, there’s almost a perfect correspondence between the speed of forgetting and your probability of being diagnosed by a doctor,” Stocco said. “It can be as accurate as the best clinical tests but, instead of taking two or three hours, this can be done in eight minutes, and you don’t need a doctor.” 

A Tier 3 grant from the Population Health Initiative and a collaboration with the Central Washington Area Health Education Center will allow the researchers to share the app with up to 500 people in rural Chelan and Douglas counties. Participants can take the test on their own time, and the results will be shared with researchers. If a potential problem emerges, the researchers plan to invite participants to Seattle for an in-person evaluation.  

“It’s a solution that seems to solve these problems of early access and diagnostic bottlenecks,” Stocco said. “If this works, there’s no problem giving it to everybody in the state. We’re really interested in expanding and adding people from underrepresented populations and underrepresented areas, and the grant will allow us to do that.” 

Nancy Spurgeon of the Central Washington Area Health Education Center is also a collaborator on the project to test the prototype app, which is not yet available to the public. 

Revamping the Point-In-Time Count to better understand King County’s unhoused population 

For years, volunteers fanned across King County on a cold night each January, flashlights and clipboards in hand, searching for people sleeping outside. They’d also gather the shelter head counts for that night. Officially called the Point-In-Time Count, this effort attempted to tally the number of people who lacked stable housing. This endeavor was replicated in cities across the country, and the results were combined to create a national count that influences how the federal government allocates funding. 

There’s just one problem – the count is notoriously inaccurate. Volunteers can’t possibly find everybody. It captures only a single moment in time, and collects only limited data on people’s circumstances or personal needs. A person sleeping in their car might need different services than a person who sleeps in a tent, and the count didn’t fully capture that distinction. 

So, a team of UW researchers designed a better way to count. Their method, detailed in a paper published Sept. 4 in in the American Journal of Epidemiology, taps into people’s social networks to generate a more representative sample, which the researchers then ran through a series of calculations to estimate the total unhoused population.   

Called “respondent-driven sampling,” the method stations volunteers in common “hubs,” like libraries or community centers, and offers cash gift cards for in-person interviews and peer referrals. Volunteers collect detailed information on people’s circumstances and needs, giving each person three tickets to share with their unhoused peers. When those peers come in for an interview and show the ticket, the person who referred them receives another small reward. The new person gets a gift card and another three tickets. 

“This method gives people a more active voice in being counted. It’s a more humane way to count people, and it’s also voluntary,” said Zack Almquist, a UW associate professor of sociology and co-lead on the project. “The regular PIT (Point-In-Time) count just counted people. Now we can collect all sorts of information from people on their circumstances and their needs. Should policymakers want to, they could leverage that data to change service offerings.” 

The researchers received a Tier 2 grant to develop the system. They launched it in partnership with King County in 2022 and 2024, and were recently awarded a Tier 3 grant to test out the feasibility of running it quarterly.  

“Running the count quarterly allows us to estimate how many people move in and out of homelessness and whether there are seasonal changes, which are rarely measured,” Almquist said. “Also, people’s needs change depending on the time of year, and this method will help us better understand those rhythms.”  

Other cities and counties have expressed interest, the researchers said. The team has also begun to expand the effort, aiming to improve data across the broad spectrum of housing and homelessness services.  

“A very important byproduct of this work across schools and departments at UW is that we can create an ecosystem of people and projects,” said Amy Hagopian, a UW professor emeritus of health systems and population health and co-lead on the project. “We’ve spun off projects on sleep assessments, relationships with organizations that collect data on homelessness, and we’re mapping the sweeps of encampments in relationship to where people choose to be located. We have a whole network of homelessness-related research now. 

“These PHI grants gave us the fuel to ignite these projects.” 

Other collaborators are Paul Hebert of the UW Department of Health Systems and Population Health and of the VA Health Services Research and Development; Tyler McCormick of the UW Departments of Sociology and Statistics; Junhe Yang of the Center for Studies in Demography & Ecology and the eScience Institute; and Owen Kajfasz, Janelle Rothfolk and Cathea Carey of the King County Regional Homelessness Authority. 

Engaging community to mitigate flood risk in the Duwamish Valley 

More than a century ago, Seattle leaders set out to control and redirect the Duwamish River. They dredged the riverbed and dug out its twists and turns. Wetlands were filled in, the valley was paved over and a system of hydrology was severed. What had been a wild, winding river valley with regular flooding became an angular straightaway built for industry. But when UW postdoctoral scholar Maja Jeranko looks out at the Duwamish, she sees the river fighting back.  

“The water was always there,” Jeranko said, “and now it’s fighting to come back up.”  

The river returned with devastating effect in December 2022, when a king tide and heavy rainfall flooded the South Park neighborhood, submerging homes and shuttering local businesses. The underserved neighborhood faces a significant risk of future floods. 

To mitigate that risk, the City of Seattle has updated the neighborhood’s stormwater drainage system and launched a new flood-warning system. But the Duwamish River Community Coalition, a nonprofit focused on river pollution and environmental health, saw an opportunity for something greater. The DRCC asked a team of UW researchers to help develop flood adaptation plans that are community-based, culturally responsive and that enrich the local environment.  

“In the community, people don’t think there’s been enough engagement. There’s all this talk about flood mitigation, but all they see are sandbags,” Jeranko said. “So DRCC was like, ‘Look, we really need the people who live in the flood zone to understand the solutions.’ Because we have this long-lasting relationship with them, they see us as someone who’s able to provide a list of solutions, not favor one over the others, and do it in an informative way.” 

Boosted by a Tier 3 grant from the PHI, Jeranko and a team representing five UW departments, the Burke Museum and the DRCC are engaging with the community. This fall, the team will present the neighborhood with an expansive list of flood mitigation options and encourage city leaders to consider people’s preferences. Early work shows the community would favor nature-based solutions, Jeranko said. Floodable parks, for example, would provide ecological, recreational and public health benefits to the entire community, while storing flood water during storms.  

“It has been wonderful to collaborate with the UW team on this to make sure we are centering community voices in every single step of the planning for climate resilience,” said Paulina López, executive director of the DRCC. “Community leadership and representation is indispensable to bring climate justice to the Duwamish Valley.” 

Jeranko hopes their community-based model will be replicated by communities across the country facing similar risks from climate change and sea level rise. 

“Even though UW and a lot of other universities really support and invest in community-engaged work, a lot of times it’s fundamentally hard to make that research happen,” Jeranko said. “But the Population Health Initiative grant was about supporting all those things.” 

Other collaborators on the project are Nicole Errett, BJ Cummings, Katelin Teigen and Juliette Randazza of the Department of Environmental & Occupational Health Sciences; Celina Balderas Guzman of the Department of Landscape Architecture; Bethany Gordon of the Department of Civil & Environmental Engineering, Sameer Shah of the School of Environmental and Forest Sciences; Amir Sheikh of the Quaternary Research Center and the Burke Museum; and López and Robin Schwartz of the DRCC. 

For more information on any of the projects mentioned, or to learn more about the UW Population Health Initiative, visit the Initiative’s website or contact Alden Woods at acwoods@uw.edu.  

Twelve years after Washington and Colorado became the first states to legalize recreational marijuana, it’s safe to say that weed is here to stay. Nearly 30% of Washington adults report using cannabis in the last month, and a majority of Americans believe marijuana products are safe.  

When it comes to the safety of long-term marijuana use among the general population, the jury’s still out. But there are some groups for whom cannabis poses a serious health risk. Among the most vulnerable are young adults with psychosis, who tend to use cannabis at extremely high rates, and whose symptoms can be exacerbated by long-term marijuana use. A team of University of Washington researchers is focused on this particular group. 

To effectively treat these patients’ symptoms and improve long-term outcomes, it’s critical for providers to help young adults stop using marijuana as quickly as possible after their first psychotic episode. But that’s proven tricky. Current best practices aren’t always effective for young adults with psychosis, who tend to use cannabis for different reasons than their peers and who may feel different effects. 

That leaves mental health care providers with a difficult problem: How can they best discern why their patients use cannabis, and what’s the best way to help them stop?  

UW researchers Denise Walker and Ryan Petros, from the School of Social Work, and Maria Monroe-DeVita, an associate professor in department of psychiatry and behavioral sciences in the UW School of Medicine, studied motivations among this group and then developed a novel treatment method. A pilot study of 12 people showed the method to be effective, though final results have yet to be published. UW News sat down with the research team to discuss their intervention and why it’s so important to help young people in this group cut down their use. 

Cannabis use is increasing across the board, but the numbers are staggeringly high among young adults with psychosis – you cite statistics estimating that 60-80% have used cannabis at some point in their lifetime. What makes a person experiencing psychosis so much more likely to use cannabis?  

Denise Walker: Many people were probably using cannabis before the onset of their psychosis symptoms, because there is strong research evidence that cannabis increases the risk for developing psychosis-related disorders. For those who do develop a psychosis-related disorder like schizophrenia, continued cannabis use impedes the recovery process and makes outcomes worse. There is still a lot more to learn about the cause and effect of these relationships, but cannabis does seem to have a unique relationship with psychosis. 

Ryan Petros: In addition, there is some evidence to suggest that people with schizophrenia are more prone to feeling bored than people without schizophrenia. In general, a lot of people use cannabis because they like it, and they find the associated high to be fun. It may be that people with schizophrenia-spectrum disorders are more likely to use cannabis to have fun and feel good because they are more likely to feel bored and less likely to feel pleasure in everyday activities. But the fact of the matter is, we don’t really know. Another reason that people use cannabis, in general, is because it facilitates social interactions or provides a shared activity in social settings. Because people with schizophrenia-spectrum disorders have smaller social networks and fewer social engagements, it may be that they use cannabis to facilitate improved social interaction, but here again, we need more research to know with more certainty. 

At the heart of all this research is the different health risks of cannabis use for people with and without psychosis or other mental health challenges. What are those differences, and why is cannabis use among young adults with psychosis particularly concerning? 

RP: For people with a psychosis, cannabis use is associated with higher rates of dropping from treatment and decreased adherence to medication. It leads to increased symptoms of psychosis and higher rates of psychiatric rehospitalization. In the long –term, cannabis use increases the risk of poor psychosocial outcomes and diminished overall functioning. 

DW: Essentially, continued cannabis use makes it much harder for young adults with psychosis to take advantage of treatment, make strides in their recovery and, ultimately, get on with having the life they want. 

RP: Another major reason for concern is that not only is cannabis use on the rise, people also have progressively adopted more tolerant attitudes toward cannabis. Cannabis has recently overtaken alcohol as the drug most often used on a daily basis in the United States. While some people can use cannabis without a problem, it’s recommended that some others abstain from using at all.  Over time, however, people have come to believe that cannabis use has health benefits, and they are less likely to perceive risks of use. This may result in a particularly challenging set of circumstances for helping someone with psychosis to learn about the real risks that cannabis use has for their health and wellness and to make the choice to reduce or abstain from use. 

DW: I agree. Perceptions surrounding cannabis are often polarized – it is often viewed as either “good” or “bad,” when in reality, it’s somewhere in the middle. There can be benefits for some to use cannabis and real risks of harm for others. These mixed messages, or at least the lack of acknowledgement of harms, contribute to continued hardship for those experiencing psychosis and their families. 

What methods are currently recommended to help people reduce their cannabis use, and why might those not be as effective for young adults with psychosis?  

DW: The gold standard treatment includes a combination of motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), and contingency management. Contingency management is often not available in the community, and studies show that MET plus CBT perform almost as well. Because it is normal for motivation to wax and wane for someone contemplating changing their cannabis use, MET addresses the issue of motivation early on. CBT teaches skills to avoid drug use, cope with social situations and negative moods, and solve problems without the use of cannabis. Family therapy is another option with strong support.  

The big problem is that we don’t know if these treatments are effective for young adults with psychosis.  MET is the most studied intervention in cannabis treatment, alone and in combination; however, it has not been tested with young adults with psychosis.  With a few optimizations, we believe that it could perform even better than with the general population, and we have begun to test it with young adults with psychosis. 

Your team has developed an intervention for young adults with psychosis that incorporates MET. Can you describe what that intervention looks like, and why it might be more effective for this population?  

DW: MET is a person-centered, nonjudgmental approach that facilitates an honest and candid discussion about cannabis use. The techniques are intended to draw out the individuals’ personal reasons for making a change and to grow their motivation to do so. Individualized feedback is created based on a client’s responses to an assessment of their cannabis use and related experiences and summarizes information about their cannabis use patterns, how their cannabis use compares with others, and their risk factors for developing a cannabis use disorder. It also provides an opportunity for clients to think about their personal goals and how their cannabis use promotes or detracts from their ability to attain those goals.  

When we asked young adults with psychosis what they wanted in a cannabis intervention, they were clear that they wanted an individualized and nonjudgmental approach. They also said they wanted accurate and science-based information about the relationship between cannabis and psychosis. MET ticks those boxes. With a few adaptations, it is an ideal format for providing objective information, while also inviting the young adult to talk it through and consider what the information means to them personally. 

Currently, providers are giving the message to patients that cannabis is harmful for those with psychosis, which is a great start.  But most providers don’t feel confident discussing why cannabis is harmful and what the research has found.  My sense is that patients often take that message and defend against it with their own personal experiences of what they like about cannabis. MET offers an invitation to receive and discuss objective evidence, consider their own experiences of how cannabis affects their symptoms and what they want for their future, and do so in a supportive environment that allows for looking at their use from a variety of perspectives.   

You ran a pilot program to understand how the new intervention works. What did you learn in that pilot study?  

DW: We adapted the MET intervention to include personalized feedback on the interaction between cannabis and psychosis and included some graphics and ideas about ways to reduce those risks in addition to abstinence. Twelve young adults experiencing psychosis who used cannabis regularly enrolled in the study and were offered the intervention. Most of the participants were not interested in changing their use of cannabis at the outset of the study, and by the end, several chose to reduce their cannabis use. 

Overall, the feedback was very positive. Participants overwhelmingly said they would recommend the intervention and would retain the psychosis specific pieces of the conversation. They appreciated the data that was included and the opportunity to discuss what it meant for them. They also said they enjoyed talking about how cannabis fits into their larger life and goals for the future. Overall, the feedback suggests this intervention has promise and should be studied in a larger trial. 

Maria Monroe-DeVita: My long-term goal would be to offer this new intervention either in addition to, or integrated within, the evidence-based package of services known to work best for individuals experiencing first episode psychosis. 

Denise Walker is a research professor in the UW School of Social Work, Ryan Petros is an associate professor in the UW School of Social Work, and Maria Monroe-DeVita is an associate professor of psychiatry and behavioral sciences in the UW School of Medicine.  

For more information or to reach the researchers, contact Alden Woods at acwoods@uw.edu. 

DALLAS, Feb. 22, 2025 — More than 60,000 people die from heart valve disease (HVD) in the U.S. each year, according to the American Heart Association 2025 Heart Disease and Stroke Statistical Update. Additionally, data from the Statistical Update shows that more than 28 million people worldwide are living with some type of heart valve disease, an increase of more than 30% in the past decade. On Heart Valve Disease Awareness Day (Feb. 22), the American Heart Association, a global force changing the future of health for all, urges everyone to recognize the symptoms of this condition, learn more about HVD and seek medical advice if they experience any symptoms.

Heart valve disease occurs when one or more of the heart’s four valves do not function properly, disrupting blood flow and putting strain on the heart. Many people with HVD may not experience symptoms until the disease reaches an advanced stage. Early detection through regular heart check-ups, including listening for murmurs, can lead to timely treatment and improved outcomes.

“Heart valve disease often goes undetected until it becomes serious, but early diagnosis can make all the difference,” said Marc Ruel, M.D., M.P.H., FAHA, American Heart Association volunteer, cardiac surgeon and endowed chair of minimally invasive cardiac surgery at the University of Ottawa Heart Institute, Canada. “The earlier we catch it, the more treatment options we have, and the better the outcome for the patient.”

Aortic Stenosis: The Most Common Form of HVD

One of the most prevalent and serious forms of heart valve disease is aortic stenosis (AS), a condition characterized by the narrowing of the aortic valve opening, which affects approximately 5% of adults over 65—a number expected to more than double by 2050. AS occurs when the aortic valve narrows, restricting blood flow from the heart to the body. If untreated, it can lead to severe complications, including heart failure and death.

Key symptoms of aortic stenosis include:

• Chest pain
• Shortness of breath
• Dizziness or fainting
• Fatigue
• Rapid or irregular heartbeat

Gender Disparities in Diagnosis & Treatment

Studies have shown that women and men experience heart valve disease differently. Women with conditions like mitral valve prolapse or rheumatic mitral valve disease often have more severe symptoms but are less likely to be referred for surgical interventions compared to men. Ruel said these disparities highlight the importance of advocating for equitable care and increasing awareness of early symptoms, particularly among women.

The Association’s Commitment

The American Heart Association is dedicated to raising awareness about heart valve disease through initiatives like Target: Aortic Stenosis™, which aims to improve timely diagnosis, appropriate treatment and comprehensive patient and caregiver resources.  

The Association encourages everyone, especially those over 65, to be vigilant about their heart health. Recognizing symptoms early and seeking medical advice can lead to better outcomes and improved quality of life.

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About the American Heart Association 

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.    

For Media Inquiries: 214-706-1173 

Devin T. Jones: Devin.Jones@heart.org 

For Public Inquiries: 1-800-AHA-USA1 (242-8721) 
heart.org and stroke.org  

Research Highlights:

• A data analysis projected that South Asian adults living in the United Kingdom may experience elevated blood pressure nine years earlier than East Asian adults on average.
• The largest blood pressure disparities between South Asian and East Asian adults were projected to be in 18-39-year-old men and 40–64-year-old women.
• The projected increase in systolic blood pressure in middle age East Asian adults was linked to a nearly 2.5 times higher risk for heart disease caused by blocked arteries and a nearly fourfold greater risk of stroke. Even at an older age, high systolic blood pressure predicted risk for all types of stroke.

Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, February 12, 2025

DALLAS, Feb. 12, 2025 — South Asian and East Asian adults living in the United Kingdom may have distinct trajectories to develop high blood pressure over their life course, according to new research published today in Hypertension, an American Heart Association journal.

Researchers analyzed health records for more than 3,400 adults enrolled in the UK Biobank who self-identified as having South Asian or East Asian ethnicity. Previous research found that individuals with South Asian ancestry living in the United Kingdom had substantially higher risk of heart disease caused by blocked arteries, or atherosclerotic cardiovascular disease (ASCVD), compared with individuals with European ancestry, as well as that South Asian adults living in the United States had higher death rates from ASCVD compared with white adults. Here, researchers explored differences in long-term blood pressure patterns and their potential lifetime effects on cardiovascular disease of those differences between South Asian and East Asian adults.

“High blood pressure and its management varies widely across racial and ethnic populations, and the frequently used ‘Asian’ category hides those differences,” said lead study author So Mi Jemma Cho, Ph.D., a postdoctoral fellow at Massachusetts General Hospital and the Broad Institute of MIT and Harvard. “This is crucial considering that high blood pressure at a young age is a major contributor to premature heart disease risk and given the emerging initiatives to study distinct cardiometabolic profile across different Asian subpopulations.”

The study used data for South Asian and East Asian adults who had at least two blood pressure readings taken during primary care visits after age 18 years. Researchers tracked participants’ heart disease events, including heart attacks, stroke and peripheral artery disease, using hospitalization and outpatient care records. Building on these baseline differences, as well as risk factors including current smoking status, dietary score and a metric of social determinants of health, the researchers estimated participants’ blood pressure patterns at five-year increments and modeled their predicted relationships to cardiovascular disease risk.

The analysis found that:

• South Asian adults underwent earlier and faster increases in blood pressure compared to East Asian adults. At age 30 years, the average projected systolic blood pressure was 124.9 mmHg in South Asian men and 107.4 mmHg in South Asian women compared to 120.7 mmHg and 105.7 mmHg in East Asian men and women.
• On average, South Asian men were projected to reach a systolic (top number) blood pressure of 130 mmHg or higher, classified as high blood pressure by the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, 10 years sooner than East Asian men (at 36 vs. 46 years). For women, the gap was 7 years (45 vs. 52 years).
• The combined projection for South Asian men and women to reach a systolic blood pressure of 130 mmHg was age 40 years, compared to age 49 years for East Asian men and women—a 9-year difference.
• For South Asian adults, high blood pressure observed in early adulthood was associated with higher lifetime cardiovascular disease risks. For East Asian adults, higher blood pressure in midlife was associated with higher atherosclerotic cardiovascular disease risk; even at ages 65 and older, high blood pressure was associated with heightened risk of stroke.
• Each standard deviation increase in midlife systolic blood pressure in East Asian adults was linked to a nearly 2.5 times higher risk for ASCVD and a nearly fourfold greater risk of stroke. Systolic blood pressure in East Asian adults ages 65 years or older was significantly linked to all types of stroke risk.
• Young adulthood diastolic blood pressure was strongly linked to peripheral artery disease in South Asian adults (2.18 times higher risk per standard deviation increase).
• These findings were consistent when examining blood pressure trajectory based on genetic ancestry, rather than self-identified ethnicity.

“These findings demonstrate the need to tailor blood pressure screenings and treatment timing for different Asian subpopulations to advance personalized care and prevention strategies for historically understudied communities,” said senior study author Pradeep Natarajan, M.D., M.M.Sc., an associate professor at Harvard Medical School. “Distinct age-related blood pressure patterns provide valuable insights to better manage cardiovascular risks and improve care for diverse populations.”

Study details, background and design:

• Health data was from the UK Biobank, a study of 503,325 adults living in the United Kingdom who were 40 to 69 years of age at enrollment between 2006 and 2010. The in-depth health and biomedical information was collected for participants registered in the United National Health Service with a U.K. general practitioner (similar to a primary care physician in the U.S.).

• This analysis included 3,453 participants. 3,077 of the participants self-identified as originating from South Asia and 376 of participants self-identified as being from East Asia. 47% of the South Asian participants self-identified as women and 53% as men; 64.9% of East Asian participants self-identified as women and 35.1% as men.

• The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults classifies high blood pressure as having top or bottom blood pressure measures greater than or equal to 130/80 mm Hg.

• Within the UK Biobank, participants who self-identified as originating from India, Pakistan, Bangladesh, Bhutan, Maldives, Nepal or Sri Lanka are defined as South Asian. Participants who self-identified as originating from China are defined as East Asian.

• Participants’ characteristics at UK Biobank enrollment included that:
  • South Asian adults had higher blood pressure readings and were at least three times more likely to be on antihypertensive medications compared to East Asian adults.
  • South Asian adults had higher body weight on average, measured by body mass index, with an average of 27.6 kg/m² compared to 24.2 mg/m² in East Asian adults.
  • South Asian adults had slightly lower levels of "bad" LDL cholesterol (128.1 vs. 133.4 mg/dL), likely because they were more frequently prescribed cholesterol-lowering medications (27.5% vs. 10.6%).

• Outcomes and health records collected after enrollment found that:
  • High blood pressure affected nearly twice as many South Asian adults as East Asian adults by age 40 years.
  • South Asian adults were more likely to begin taking medication for high blood pressure three years sooner (age 53.7 vs. 56.9 years, and at an average SBP of 143 mmHg and 141 mmHg, respectively).
  • South Asian adults had four times the lifetime incidence of heart disease caused by blocked arteries than East Asian adults (3.5 vs. 0.9 per 1,000 person-years).

• Key risk factors included in projections were: current smoking status, defined as lifetime smoking of at least 100 cigarettes and without indication of cessation at enrollment; dietary score was quantified based on self-recalled average intake of fruit, vegetable, whole grains, fish, dairy and vegetable oils, refined grains, meats, and sugar-sweetened beverages by the U.K. National Health Service’s Eatwell Guide; and socioeconomic status was determined using the Townsend Deprivation Index, which is  based on occupation, car ownership, home ownership and household overcrowding.

The study’s limitations include that its findings may not apply to Asian people living outside the U.K., as differences in health care systems, living environments and cultural adaption could influence the results.

“The authors provide important evidence supporting that cardiovascular risk factors like hypertension are not uniformly experienced among the diverse communities that are frequently but inappropriately aggregated under the race label ‘Asian,’” said Nilay S. Shah, M.D., M.P.H., FAHA, chair of the Association’s 2024 scientific statement “Social Determinants of Cardiovascular Health in Asian Americans.” Shah, who was not involved in the study, is an assistant professor of cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and a general and preventive cardiologist in the Bluhm Cardiovascular Institute of Northwestern, both in Chicago.

“It’s increasingly recognized that ethnicity is distinct from biological exposures like genetics. Given the authors’ ability to evaluate both, these findings showing that hypertension epidemiology varies by both self-identified Asian group ethnicity and genetic Asian ancestry should prompt greater exploration of differences in social risk factors that may explain the differences in hypertension and CVD outcomes among self-reported Asian ethnicity groups; simultaneously, the genetic composition leading to differences in hypertension epidemiology among Asian genetic ancestry groups remain to be more thoroughly understood,” Shah said.

“Ultimately, these findings from a U.K. population of Asian adults suggest a complex interplay of social factors and genetics resulting in varying experiences of hypertension in Asian populations. There is much, much more work to be done to understand cardiovascular risk factors and outcomes experienced by Asian populations.”

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/high-bp-may-develop-at-different-ages-and-paces-in-east-south-asian-adults-in-the-uk?preview=14d738d687f204f79c59a7e28beaaa25
• After February 12, 2025 view the manuscript online.
• AHA news release: Interrelated social factors may affect cardiovascular health in Asian American subgroups (September 2024)
• AHA resource: South Asians and heart disease: A House Calls headline
• AHA journal article: Higher Risk of Heart Disease Among South Asians Calls for Targeted Interventions (March 2022)
• Follow AHA/ASA news on X @HeartNews
• Follow news from AHA’s Hypertension journal @HyperAHA 

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. Dedicated to ensuring equitable health in all communities, the organization has been a leading source of health information for more than one hundred years. Supported by more than 35 million volunteers globally, we fund groundbreaking research, advocate for the public’s health, and provide critical resources to save and improve lives affected by cardiovascular disease and stroke. By driving breakthroughs and implementing proven solutions in science, policy, and care, we work tirelessly to advance health and transform lives every day. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and AHA/ASA Expert Perspective: 214-706-1173

John Arnst: John.Arnst@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

Puntos destacados de la investigación:

• En un análisis de más de 1,300 supervivientes de ataque o derrame cerebral, se observó que las mujeres eran menos propensas que los hombres a tomar, conforme a las indicaciones dadas, medicamentos para prevenir los ataques o derrames cerebrales recurrentes, como estatinas para reducir el colesterol y medicamentos para diluir la sangre y prevenir los coágulos.
• Las mujeres mexicoamericanas fueron tres veces más propensas a informar que no tomaban los medicamentos para reducir el colesterol de acuerdo con las indicaciones en comparación con los hombres mexicoamericanos que participaron en el estudio.
• Las mujeres de mayor edad o casadas también tenían más probabilidades de omitir dosis indicadas. Los investigadores sugieren analizar estos factores para mejorar la adherencia terapéutica y prevenir los ataques o derrames cerebrales recurrentes, particularmente entre mujeres mexicoamericanas.

Prohibida su divulgación hasta las 4 a. m. CT/5 a. m. ET del miércoles, 4 de diciembre de 2024

DALLAS, 4 de diciembre de 2024 — Las mujeres que han tenido un ataque o derrame cerebral pueden ser menos propensas que los hombres a tomar medicamentos para prevenir un segundo ataque o derrame cerebral, y las mujeres mexicoamericanas informan las mayores tasas de incumplimiento terapéutico, según lo señala una nueva investigación publicada hoy en la revista profesional de la American Heart Association, una publicación con revisión por pares abierta de la American Heart Association (Asociación Americana del Corazón).

“Nuestras conclusiones señalan desigualdades preocupantes entre lo que informan los hombres y las mujeres acerca de la toma habitual de medicamentos para prevenir el ataque o derrame cerebral conforme a las indicaciones dadas, especialmente entre personas mexicoamericanas”, señaló la autora sénior del estudio, Lynda Lisabeth, Ph.D., M.P.H., FAHA, profesora de Neurología y Epidemiología en la University of Michigan de Ann Arbor. “Los médicos clínicos podrían considerar la posibilidad de analizar estos factores y discutir la importancia de no omitir dosis al indicar estos medicamentos a pacientes para ayudar a reducir su riesgo de sufrir otro ataque o derrame cerebral”.

El estudio incluyó a más de 1,300 personas adultas, de 45 años o más, que tuvieron un primer ataque o derrame cerebral isquémico (causado por un coágulo de sangre o por la acumulación de placa que bloquea el flujo sanguíneo al cerebro) entre 2008 y 2019.

Los investigadores analizaron si, 90 días después del ataque o derrame cerebral, los participantes informaban que tomaban sus medicamentos para prevenir un ataque o derrame cerebral secundario. Se consideraron cuatro tipos de medicamentos comunes para prevenir el ataque o derrame cerebral: antihipertensivos para reducir la presión arterial; estatinas para reducir el colesterol; y antiplaquetarios y anticoagulantes, dos medicamentos que reducen la formación de coágulos de sangre.

A través del análisis, se observó que, 90 días después del ataque o derrame cerebral:

• El 11.5% de los participantes informó que no tomaba sus medicamentos para prevenir el ataque o derrame cerebral de acuerdo con las indicaciones dadas.
• En la comparación entre hombres y mujeres, estas fueron más propensas a informar la omisión de dosis de medicamentos para reducir el colesterol y antiplaquetarios, pero no de medicamentos para reducir la presión arterial.
• En comparación con los hombres mexicoamericanos, las mujeres mexicoamericanas fueron tres veces más propensas a informar que no tomaban los medicamentos para reducir el colesterol de acuerdo con las indicaciones.
• Las mujeres casadas o de mayor edad también fueron más propensas que los hombres a informar que habían omitido dosis de los medicamentos recetados para prevenir el ataque o derrame cerebral.

“Nos sorprendió la magnitud de las diferencias en los comportamientos relativos a la toma de medicamentos entre hombres y mujeres, especialmente entre mujeres de origen mexicoamericano”, manifestó la coautora del estudio Chen Chen, estudiante del doctorado en Epidemiología de la University of Michigan. “Nuestro análisis revela factores potenciales que pueden estar exacerbando estas desigualdades. Por ejemplo, las mujeres en general y las mujeres mexicoamericanas en particular tienen más probabilidades de estar a cargo del cuidado de otros familiares. Como resultado, es posible que tengan menos oportunidades de priorizar y gestionar su propia salud, lo cual puede contribuir a una mayor probabilidad de falta de adherencia terapéutica”.

Los investigadores dijeron que era posible que los efectos adversos específicos de las estatinas, como el dolor y la debilidad muscular, explicaran por qué más personas informaban no tomar los medicamentos para reducir el colesterol según las indicaciones dadas.

El estudio estuvo afectado por varias limitaciones. Cada participante informó con qué frecuencia tomaba sus medicamentos; por eso, es posible que los resultados estén afectados por el sesgo de memoria. Algunos factores sociales y comportamentales no se consideraron en este estudio, como los niveles de ingresos y los motivos por los cuales los pacientes no tomaban las dosis indicadas. Por último, las personas que participaron del estudio pertenecían a una sola comunidad del sur de Texas que incluía, de manera predominante, a personas adultas blancas no hispanas y mexicoamericanas nacidas en los EE. UU.; por eso, es posible que estas conclusiones no puedan traspolarse de manera generalizada a otras poblaciones como las personas mexicoamericanas que han inmigrado a los EE. UU.

“Los resultados de este estudio mantienen una buena correspondencia con observaciones previas de bases de datos nacionales y estudios longitudinales basados en poblaciones, que mostraban una frecuencia superior de incumplimiento terapéutico para la prevención del ataque o derrame cerebral secundario en las mujeres”, afirmó Fernando D. Testai, M.D., Ph.D., FAHA, profesor de neurología y rehabilitación en la University of Illinois College of Medicine de Chicago, quien se desempeñó también como presidente de la reciente declaración científica de la asociación, Cardiac Contributions to Brain Health (Contribuciones del corazón a la salud cerebral).

“El valor incremental de este estudio radica en que analiza la adherencia durante los meses críticos posteriores a un ataque o derrame cerebral agudo, período en el cual el riesgo de experimentar un segundo ataque o derrame cerebral es mayor. Abordar factores que contribuyan a desigualdades asociadas con el sexo en la atención del ataque o derrame cerebral, particularmente en las minorías raciales y étnicas, debería ser una prioridad para una sociedad que procure eliminar las desigualdades e inequidades sociales”.

Detalles, antecedentes y diseño del estudio:

• Los datos utilizados en este análisis se obtuvieron del proyecto Brain Attack Surveillance in Corpus Christi (BASIC), que reclutó participantes del condado de Nueces, Texas.
• El estudio incluyó a 1,324 personas adultas de 45 años o más que tuvieron un primer ataque o derrame cerebral isquémico entre 2008 y 2019. Las mujeres representaron el 48.4% del total de participantes. El 58% de las personas participantes se identificaron como mexicoamericanas, el 34.3% como blancas no hispanas y el 7.7% como pertenecientes a “otra” raza/etnia.
• En una entrevista con traducción al español, se pidió a cada participante que mostrara a los entrevistadores todos los envases de los medicamentos que se les habían recetado para que tomaran en ese momento. Respecto de cada uno de los cuatro tipos de medicamentos de prevención del ataque o derrame cerebral (antihipertensivos, medicamentos para reducir el colesterol, antiplaquetarios y anticoagulantes), se preguntó a los participantes: “¿Con qué frecuencia, en una semana habitual, usted omitió una dosis indicada de este medicamento? Nunca, Rara vez, Ocasionalmente, Con frecuencia, Con mucha frecuencia, Abandoné o no completé el tratamiento, o No lo sé”.
• Los investigadores consideraron que había adhesión a cada medicamento recetado cuando las personas informaban que “Nunca” o “Rara vez” omitían una dosis en una semana habitual, y todas las demás respuestas se consideraron como falta de adhesión.

Lisabeth señaló que deben realizarse nuevas investigaciones para analizar otros factores que no están incluidos en el estudio actual y que pueden contribuir a las diferencias entre sexos al tomar los medicamentos conforme a las indicaciones dadas, lo cual incluye factores psicológicos e interpersonales, como las preocupaciones de los pacientes por posibles efectos secundarios, percepciones de los pacientes sobre los beneficios de los medicamentos, roles de cuidado y si los pacientes recibían cuidado de profesionales de cuidado de la salud del mismo sexo, lo cual se ha demostrado que mejora la adhesión terapéutica.

Según la American Stroke Association (la Asociación Americana del Derrame Cerebral), más de 9 millones de americanos son supervivientes de ataque o derrame cerebral, y aproximadamente 1 de cada 4 de ellos sufre un segundo episodio. Los investigadores señalaron que las mujeres se ven afectadas de manera desproporcionada después de un ataque o accidente cerebral, con discapacidades más graves, mayor riesgo de muerte, y ataques y derrames cerebrales más recurrentes que los hombres. Las investigaciones demuestran que los medicamentos de prevención del ataque o derrame cerebral secundario pueden reducir el riesgo de muerte y ataque o derrame cerebral recurrente. No obstante, la adhesión terapéutica después de un ataque o derrame cerebral es fundamental para reducir el riesgo y prevenir que vuelvan a producirse.

Los coautores y los datos públicos se enumeran en el artículo. El estudio contó con el financiamiento parcial de una subvención otorgada por la American Heart Association.

Los estudios publicados en las revistas médicas de la American Heart Association están sujetos a revisiones de pares. Las declaraciones y conclusiones hechas en cada manuscrito son únicamente las de los autores del estudio y no reflejan necesariamente la política o la posición de la AHA. La AHA no hace manifestaciones ni brinda garantías sobre su precisión o confiabilidad. La AHA recibe financiamiento principalmente de personas físicas; las fundaciones y sociedades (incluidos los fabricantes de dispositivos y las empresas farmacéuticas y de otro tipo) también hacen donaciones y financian programas y eventos específicos de la AHA. La AHA mantiene políticas estrictas para evitar que estas relaciones influyan en el contenido científico. Los ingresos de las empresas farmacéuticas y biotécnicas, los fabricantes de dispositivos y los proveedores de seguro de salud, así como AHA, se encuentran disponibles aquí.

Recursos adicionales:

• En la columna derecha del enlace de publicación se ofrece material multimedia para consultar.
• Comunicado de prensa en Inglés
• Después del 4 de diciembre de 2024, lea el artículo en línea.
• Comentario de la AHA: Nonadherence to Preventive Medications after Ischemic Stroke: Opportunities to Target Interventions by Sex, Race, and Ethnicity (Incumplimento terapéutico relativo a medicamentos de prevención después de un ataque o derrame cerebral isquémico: oportunidades para orientar las intervenciones según el sexo, la raza y el origen étnico; dic. de 2024)
• Comunicado de prensa de la AHA: New Spanish language stroke prevention website aims to remove barriers to equitable health (Nuevo sitio web en español sobre prevención del ataque o derrame cerebral procura eliminar los obstáculos que impiden el acceso equitativo a la salud; septiembre de 2024)
• Pauta de la AHA/ASA: Guía 2021 para la prevención del ataque cerebral en pacientes con ataque cerebral y accidente isquémico transitorio: Una guía de la American Heart Association/American Stroke Association (mayo de 2021)
• Siga las noticias de AHA/ASA en X @HeartNews
• Siga las noticias de la revista profesional de la American Heart Association @JAHA_AHA

###

Acerca de la American Heart Association

La American Heart Association es una fuerza implacable que trabaja para lograr un mundo con vidas más largas y saludables. Nos dedicamos a garantizar la igualdad en materia de salud en todas las comunidades. A través de la colaboración con numerosas organizaciones y el impulso de millones de voluntarios, financiamos investigaciones innovadoras, defendemos la salud pública y compartimos recursos para salvar vidas. La organización con sede en Dallas ha sido una fuente de información sobre salud líder durante un siglo. Durante 2024, el año de nuestro centenario, celebraremos 100 años de historia y logros relevantes. Mientras nos preparamos para el segundo siglo de descubrimiento e impacto, nuestra visión es promover la salud y la esperanza para todos, en todo el mundo. Comuníquese con nosotros en heart.org, Facebook, X o llamando al 1-800-AHA-USA1.

Para realizar consultas desde medios de comunicación y conocer el punto de vista de un experto de la AHA/ASA: 214-706-1173

Amanda Ebert: Amanda.Ebert@heart.org

Para consultas públicas: 1-800-AHA-USA1 (242-8721)

heart.org y stroke.org

Aspectos destacados de la declaración:

• Una nueva declaración científica describe el papel de los profesionales de atención primaria en la ayuda a sus pacientes para lograr Los Ocho Pases Esenciales Para Mi Salud, las medidas clave para mejorar y mantener la salud cardiovascular definidas por la American Heart Association.
• La nueva declaración destaca cómo los médicos de atención primaria pueden ayudar a los pacientes a seguir y mantener las métricas de salud Los Ocho Pases Esenciales Para Mi Salud de la Asociación, para una salud cardiovascular óptima, que incluyen cuatro conductas de salud (dieta, actividad física, exposición a la nicotina y sueño) y cuatro métricas de salud (índice de masa corporal, colesterol, glucemia y presión arterial).
• A pesar de su potencial para impactar positivamente en la salud cardiovascular, el campo de la atención primaria afronta numerosos desafíos, incluidas las brechas en el acceso a la atención, una fuerza laboral pequeña que enfrenta agotamiento, dificultades en la coordinación de la atención y compensación insuficientes por la atención.

Prohibida su divulgación hasta las 4:00 a. m. CT/5:00 a. m. ET, del miércoles, 13 de noviembre de 2024

DALLAS, 13 de noviembre de 2024 — Los médicos y los consultorios de atención primaria están en una posición única para ayudar a las personas a lograr una salud cardiovascular óptima a través de la detección, el diagnóstico y el tratamiento de los factores y las conductas de salud establecidos en las métricas de salud Los Ocho Pases Esenciales Para Mi Salud  de la American Heart Association (la Asociación Americana del Corazón) para reducir el riesgo de enfermedades cardíacas y ataque o derrame cerebral, según una nueva declaración científica publicada hoy en la revista profesional de la Asociación Circulation: Calidad y resultados cardiovasculares.

La enfermedad cardiovascular es la principal causa de muerte en los EE. UU., sin embargo, se estima que 1 de cada 4 muertes por enfermedad cardiovascular podrían evitarse abordando los factores de riesgo modificables con cambios en el estilo de vida y tratamiento. Las medidas Los Ocho Pases Esenciales Para Mi Salud de la Asociación son clave para mejorar y mantener una salud cardiovascular óptima y reducir el riesgo de enfermedades cardíacas, derrame cerebral y otros problemas de salud importantes. Los Ocho Pases Esenciales Para Mi Salud describe cuatro conductas de salud: dieta, actividad física, exposición a la nicotina y sueño; y cuatro factores de salud: índice de masa corporal, lípidos en sangre, glucemia y presión arterial.

“La atención primaria desempeña un papel central en la salud de las personas y en sus cuidados de salud a lo largo de la vida”, afirmó la Presidenta del grupo de redacción de la declaración, Madeline R. Sterling, M.D., M.P.H., M.S., FAHA, Profesora Adjunta de Medicina en Weill Cornell Medicine en New York. “Los profesionales de atención primaria tienen el potencial de mejorar enormemente la identificación y el tratamiento de los factores de riesgo cardiovascular y las conductas de salud en sus pacientes”.

En particular, datos recientes revelan que la atención primaria, en lugar de la atención especializada, es la principal fuente de atención que puede ayudar a los pacientes a abordar los factores y conductas de salud descritas en Los Ocho Pases Esenciales Para Mi Salud de la American Heart Association para una salud cardiovascular óptima.

Cada área dentro de Los Ocho Pases Esenciales Para Mi Salud se puede modificar con cambios de conducta o administración de medicamentos, y los profesionales de atención primaria suelen ser los que rutinariamente examinan, diagnostican y tratan la presión arterial alta, el azúcar en sangre y el colesterol. Además, la detección y el asesoramiento para dejar de fumar y el control del peso se realizan con mucha más frecuencia en consultas de atención primaria que en entornos de atención especializada.

Tal como se destaca en la declaración científica, la atención primaria efectiva se centra en la persona, se basa en el trabajo en equipo, se alinea con la comunidad y está diseñada para lograr una mejor salud a menor costo. Se ha demostrado que la atención primaria mejora la identificación y el tratamiento de los factores de riesgo y las conductas de salud cardiovascular, como se describe en Los Ocho Pases Esenciales Para Mi Salud, que incluye:

• Nutrición y actividad física: los médicos y equipos de atención primaria desempeñan un papel central en el asesoramiento sobre nutrición y planes de alimentación saludables para el corazón, como la dieta mediterránea y la dieta de Enfoques dietéticos para detener la hipertensión (Dietary Approaches to Stop Hypertension, DASH), así como en la implementación de programas e intervenciones relacionadas con la dieta y la actividad física.
• Exposición a la nicotina: La exposición a la nicotina a través del consumo de tabaco, el vapeo y el humo de segunda mano es la principal causa prevenible de morbilidad y mortalidad en los Estados Unidos y es responsable del 20 % de las muertes por enfermedades cardiovasculares (ECV) anualmente. Las intervenciones conductuales y basadas en medicamentos son efectivas y pueden ser abordadas por profesionales de atención primaria.
• Sueño: La falta de sueño o el sueño de mala calidad se asocian con factores de riesgo para enfermedades cardíacas, que incluyen presión arterial alta y diabetes tipo 2. Los profesionales de atención primaria pueden detectar problemas de sueño, examinar sus posibles causas e iniciar ajustes de medicación y derivaciones a especialistas cuando sea necesario.
• Control de peso: la obesidad afecta al 42 % de los adultos en los Estados Unidos, y la atención primaria es un entorno ideal para detectar exceso de peso, remitir a las personas a programas de nutrición y pérdida de peso, recetar medicamentos y, cuando sea apropiado, proporcionar referencias para cirugía bariátrica u otras intervenciones. Un metaanálisis y revisión sistemática reciente revelaron que las intervenciones de control del peso para adultos con obesidad, llevadas a cabo en centros de atención primaria, fueron efectivas para la pérdida de peso.
• Presión arterial, glucemia y colesterol: la detección de factores de riesgo como presión arterial elevada, glucemia y lípidos son pilares de la prevención primaria de enfermedades cardiovasculares y se llevan a cabo en el ámbito de la atención primaria. Los médicos y centros de atención primaria pueden brindar asesoramiento sobre estilo de vida y recetar tratamientos que a menudo incluyen intervenciones educativas, autocontrol de la presión arterial, programas de entrenamiento para mejorar el control dirigido por el paciente, intervenciones como asesoría nutricional o medicamentos. Una revisión actual de 42 ensayos clínicos controlados aleatorizados halló que tanto las intervenciones a nivel individual como organizacional (manejo por parte de personal de enfermería y de farmacia, trabajadores comunitarios de salud, etc.) en el ámbito de la atención primaria fueron efectivas para mejorar el control glucémico entre personas con diabetes tipo 2 mal controlada. Se han observado resultados similares en personas con presión arterial alta tratadas en centros de atención primaria.

Según el informe Estadísticas sobre enfermedades cardíacas y derrames cerebrales (ataques cerebrales) 2024 de la American Heart Association, la incidencia de enfermedades cardiovasculares ha disminuido en los Estados Unidos. Sin embargo, solo 1 de cada 5 adultos en ese país tiene lo que se considera una salud cardiovascular óptima, lo cual se asocia con una mayor longevidad y una mejor calidad de vida.

También existen marcadas disparidades en la atención y la salud debido a factores sociales y ambientales, como el nivel socioeconómico, la raza y factores comunitarios, como la disponibilidad de espacios seguros para hacer ejercicio y el acceso a alimentos saludables.

“La atención primaria como campo puede abordar algunas de estas disparidades al brindar atención preventiva para detectar factores de riesgo de enfermedades cardiovasculares en los pacientes, alentar a las personas a adoptar hábitos de vida saludables para el corazón para evitar que se desarrollen o empeoren los problemas de salud, e iniciar un tratamiento para mejorar la salud cardiometabólica si es necesario”, dijo Jeremy Sussman, M.D., M.P.H., M.S., Profesor Adjunto de Medicina en University of Michigan y Vicepresidente de la declaración científica.

A pesar del potencial de promover Los Ocho Pases Esenciales Para Mi Salud, los profesionales y las prácticas de atención primaria enfrentan desafíos que pueden limitar su éxito en el apoyo a los pacientes para reducir los riesgos cardiovasculares. Las investigaciones muestran que una mayor proporción de médicos de atención primaria por persona se asocia con un costo total de atención más bajo y una disminución de la morbilidad y la mortalidad. Sin embargo, existen preocupaciones sobre la disminución de la fuerza laboral en atención primaria, que enfrenta altos niveles de agotamiento, dificultades en la coordinación de la atención con otros profesionales de la salud y compensación y apoyo financiero insuficientes. La falta de cobertura de seguro de salud, el acceso desigual a la atención y los recursos limitados en áreas rurales también pueden crear barreras para una mejor salud.

“La atención primaria como profesión está infravalorada y cuenta con pocos recursos: representa el 35 % de las visitas de cuidados de salud en los Estados Unidos y solo el 5 % de los gastos de atención médica”, afirmó Sterling. “Para que la atención primaria tenga el máximo impacto en las variables descritas en Los Ocho Pases Esenciales Para Mi Salud, debe ser apoyada, promovida y valorada por la comunidad de cuidados de salud, los sistemas de salud pública y los formuladores de políticas”.

La declaración destaca formas de abordar estos desafíos, como la reforma de los sistemas de pago, el aprovechamiento de la tecnología y la promoción de la atención basada en equipos. Cabe señalar que los profesionales de atención primaria se encuentran entre los médicos con los salarios más bajos en Estados Unidos. 

“El apoyo efectivo a la atención primaria requeriría legislación federal y estatal para aumentar la proporción general del gasto en cuidados de salud destinado a la atención primaria y actualizar la forma en que se paga la atención y los programas de apoyo”, afirmó Sussman.

También se necesita un enfoque de atención basado en el trabajo en equipos para apoyar a los profesionales de atención primaria y promover la colaboración a través de iniciativas basadas en el sistema de salud y en las clínicas. La tecnología y la infraestructura de datos, como los sistemas de registros electrónicos de salud, las herramientas de apoyo a la decisión clínica y las consultas por telemedicina, pueden mejorar la prestación de servicios de cuidados de salud y ofrecer un mejor apoyo a las prácticas de atención primaria y, a su vez, a los pacientes. También es necesario incorporar los tratamientos basados en evidencia de manera más eficiente y consistente en la atención.

Esta declaración científica fue preparada por el grupo de redacción de voluntarios en nombre del Comité de Ciencias de Atención Primaria de la American Heart Association del Consejo de Calidad de la Atención y la Investigación de Resultados y del Consejo de Enfermería Cardiovascular y de Derrame Cerebral; el Consejo de Cuidados Cardiopulmonares, Críticos, Perioperatorios y de Reanimación; y el Consejo de Salud Cardiometabólica y de Estilo de Vida. Las declaraciones científicas de la American Heart Association promueven una mayor conciencia sobre las enfermedades cardiovasculares y los derrames cerebrales y ayudan a facilitar la toma de decisiones informadas sobre el cuidado de salud. Las declaraciones científicas describen lo que se sabe actualmente sobre un tema y qué áreas necesitan más investigación. Si bien las declaraciones científicas informan el desarrollo de pautas, no hacen recomendaciones de tratamiento. Las pautas de la American Heart Association proporcionan las recomendaciones de práctica clínica oficiales de la Asociación.

Otros coautores y miembros del grupo de redacción de la declaración son Erin Ferranti, Ph.D., M.P.H., R.N., FAHA; Beverly B. Green, M.D., M.P.H., FAHA; Nathalie Moise, M.D., M.S., FAHA; Randi Foraker, Ph.D., M.A., FAHA; Soohyun Nam, Ph.D., A.P.R.N., A.N.P.-B.C., FAHA; Stephen P. Juraschek, M.D., Ph.D., A.H.S.C.P.-C.H.S., FAHA; Cheryl A.M. Anderson, Ph.D., M.P.H., M.S., FAHA; y Paul St. Laurent, D.N.P., R.N. Los datos públicos de los autores se encuentran en el artículo.

La Asociación recibe financiación de personas particulares principalmente. Algunas fundaciones y empresas (incluidas compañías farmacéuticas y fabricantes de dispositivos, entre otras) también realizan donaciones y financian eventos o programas específicos de la Asociación. La Asociación tiene políticas estrictas para evitar que estas relaciones influyan en el contenido científico. Los ingresos de las compañías farmacéuticas y de biotecnología, los fabricantes de dispositivos y los proveedores de seguros de salud y la información financiera general de la Asociación están disponibles aquí.

Recursos adicionales:

• Los recursos multimedia se encuentran en la columna derecha del enlace de la publicación.
• comunicado de prensa en inglés
• Después del 13 de noviembre de 2024, lea el artículo en línea.
• Comunicado de prensa de la AHA: Nueva guía: Prevenir un primer derrame cerebral puede ser posible con una prueba de detección y cambios en el estilo de vida (octubre de 2024)
• Consejo del presidente de la AHA:  Previsión de la carga de enfermedades cardiovasculares y derrames cerebrales en los Estados Unidos hasta 2050: Prevalencia de factores de riesgo y enfermedades (junio de 2024)
• Consejo del presidente de la AHA: Salud cardiovascular, renal y metabólica (octubre de 2023)
• Consejo del presidente de la AHA Los Ocho Pases Esenciales Para Mi Salud Actualización y mejora del constructo de salud cardiovascular de la American Heart Association: (junio de 2022)
• Siga las noticias de AHA/ASA en X @HeartNews
• Siga las noticias de Circulation: Calidad y resultados cardiovasculares, la revista profesional de la AHA @CircOutcomes

###

Acerca de la American Heart Association

La American Heart Association es una fuerza incansable cuyo objetivo es prolongar la vida y la salud de todos. Nos dedicamos a garantizar la igualdad en materia de salud en todas las comunidades. A través de la colaboración con numerosas organizaciones y el impulso de millones de voluntarios, financiamos investigaciones innovadoras, defendemos la salud pública y compartimos recursos para salvar vidas. La organización con sede en Dallas ha sido una fuente de información sobre salud líder durante un siglo. Durante 2024, el año de nuestro centenario, celebraremos 100 años de historia y logros relevantes. Mientras nos preparamos para el segundo siglo de descubrimiento e impacto, nuestra visión es promover la salud y la esperanza para todos, en todo el mundo. Comuníquese con nosotros a través de heart.org, Facebook, X o llamándonos al 1-800-AHA-USA1.

Para consultas de medios de comunicación: 214-706-1173

Amanda Ebert: Amanda.Ebert@heart.org

Para consultas públicas: 1-800-AHA-USA1 (242-8721)

heart.org y stroke.org

Research Highlights:

• A version of the Multi-Ethnic Study of Atherosclerosis (MESA) heart disease risk score that did not include race predicted heart disease risk just as well as the original version that includes race.
• The original MESA risk score, developed in 2015[1], combines traditional risk factors, sex and race with a coronary artery calcium score.
• The MESA formula without race may be used for people who identify with more than one racial or ethnic group or those who prefer not to disclose their race or ethnicity.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 11, 2024

CHICAGO, Nov. 11, 2024 — A version of the MESA heart disease risk score that did not include race predicted heart disease risk just as well as the version that includes race, according to a preliminary study presented today at the American Heart Association’s Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“Our work is part of a growing effort to assess the implications of including race and ethnicity in clinical risk prediction models,” said lead investigator Quinn White, B.A., a doctoral student at the University of Washington, Seattle. “This change broadens the potential use of the score, since it can now be calculated for those who do not fit into one of the racial or ethnic groups of the original score and for those who do not wish to disclose their race.”

The MESA score is used to predict risk for coronary heart disease (CHD) — including heart attack, cardiac arrest, revascularization and CHD death[2] — over the next 10 years. It was originally developed in 2015 from participant data in the Multi-Ethnic Study of Atherosclerosis, a community-based study that followed more than 6,000 adults, free of heart disease at the start of the study, for 10 years. Participants were from six areas of the U.S. and the study group was 39% non-Hispanic white, 12% Chinese American, 28% Black and 22% Hispanic, with equal numbers of men and women.¹

Risk scores have often used a modifier, or adjusted the calculation, to account for the statistically higher risk of heart disease among people of certain racial and ethnic groups. However, race is not a biological factor and using it to predict risk may lead to treatment decisions that perpetuate disparities.

The original risk score is based on traditional risk factors for heart disease, sex, race and coronary artery calcium (CAC) levels, which are obtained from computed tomography (CT) imaging. Traditional risk factors in the MESA score include total cholesterol; low “good” cholesterol, or HDL; high blood pressure; family history of heart disease; smoking; and Type 2 diabetes status.

In this study, researchers developed a version of the MESA risk score without including race or ethnicity, then compared its effectiveness to the original that includes race and ethnicity.

Investigator White and colleagues found virtually no difference in heart disease prediction between the risk scores:

• In a statistical analysis, the score without race had a concordance value of 0.800 while the original score had a value of 0.797. Concordance is how well the equation could identify those at risk vs. those not at risk. A value over 0.7 indicates a very good model.

• The actual rate of heart disease among participants matched the predicted rate when using either version of the risk score.

“We hope this work can continue the conversation about how researchers and clinicians can think carefully about whether it is necessary to include race and ethnicity in risk prediction models, and the impact such a decision could have for patient care,” White said.

“I think this study reinforces two important points,” said Sadiya Khan, M.D., M.Sc., Magerstadt Professor of Cardiovascular Epidemiology and associate professor at Northwestern School of Medicine in Chicago, and head of the writing group for the PREVENT equations. “First, there is the importance of a diverse population sample in which to develop models. Second is ensuring that the relevant predictors are included. With these two things in place, the model performs well, even without the social construct of race.”

Background on the MESA study:

• MESA enrolled 6,814 adults, ages 45-84, without heart disease between 2000 and 2002 as part of a long-term, observational study of the development of atherosclerosis.
• Participants in MESA were seen at clinics at Columbia University in New York; Johns Hopkins University in Baltimore; Northwestern University in Chicago; University of California in Los Angeles; University of Minnesota, Twin Cities in St. Paul and Minneapolis; and Wake Forest University in Winston-Salem, North Carolina.
• The original MESA study was funded by the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health.

A limitation to White’s analysis is that the MESA study included only four racial and ethnic groups, which do not represent the full racial and ethnic diversity of people in the U.S.

White’s study was funded by the American Heart Association’s De-biasing Clinical Care Algorithms project. The de-biasing project is a two-year initiative supported by a grant from the Doris Duke Foundation to investigate and elevate the complex issue of how race and ethnicity, when factored into clinical care algorithms and risk prediction tools, affect equity in clinical decision-making. The American Heart Association supports developing unbiased tools that are not based on race or ethnicity to predict the risk of heart disease.

“This research is helping change assumptions about the role of race in risk calculation,” said Jennifer Hall, Ph.D., FAHA, chief of data science for the American Heart Association and lead scientist for the de-biasing initiative. “As other risk calculators are revised with contemporary patient data and additional measures for health, social, community and historical factors, we hope that they support more equitable clinical decision-making.”

Co-authors and disclosures are listed in the abstract.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/mesa-heart-disease-risk-score-worked-well-with-or-without-race-included?preview=ef84ee743a6446f3ab0ae847fab7662d
• Spanish news release
• Link to abstract; and AHA Scientific Sessions 2024 Online Program Planner
• AHA news release: Structural racism causes poor health, premature death from heart disease and stroke (Nov. 2020)
• AHA news release: Race is a social construct and often used as proxy for biological variables, may affect patient care, outcomes (June 2023)
• AHA health information: Championing Health Equity for All
• For more news at AHA Scientific Sessions 2024, follow us on X @HeartNews, #AHA24

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact, our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and AHA Expert Perspective:

AHA Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Maggie Francis, maggie.francis@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org