Dr. Rx: Diet and exercise are keys to heart health
By Tabitha Robinson
Q: My family doctor told me that I was at an increased risk of having a heart attack because I have a family history of heart disease. What can I do to reduce my risk?
A: There are many lifestyle changes that can be made to help reduce your risk of heart disease. Diet and exercise will be your mainstays.
You want to include plenty of fruits and vegetables, grains, and the healthy fats called omega-3 in your diet. You can find omega-3 in wild salmon and herring fish, shellfish, walnuts, canola oil and flaxseed. Fish-oil supplements containing omega-3 are also available. It is best to avoid salts, most fats, sweets and red meat — if you can’t avoid these foods, try to reduce your intake. The more variety in your diet, the better.
Studies show that regular exercise for 30 to 60 minutes a day lowers blood sugar and blood pressure, boosts HDL (your good cholesterol), and can reduce blood clots, thus reducing heart disease.
Walking is a great way to get exercise. Yoga and meditation can also help you relax and keep stress levels down. Being overweight can increase your risk for heart disease; these lifestyle changes can help you maintain a healthy weight.
Getting enough sleep and good sleep hygiene is a component that is often neglected. Limited amount of sleep can raise your risk of high blood pressure, obesity, and diabetes, thus increasing your risk of heart disease. Most adults need seven to nine hours of sleep per night.
Cigarette smoking can increase your risk by raising your blood pressure. If you are an avid smoker, the first step is to start thinking about quitting. Your doctor can set you up with a support group or medication that can help you quit. Limiting alcohol is also a benefit. Drinking too much alcohol can raise your blood pressure and adds extra calories, which may cause weight gain. Both raise your risk of heart disease.
If you already have been diagnosed with high blood pressure, cholesterol and/or diabetes, it is important that you monitor and keep these under control. Make sure to always take your medications and check your blood pressure and/or blood sugar regularly. Report any changes to your doctor. High cholesterol can clog your arteries and raise your risk of heart attack or stroke. Taking cholesterol lowering medication, if prescribed, and diet and exercise changes can help keep cholesterol levels controlled.
There are some factors — such as age, gender, race and ethnicity, and family history — that you cannot change but are good to be aware of. The risk of heart disease increases with age. Studies show that African Americans are more at risk than whites. East Asians have a lower risk while South Asians have a higher risk. Hispanics are among the least likely to have heart disease. Family history plays major role, especially if you have a family member who had it at an early age.
Tabitha Robinson is a P4 Pharm.D. candidate at the Virginia Commonwealth University School of Pharmacy. Robinson is from Charles City, Virginia, and is a 2013 graduate of Virginia Commonwealth University. She holds a B.S in biology and a minor in chemistry.
Dr. Rx is a monthly publication of the VCU School of Pharmacy. It can be read in Fifty Plus magazine, available at many outlets in the Richmond area and online via Beacon Newspapers. To submit a question or to request more information, contact us.
VCU receives $2.7M to study use of anti-inflammatory medicine for treatment of heart failure
The National Institutes of Health recently awarded a $2.7 million grant to Virginia Commonwealth University’s Schools of Pharmacy and Medicine to evaluate the use of anti-inflammatory therapy to treat heart failure.
The grant will fund a clinical trial with 102 heart-disease patients. Researchers will investigate if reducing inflammation in the heart muscle can improve the patients’ health and reduce the need for hospitalization. Researchers expect to begin enrolling patients later this year.
It is the fourth NIH grant for the research team that is co-led by Benjamin Van Tassell, Pharm.D., vice chair for clinical research and associate professor in the VCU School of Pharmacy Department of Pharmacotherapy and Outcomes Science, and Antonio Abbate, M.D., Ph.D., vice chair of the Division of Cardiology in the VCU School of Medicine. The current study will build on encouraging results from a smaller 2016 study also funded by the NIH.
The researchers are investigating the possibility that inflammation could be a major cause of heart failure, rather than simply a symptom of the condition.
“The heart is a muscle,” Van Tassell said. Like other muscles, when inflamed it becomes swollen and difficult to move. Swelling could have major effects on the heart’s ability to pump blood and could result in heart failure and death.
Heart disease remains the leading cause of death in the United States, according to the Kaiser Family Foundation. The condition is difficult to treat and expensive to manage. Nearly 1 in 4 people hospitalized for heart failure return to the hospital within 30 days of leaving, according to a 2017 study published in the journal Risk Management and Healthcare Policy.
Earlier efforts by scientists to connect heart problems to inflammation have shown inconsistent results, possibly from focusing on the wrong types of inflammation, Van Tassell said. In the past few years, however, Abbate and Van Tassell have led multiple clinical trials using a drug originally developed to treat rheumatoid arthritis to target a specific type of inflammation that is driven by a protein called Interleukin-1.
In the VCU researchers’ 2016 study of 60 heart-failure patients with a recent hospitalization, those who received treatment achieved lower levels of inflammation and were able to exercise longer than patients who did not receive treatment. In the course of six months, only one patient receiving long-term anti-inflammatory treatment went back to the hospital. Nearly one-third of the patients who did not receive the anti-inflammatory treatment were hospitalized in the same period.
Last year, a large-scale study from the pharmaceutical company Novartis used a similar drug to reduce inflammation. The Novartis research found the number of heart attacks was cut by about 15 percent. The VCU study will examine if a similar approach can help people with heart failure.
Xu wins Ralph E. Powe Award from Oak Ridge Associated Universities
Qingguo Xu, assistant professor in the Department of Pharmaceutics, holds his award. He is accompanied by John Ryan, VCU associate vice president for research development, and the School of Pharmacy’s Aron Lichtman, associate dean, and Dean Joseph DiPiro.
Qingguo Xu, an assistant professor in the Department of Pharmaceutics, has received the Ralph E. Powe Award from Oak Ridge Associated Universities to support research by junior faculty.
The annual Ralph E. Powe Junior Faculty Enhancement Awards provide seed money for research by junior faculty at ORAU member institutions. These awards are intended to enrich the research and professional growth of young faculty and result in new funding opportunities, according to the organization.
VCU last received a Powe award in 2012.
Oak Ridge Associated Universities is a consortium of Ph.D.-granting institutions based in Tennessee and affiliated with the Oak Ridge National Labs, the largest science and energy laboratory in the United States, and the Oak Ridge Institute for Science and Education, supported by the U.S. Department of Energy.
Learn more about the Powe award here.
Since ancient Greece, doctors have relied on patients to tell them what medications they are taking. They may no longer need to.
Director of Communications, VCU School of Pharmacy
Every day, in thousands of emergency rooms around the world, doctors face a daunting mystery: What medications are in a patient’s body?
That question can be one of life or death, and since the days of Hippocrates doctors have relied on the same method for answers: They ask the patient.
Now, thanks to collaborative research at Virginia Commonwealth University, they may soon have a much better option.
The presence of drugs such as blood thinners or heart medications can dramatically affect the way a patient reacts to wounds or medical treatment. Unplanned withdrawal from medication can lead to medical crises in patients who are hospitalized. Drugs used in emergencies could interact badly with those that are already in a patient’s system.
“In emergencies, we have to depend on the patients or their families to tell us what they are taking,” said Sudha Jayaraman, M.D., a VCU Health surgeon who specializes in trauma and other emergency cases.
There are major drawbacks with that approach, particularly in emergencies. Patients may be unconscious or incoherent or simply unsure. Family members may not know what medicines have been prescribed, much less taken. The patients’ doctors and pharmacists may be hard to reach on short notice.
And while paramedics transporting patients to the hospital are trained to “grab all the meds and bring them in a bag,” Jayaraman said, that information is of limited use if there is no way to know which of those drugs might be in a patient’s system.
A national problem
More than half of hospitalized patients have at least one unintended drug interaction while under medical care, according to the U.S. Department of Health and Human Services. Of the unintended interactions, 39 percent had potential for severe or moderate harm.
“Those kind of things happen all the time,” said Gretchen M. Brophy, Pharm.D., professor of pharmacotherapy and outcomes science and neurosurgery at the VCU School of Pharmacy. Brophy is also a practicing neurocritical care clinical pharmacist at VCU Health and president of the national Neurocritical Care Society.
She offered an example: “A patient might go into a seizure in the emergency department and no one knows why,” Brophy said. “It turns out he is supposed to be on anticonvulsant or anti-epilepsy drugs, but he no longer has the medication in his system.”
The process of ferreting out which medicines are affecting patient health is called medication reconciliation. It is an important part of health care in general. In emergencies, the mystery can rise to a crisis level.
Standard blood tests for medications can take up to two weeks to process. Emergency department physicians, sometimes making decisions in seconds, need answers quickly.
With more than 130 million emergency department visits a year in the U.S. — 12 million of them serious enough to warrant hospital admission, according to the U.S. Centers for Disease Control and Prevention — a lot of patients are potentially at risk for dangerous medication interactions.
A new approach
A few years ago, the situation got Jayaraman thinking. How can modern emergency medicine, with its wondrous technology, still be using the same medication-reconciliation techniques it has for centuries — even as drugs have become more common? It was like a modern crime-scene investigator forced to use 18th-century technology rather than current forensic science.
Jayaraman, an associate professor of surgery in the School of Medicine, mentioned the mystery to a colleague, Dayanjan “Shanaka” Wijesinghe, Ph.D., an assistant professor in the Department of Pharmacotherapy and Outcomes Science at the VCU School of Pharmacy.
Wijesinghe was intrigued: “Basically, the doctors are working blind when it comes to medications,” he said.
But Wijesinghe quickly connected the issue to a technology he knew well. “I told her, ‘We have been doing this in the lab for a long time,’” he recalled.
The technology was mass spectrometry.
Mass spectrometry is a term used to describe an umbrella of technologies that allow the identification of a molecule by measuring its mass and then breaking those molecules apart and also measuring the masses of the fragmented components. The information gleaned from the technology can be compared to a database of intact and fragmented component masses of known compounds of interest to find the identity of the mystery molecule.
With this approach in mind, Wijesinghe and Jayaraman obtained grants from VCU’s C. Kenneth and Dianne Wright Center for Clinical and Translational Research and the Commercialization Fund, which is intended to advance VCU inventions to a more mature stage and improve their chances of being brought to market. Their objective was to assess the feasibility of using mass spectrometry in a clinical setting. With support from VCU Innovation Gateway, they have applied for a patent on the application and set up a company to market it, Mass Diagnostix.
In this early phase, the project aims to catalog 50 common drugs; so far, they have molecular signatures for 45, Wijesinghe said.
The future of patient care?
The interdisciplinary VCU team hopes the use of mass spectrometry to analyze patients’ medications will become common practice. They predict in a few years, use of the machines — which cost about $500,000 — will be standard practice for hospital laboratories.
The next step will be to expand the catalog of molecular signatures to many more medications — at least 100, Jayaraman said.
Wijesinghe suggests other possible uses. For example, he said, these instruments could record subtle changes in patients’ metabolisms that could predict life-threatening health crises before they happen.
Jayaraman and Wijesinghe are among the co-authors of a recent paper in the medical journal Shock that examines the possibility that mass spectrometry, along with other tests, could reduce deaths from trauma and its ensuing complications. Almost 200,000 trauma-related deaths occur every year in the U.S., most as a result of complications arising after the injury itself.
If this expansion of the technology into diagnosing future problems proves fruitful — and the researchers caution that years of study remain before that is determined — the effort to solve the mystery of what medications hide inside a patient’s body could have major advantages.
“We are hoping that this test will improve patient care,” Jayaraman said.
Pharmacy students present at pharmacoeconomics conference, win best poster award
By Purva Parab (VCU-ISPOR Chapter President 2017-2018)
Hrishikesh Kale, a fourth-year Ph.D. candidate in the VCU School of Pharmacy, received the Best Student Poster Research Presentation Award at the recent conference of the International Society for Pharmacoeconomics and Outcomes Research.
The top 10 percent of posters out of 1,600 submitted were considered for the award this year; three including Kale received the award. Kale won for his poster, “Economic Burden of Renal Cell Carcinoma among Older Adults in the Targeted Therapy Era.” His adviser is Dr. Norman Carroll.
Other VCU School of Pharmacy students presenting posters at the conference include second-year master’s student Purva Parab (“Patterns of Use and Quality of Life Associated with the Utilization of Antidepressants amongst Cancer Patients with Depression”), whose adviser is Dr. Pramit Nadpara; and Yiran Zhang (“Transplanting Kidneys from HCV Positive Donors Into HCV Negative Recipients in the Era of Direct Acting Antiviral Therapy: A Cost Effectiveness Analysis”), a second-year VCU-Indivior fellow currently working with Carroll.
Graduate students from the Department of Pharmacotherapy and Outcomes Science (Division of Pharmacoeconomics and Health Outcomes) and the members of the VCU chapter of the International Society for Pharmacoeconomics and Outcomes Research represent the VCU School of Pharmacy every year and exhibit their research at the ISPOR international annual conference. (Read about some previous years’ conferences here and here.)
This year’s annual meeting was held in Baltimore. More than 4,000 people from more than 40 countries attended the conference, whose theme was “Real-World Evidence, Digital Health, and the New Landscape for Health Decision Making.”
The VCU-ISPOR team included Kale, Parab, Zhang and Ph.D. student Elena Fernandez.
VCU-ISPOR students chapter also hosted a VCU alumni dinner at the conference. Parab, the president of VCU-ISPOR chapter, received funding for the alumni dinner from the VCU development office.
“We would like to thank [former School of Pharmacy development director] Ellen Carfagno for arranging the funds for the dinner,” Parab said. “It was great!”
Promotions for School of Pharmacy faculty
Congratulations to the following faculty members on their promotions, effective July 1st, 2018. The promotions were approved by the VCU Board of Visitors at its most recent meeting.
Dr. Karolina Aberg has been promoted to associate professor in the Department of Pharmaceutics.
Dr. Krista Donohoe has been promoted to associate professor in the Department of Pharmacotherapy and Outcomes Science.
Dr. Keith Ellis has been promoted to associate professor in the Department of Medicinal Chemistry. He has also been awarded tenure.
Dr. Emily Peron has been promoted to associate professor in the Department of Pharmacotherapy and Outcomes Science.
Dr. Masahiro Sakagami has been promoted to professor with tenure in the Department of Pharmaceutics.
Introducing the school’s new development director, Louie Correa
We are pleased that Louie A. Correa is joining us in June as the the school’s senior director of development. He first joined VCU in 2015 as associate director of development for VCUArts. Learn more about him in this Q&A.
Thanks for agreeing to do this! Let’s start with the big picture. What draws you to development as a career?
CORREA: I started in nonprofit management and like most development professionals stumbled into this field. I quickly fell in love with being able to visit with supporters and connect them to the causes they are passionate about. I enjoy hearing about their interests and strategizing to find the place where their interests best serve the institution.
What personal values do you draw on in your life and work? And how do you see those values fitting with those of VCU and the School of Pharmacy?
CORREA: I have a passion for higher education and our students. These are transformative years in their lives and we get to be a part of setting them on a course for future success. I want to do all I can to ensure cost isn’t a barrier to a great education and I want to ensure cost isn’t a barrier for the School of Pharmacy to have the very best faculty and programs. I love the grit I have seen from VCU students. They are often nontraditional, hard-working, self-made type people and I aim to be just as gritty in working to ensure they have the resources they need to receive a great education!
What should people know about your background and what brought you here?
CORREA: I am a Midwesterner, but married a Richmond woman in 2010. We moved here to be closer to family when we decided we wanted to start a family of our own. We have a 2-year-old daughter, Madison, and an 11-year-old puggle named Rex. I got to know a lot of pharmaceutical companies through my work as CEO of The Brandon Marshall Foundation (now called Project 375) where we worked toward promoting positive mental health and de-stigmatizing mental illness. In my spare time (which is confined to my daughter’s sleeping hours) I enjoy exercising, television/film (specifically documentaries), and sports.
Tell us something people might not know about you on the first meeting.
CORREA: I have a robust catalog of dad jokes!
Title: Senior Director of Development
Preferred Name: Louie
Hometown: Chicago, Illinois
Favorite Sport/team/hobby: VCU Rams basketball!
Family members: Erin (owns her own executive coaching practice), Madison (2), Rex (dog, 11)
Artificial intelligence, “authentic interaction” will guide future pharmacists, speaker tells graduating Class of 2018
BY GREG WEATHERFORD
Director of Communications, VCU School of Pharmacy
Pharmacists of the future will need to understand artificial intelligence, “augmented intelligence” and the growth of interconnected data systems, the head of the nation’s largest pharmacy-education association told the graduating School of Pharmacy Class of 2018.
“There is no doubt that the diagnostic and therapeutic processes and research of pharmacy will be forever changed by the advent of artificial intelligence and big data,” said Lucinda Maine, executive vice president and CEO of the American Association of Colleges of Pharmacy, in her convocation speech.
Artificial and augmented intelligence are not the only aspects of “A.I.” the students must keep in mind as they move through their careers, Maine added: Another is “authentic interaction” — the vital human touch pharmacists should use with patients, clients and colleagues.
About 800 graduating students, faculty and guests packed the auditorium of St. Paul’s Baptist Church in Henrico County near Richmond on Friday for the 2018 Hooding and Diploma ceremony, which opened with a soaring rendition of the national anthem sung by graduating Pharm.D. Kailey Conner. Dean Joseph T. DiPiro then welcomed the assembly.
This year’s ceremony included the announcement of annual student and teacher awards. Previous years’ awards had been announced at an annual banquet, but by student request the announcements were moved to the graduation ceremony.
Among the awards granted were the Research Award, presented to Crystal Leibrand; the Academic Excellence Award, presented to Katherine Ciampa; and the Dean’s Award, which includes a $2,500 prize, presented to Adrienne Simmons. A full list of the annual student awards can be found here. The annual teaching award went to Phillip Gerk, Ph.D., an associate professor in the Department of Pharmaceutics.
Following the awards, the 131 Pharm.D. students and 22 Ph.D. and master’s students received their hoods or diplomas.
Pharmacy professor and VCU alumna Leigh Anne Gravatt, Pharm.D., led the new pharmacists in the Oath of a Pharmacist, which concludes: “I will utilize my knowledge, skills, experiences and values to prepare the next generation of pharmacists.”
Of the 52 graduating Pharm.D. students who are going on to postgraduate pharmacy and training experience, 56 percent — 29 — will remain in Virginia.
The VCU School of Pharmacy was founded in 1898 as part of the Medical College of Virginia. It ranks among the top 20 pharmacy schools in the United States. — Greg Weatherford
Convocation speaker Maine to discuss A.I. and the future of pharmacy
BY GREG WEATHERFORD
Director of Communications, VCU School of Pharmacy
As a child, Lucinda Maine, Ph.D., R.Ph., wanted to be an elementary-school teacher.
“I walked out of first grade, looked at [my teacher] and said, ‘I want to be just like you,'” Maine recalled with a chuckle.
That plan did not work out. Instead, as a teenager Maine followed the advice of her submarine-building father. “I was interested in healthcare, but I knew I wasn’t going to medical school or nursing,” Maine explained. “My dad said, ‘Have you thought about pharmacy?'”
She had not. She met with her family pharmacist, whom she barely knew. His enthusiasm and encouragement — and the offer of a summer job after her freshman year at Auburn University — led her to pharmacy, then to pharmacy education and association management.
Since 2002, Maine has been executive vice president and CEO of the American Association of Colleges of Pharmacy. In that role, she will be the convocation speaker this week for the hooding and diploma ceremony for the VCU School of Pharmacy’s Class of 2018.
“I envy the Class of 2018 because the opportunities that await them are so different and more expansive than I ever could have imagined when I walked across that stage almost 40 years ago,” Maine said.
Among the changes for the profession she plans to discuss in her talk is the increasing role of technology in pharmacy, from artificial intelligence to the concept of “augmented intelligence,” which she described as “how to make information technology your friend.”
Maine also plans to address another “AI”: authentic interactions. Pharmacy is “going to be all about relationships,” she said.
For example, pharmacists are likely to be more familiar with technology than many of their patients and will need to explain it and its role in health care to them, Maine said.
Maine holds a B.S. in pharmacy from Auburn and a doctorate from University of Minnesota, where she also taught and practiced in the field of geriatrics. She was an associate dean at the Samford University School of Pharmacy. Before being hired to lead AACP, Maine served for 10 years as a senior vice president with the American Pharmacists Association.
She serves on the board of directors for Research!America and is an Executive Committee member of the American Foundation for Pharmaceutical Education.
Asked if she has any messages for faculty, Maine pointed to changes in teaching and curricula since she received her B.S., in 1980. In those days, she said, “it was lockstep … nothing like the integrated modules and experiential learning we have today.”
“[Learning] is not teacher-centered, it’s learner-centered. It can’t be the ‘sage on the stage’ for 60 minutes,” she added, acknowledging that this has been a difficult transition for some faculty.
Her association has begun to take steps to modernize pharmacy teaching along those lines, Maine said, such as emphasizing the importance of communication skills and being a change agent for the profession.
In addition, “we can’t possibly teach them everything they will need to know,” she said. “We have to teach them how to find to find, assess and apply information to patient care accurately on their own.”
Finally, Maine added, “they need to be compassionate.”
The Class of 2018 Hooding and Diploma Ceremony will be held May 11, 2018, at St. Paul’s Baptist Church in Richmond.
Chemistry. Compounding. Zombies!
BY GREG WEATHERFORD
Director of Communications, VCU School of Pharmacy
Photos by Danny Tiet, VCU School of Pharmacy
Thirty students in VCU School of Pharmacy’s third-year elective on advanced nonsterile compounding recently got a crash course in doing work in difficult conditions.
Really difficult. Zombie-invasion difficult.
The goal for the Zombie Apocalypse Lab, which comprised two weeks of the course, was to give students an experience that would help them practice pharmacy during a natural disaster, power outage or similar scenario, said assistant professor Lauren Caldas, Pharm.D., one of the course leaders and creators.
“Instead of putting them into a situation that might have actually happened to them, like a hurricane or a war zone, we thought this would teach them the same things but in a fun way,” Caldas said.
Caldas dreamed up the zombie theme with her course co-leader, Abigale Matulewicz, Pharm.D., also an assistant professor in the school’s Department of Pharmacotherapy & Outcomes Science. Both are fans of “The Walking Dead” TV show and thought something like it would work as an entertaining framework for students to learn real-life disaster-relief pharmacy skills.
They found support from VCU’s Center for Teaching and Learning Excellence, which gave them a $400 grant to cover some of the startup costs.
Why would VCU pay money for an undead invasion? “It was a beautiful combination of advancing teaching scholarship with VCU students and an innovative approach to student engagement,” enthused Enoch Hale, the center’s director.
The lab wasn’t all about zombies. The first week gave students hands-on practice extracting active ingredients from natural products.
At Caldas’ and Matulewicz’s request, School of Pharmacy professor Michael Hindle, Ph.D., and one of his postdoctoral students, Xiangyin Wei, researched the anti-inflammatory and antiseptic components of yarrow, a flowering herb found across the United States, and developed a process to extract and analyze the healing components. Students in the lab spent a week using those extraction and analysis techniques on natural dried yarrow.
That’s when the zombies came in.
For the second week of the lab, the students were informed of the scenario, given a collection of scavenged supplies and limited tools — including plastic spoons and forks and 12-ounce soda bottles — and told to create a compound with procedures, documentation and proper labeling … all without using electricity or running water.
The lab room was decorated with zombie-themed props and imagery. (The decor was handled by assistant professor Krista Donohoe, Pharm.D.)
To make the scene even more fraught, the students’ work was interrupted by spooky banging noises and occasional marauding zombies — in reality a pair of fourth-year pharmacy students in masks and lab coats spattered with fake blood.
How did the students handle the zombies and the work?
“They loved it,” Caldas said. “They were so inventive with the compounds they created!”
Students went far beyond the requirements of the course. Several used the less-than-ideal equipment to create a functioning mouthwash that included a cherry flavor to make it more palatable to patients. Labels were written and applied by hand: “Even in the apocalypse, we have to document,” Caldas noted.
Luckily, all the students made it out of the Zombie Apocalypse Lab. This time.
The team plans to repeat the course next year.