Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: While most HIV news nationally is good, troublesome pockets remain, Elizabeth Tracey reports

Deaths related to HIV have dropped beyond expectation, CDC data indicate. That’s great, and we still have work to do, says Joseph Cofrancesco, an HIV expert at Johns Hopkins.

Cofrancesco: If you’re treated early you do well. If you are delayed in that treatment you will not do well, so it’s incumbent upon public health, medicine, how to get back to this idea of universal testing. The other thing that was worrisome was that the greatest ethnicity deaths were among black persons in the US in the South. Public health experts, providers, politicians, all need to recognize that in their area, people are not having the same degree of progress that people in other parts of the country are.   :34

Cofrancesco says continuing effort must be put into removing barriers to early and frequent testing among those at risk, as well as those that stand in the way of effective and ongoing treatment for HIV infection. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: HIV numbers nationally have some sweet spots, Elizabeth Tracey reports

We’re ahead of the game nationally when it comes to getting HIV infection under control, the most recent data from the Centers for Disease Control and Prevention indicate. Joseph Cofrancesco, an HIV expert at Johns Hopkins, reviews the numbers.

Cofrancesco: HIV related deaths have decreased almost 50%, exceeding the expectations of what we hoped to obtain by 2017. If you look at gender, age, race, ethnicity, there were decreases and disparities were shrinking. The disparities between Latinx and whites basically was eliminated in terms of survival. We are getting to people earlier and treating them, you can then really expect that we are going to control this disease and have people have full and normal life expectancy.  :33

Cofrancesco notes that these numbers are the good news, but there are variations around the country in both deaths and disparities among different groups of people. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: New research is trying to tease out why young black women in the US may experience higher rates of cardiovascular problems. Elizabeth Tracey reports.

Black women experience higher rates of preeclampsia, a dangerous condition affecting blood pressure, while pregnant than other ethnicities. Garima Sharma, a cardiologist at Johns Hopkins, is trying to find out why.

Sharma: We looked at the rates of cardiovascular risk factors and preeclampsia in non-Hispanic black women. We differentiated non-Hispanic black women into US born black women and foreign born black women. The US born black women had more preeclampsia, worse cardiovascular health. We also found that when these foreign born black women had lived in the US for greater than 10 years their risks of preeclampsia and cardiovascular risk factors were closer to US born women than those that were in the US for less than 10 years.  :32

Sharma notes that many things change with immigration, often including diet, exercise, social support, and stress. She says for now, all black women should be carefully monitored while pregnant for the development of preeclampsia. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: The pandemic brings to light health burdens that have been around for some time, Elizabeth Tracey reports

Deaths from Covid-19 continue to rise, and people with existing cardiovascular disease remain in a heightened risk group. Garima Sharma, a cardiologist at Johns Hopkins, says this fact points to cardiovascular disease as an ongoing problem.

Sharma: It puts into context the overall burden of cardiovascular disease that we’re dealing with in our country. I mean let’s not forget that. Even during Covid the largest killer still is cardiovascular disease. Trials like this ground us in some ways to the reality of working in a post-pandemic world, where you’ll have Covid, and that will kind of just hang out in the background, and you’re still dealing with cardiovascular deaths, day to day cardiovascular issues. Because of this controversy it helps us not lose sight of what has been an underlying problem for decades.  :33

Sharma says the best strategy remains prevention, and notes that reducing one’s risk for cardiovascular disease is largely within an individual’s control. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should anyone who’s had a heart attack take purified fish oil? Elizabeth Tracey reports

Purified fish oil, when compared to corn oil, did not show a benefit in people who had cardiovascular risk factors, a recent study shows. Garima Sharma, a cardiologist at Johns Hopkins, says adding fish oil to drugs such as statins in those already at risk is known as secondary prevention.

Sharma: By the time it comes to secondary prevention its already kind of late, that’s why I think primary prevention primordial prevention, ranging from childhood, reduction of childhood obesity. I think those things are where most of our public health resources and public health dollars should be focusing on.  :17

Sharma notes that reducing risk factors for heart disease is mainly under your control.

Sharma: A sizeable portion of them are lifestyle related. Smoking, and diabetes, and eating poorly, and physical inactivity. In some ways it just tells us the amount of challenges that we have in trying to really change the trajectory of these patients.   :14

At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Even prescription fish oil may not reduce the risk for heart problems, Elizabeth Tracey reports

When compared to mineral oil, highly purified prescription fish oil seemed to reduce cardiovascular events among those at risk, but the most recent study comparing it to corn oil failed to show a benefit. Garima Sharma, a cardiologist at Johns Hopkins with a special interest in this area, says right now the solution may be more studies.

Sharma: It’s a challenging population. These people have diabetes, they have had heart attacks, they have had MIs, and they still have multiple components of their lipid panel that in spite of statins are not under control. You would like them to get that and the other kid on the block is the PCSK9 drugs, which are also very expensive. And so when we’re looking at choosing the right therapies for the patient we’ve got to do our due diligence in trying to make sure that our patients are being benefited by the therapies.  :29

Sharma notes that a study comparing these therapies to further reduce cholesterol would likely have to be federally funded. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A new study seems to pan even purified fish oil in improving cardiovascular disease risk, Elizabeth Tracey reports

Does fish oil help people at high risk for cardiovascular events avoid them? The most recent study comparing a highly purified prescription fish oil against corn oil seems to conclude no. Garima Sharma, a cardiologist at Johns Hopkins with a special interest in this area, explains why this issue is important.

Sharma: From a clinical perspective, from a patient’s perspective, people who are at high risk of having heart disease, recurrent heart attacks, who are diabetic, who have a very high risk of cardiovascular events, continue to have those events even when they are on really good statin drugs. And that’s the context of why we’re even debating fish oil, because we know that maximally tolerated statins can get your LDL cholesterol down, but then there still continues to be a risk.  :29

Sharma says looking carefully at purified fish oil is also important because when people take the recommended amount they may develop gastrointestinal symptoms, so the risks and benefits must be weighed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Reducing healthcare costs at end of life can result in substantial boosts elsewhere, Elizabeth Tracey reports

Failure to make your own preferences known at the end of life isn’t just a personal decision, a new book called Preparing for a Better End, written by Dan Morehaim, an emergency medicine physician and former professor in the Johns Hopkins Bloomberg School of Public Health argues, it also has enormous societal costs.

Morehaim: Medicare is $900 billion dollars, $300 billion is end of life care. If you save 10% you’d save a lot of money by respecting people’s rights and empowering them to have their values observed as opposed to the usual way we cut healthcare costs. We burden employers, taxpayers, employees, we raise copays. For no cost/low cost and respecting people’s values you could save a lot of money for the nation and then put that money into preventive healthcare, pediatrics,  underserved populations, disabled, mental health, substance abuse, that would be a good way to get those funds. We’ve got to talk about it.  :32

Morehaim notes that we’re all vested in these outcomes, so we all need to consider advance directives. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How can you prepare better for end of life? Elizabeth Tracey reports

Considering circumstances you’d choose surrounding your own death is a topic many avoid. Now a new book called Preparing for a Better End may help. Written by Dan Morehaim, an emergency medicine physician and former professor in the Johns Hopkins Bloomberg School of Public Health, the book takes a comprehensive approach to issues we all should consider.

Morehaim: My hope is that advance directives and advanced care planning become normative in our society for everybody over the age of 18. That was actually done in La Crosse, Wisconsin. People had a more complete life cycle of end of life care. It was greater support at home, it reduced their healthcare costs dramatically. What I want is people to feel empowered and valued.  The main things that people fear are isolation and pain. And both of those can be managed.  :26

Morehaim says many experiences in the emergency department brought him awareness of how poorly most people prepare for end of life, and what a toll that takes on survivors. He hopes that the book will help people realize what a gift advance directives are for their survivors. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Now it’s more important than ever to have advance directives, Elizabeth Tracey reports

Preparing for a Better End is the title of a timely new book by Dan Morehaim, an emergency medicine physician and former professor in the Johns Hopkins School of Public Health, and it’s timely because of the pandemic.

Morehaim: It’s always apt because people are always going to be dying. But it’s particularly apt now in Covid for two reasons: one of course is that more people are at risk but also because the nature of the Covid illness and the circumstances around it are that people can become fairly incapacitated in terms of their ability to communicate what they want pretty quickly. And historically we usually rely on the family at the bedside. So if the patient can’t connect you’ve got the spouse or the children or somebody there. Families are not at the bedside; in fact its even more challenging because you don’t even know who to call.   :30

Morehaim advocates for current advance directives for everyone who’s older than 18 years and also believes people should prepare a document for any hospitalization they may experience that also has a complete medical history, medications, and a current EKG if possible. At Johns Hopkins, I’m Elizabeth Tracey.