May 19 th , 2017

1. Live Long, Live Strong and Put your Heart Into Heart Health May 19th , 2017 Fighting Risk – Finding Resilience Herman Taylor, Jr., MD, MPH, FAHA, FACC Endowed Professor and Institute Director Morehouse School of Medicine Adjunct Professor of Medicine, Emory School of Medicine Adjunct Professor of Epidemiology, Harvard Chan School of Public Health Director, Morehouse-Emory Cardiovascular Center for Health Equity

3. The Jackson Heart Study

5. Advanced Phenotyping to Understand Risk

6. BMI Distribution: Comparison of Jackson and Framingham 37% 27% 12% 9% FHS JHS Taylor and C Fox, et al, Obesity 2010

7. If I'd known I was going to live this long, I'd have taken better care of myself.

8. Group comparisons focus on deficits and obscure within-group successes Significant Heterogeneity among Blacks >50% without hypertension Equal longevity among the elderly

9. Group comparisons focus on deficits and obscure within-group successes Significant Heterogeneity among Blacks >50% without hypertension Equal longevity among the elderly Resilience Health maintenance in the face of risk Understanding the environmental and individual promoters of CV health within the Black population is vastly understudied

10. Profiles in Resilience

11. What are Cardiovascular Diseases (CVD)? Diseases of the heart and blood vessels; diseases that affect the circulatory system.

12. Examples of Cardiovascular Diseases Heart Disease High Blood Pressure Stroke & TIA Cardiovascular Diseases Congestive Heart Failure Congenital Heart Defects Peripheral Vascular Disease

13. Risk Factors = Characteristics that Increase Risk for CVD • Increasing age • Male gender • Family history of heart disease • Past heart disease or stroke These cannot be changed… • Tobacco smoke • Obesity • High cholesterol • Physical inactivity • Diabetes • High blood pressure …These CAN

14. Some Key Numbers for Vitality and Longevity

15. Smoking Numbers To Know • The number of cigarettes you can safely smoke per day is 0! • Don’t breathe someone else’s tobacco smoke

16. Obesity Numbers To Know A high-risk waistline is • 35 inches or more for women • 40 inches or more for men

17. Blood Glucose(Sugar) Numbers To Know • Normal: <100 mg/dL (Hemoglobin A1C (HgA1C) <5.7 ) • Prediabetes: 100 to 125 mg/dL (HgA1C 5.7-6.4) • Diabetes: 126 mg/dL  or higher on two separate tests, you have diabetes (HgA1C >6.5)

18. Total Cholesterol Levels • Below 200 mg/dL is desirable • 200-239 mg/dL is borderline high • 240 mg/dL and above is high

19. Cholesterol Numbers To Know • Total cholesterol: < 200 desirable • HDL cholesterol: >50 men; >40 women • LDL cholesterol <100 optimal; >160 high

20. Exercise Numbers To Know: Get 30 minutes of moderately intense physical activity 5-7 days/week

21. Hypertension Prevalence

22. Blood Pressure Numbers • Normal blood pressure is less than 120/80 mmHg • Prehypertension is 120-139 mmHg • High blood pressure is 140/90 or higher

23. To Control Blood Pressure • Lose weight if overweight • Drink moderately or not at all • Eat less sodium • Be physically active • Take medication if prescribed

25. CDC Recommends< 2300mg of sodium/day

26. Heart and Soul: Jackson Heart Study findings on Spirituality Hypertension / Blood Pressure • Although many had hypertension, as a group they had lower levels of blood pressure. • Even though many were “non-compliant” and larger, they had lower blood pressures when measured in the JHS.

27. Call to Action—Control Blood Pressure

28. MECA:Towards a more complete understanding of heart health resilience

29. Arshed Quyyumi, MD Herman A. Taylor, MD, MPH Priscilla Pemu, MD, MS Priscilla Pemu, MD, MS Gregory Strayhorn, MD, PhD Sandra B. Dunbar, RN, PhD Charles Searles, MD Dean Jones, PhD Peter Baltrus, PhD Tené Lewis, PhD George Rust, MD, MPH

30. htaylor@msm.edu

31. miRNA transport modality as a functional biomarker for differences in cardiovascular risk Searles Lab: published work CAD CAD CAD Recipient Cell Donor Cell 1. Coronary artery disease decreased miRNA content of microparticles compared to healthy. 2. Coronary artery disease altered protein (Del-1) responsible for uptake of microparticles. Del-1 3. Coronary artery disease decreased MP-encapsulated miRNA uptake compared to healthy miRNA Microparticle

32. Basic Science Project Novel high-resolution metabolomics EMORY CLINICAL BIOMARKERS LABORATORY: Dean Jones Assay broadly covers human exposures New high-resolution metabolomics (HRM) measures >20,000 chemicals in human serum 40 Essential nutrients 2000 intermediates formed by enzymes encoded by the genome Plant metabolome >200,000 chemicals Largely uncharacterized (may be 10-40% of plasma metabolome) >1000 drugs in use 100,000 registered with EPA 10,000 with high volume use *Metabolome refers to chemicals associated with life Jones, Park Ziegler Annu Rev Nutr 2012

33. Call to Action—Control Blood Pressure

34. Today’s Focus:

35. Fact: The Heart and the Brain Are Inseparable

36. Fact: Risk Factors for the Brain and the Heart are Nearly Identical • Advancing age • ApoE4 allele • Smoking • Hypertension • Elevated cholesterol (LDL) • Diabetes • Obesity

37. Brain Health and Heart* Health(like brain disease and heart disease)are Tightly Linked. *Cardiovascular

38. SES (% college educated, affluence, occupation) Green Spaces Walkability % Registered to Vote** Black-owned Businesses** (Atlanta is #2 in the US) Churches Putative CV Resilience Factors: Community Fry-Johnson YW, Levine R, Rowley D, Agboto V, Rust G., 2010 “…Identification of community resilience independent of SES”

39. Putative CV Resilience Factors: Individual -Neighborhood social cohesion -Social support -Religiosity/spirituality -Optimism -Purpose in life