Houston Medical Times by Rick Delarosa

Serving Harris, Brazoria, Fort Bend, Montgomery and Galveston Counties

Special Feature: National Heart Month

HOUSTON

Volume 12 | Issue 2

Inside This Issue

February Edition 2022

Rates Of Premature Heart Attack Death Vary by Sex, Race And Region In The U.S. By The American Heart Association

M The Circadian Clock in Heart Failure See pg. 10

INDEX Legal Matters........................ pg.3 Oncology Research......... pg.5 Mental Health...................... pg.6 Hospital News....................... pg.8 The Framework.................. pg.12

MD Anderson Announces Strategic Collaboration To Develop Medicines Targeting Epigenetic Machinery in Oncology See pg. 11

iddle-aged adults, men, Black adults and adults living in rural counties have significantly higher heart attack death rates before the age of 65 compared to women, white adults and people living in urban counties, according to new research published in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association. “Cardiovascular disease is the leading cause of death in the United States, and acute myocardial infarction or heart attack, is a major contributor,” said lead study author Safi U. Khan, M.D., M.S., a cardiology fellow at the DeBakey Heart and Vascular Institute at Houston Methodist Hospital in Houston. “The cardiovascular risks among adults younger than age 65 has become increasingly complex during the last two decades. Our study focused explicitly on premature deaths due to a heart attack to identify demographic and regional differences, which may help to inform targeted interventions.” Khan and colleagues reviewed the Centers for Disease Control and Prevention (CDC) Wide-Ranging OnLine Data for Epidemiologic Research (WONDER) database to examine premature death rates in adults younger than age 65 across the U.S. According to the data, between 1999 and 2019, premature heart attack was listed as the primary cause of death

for more than 615,000 people in the U.S. The analysis found significant demographic and regional disparities

h ave reduced m ajor adver se cardiovascular outcomes for patients who have had a heart attack, so we were surprised by the deceleration in the decline of premature death rates during the last decade. This concerning trend reflects the growing burden of cardiovascular disease among younger adults. Implementing evidence-ba sed strategies to prevent and treat premature cardiovascular disease, and public health efforts targeting high-risk groups may help to narrow some of the disparities and improve outcomes among patients after a heart attack,” Khan added. During his presidential address at the American Heart Association’s 2021 Scientific Sessions, AHA President Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, said, “The rising levels of obesity and widening socioeconomic disparities are responsible for an overall stagnation in the decline of heart disease deaths. Creating and

Cardiovascular disease is the leading cause of death in the United States, and acute myocardial infarction or heart attack, is a major contributor — Safi U. Khan, M.D., M.S. in premature death rates due to heart attack: • Death rates were nearly 3 times higher among men than women • Death rates were higher among Black adults than white adults • Middle-aged adults (ages 45-64) had higher death rates than younger adults (ages 18-44) • Premature death rates in rural counties were higher than in urban counties – the average annual percent decline in heart attack deaths among those younger than 65 was -4.2 per year in large metro areas compared to only -2.4 per year in rural counties. “Recent medical advancements

see Heart Attack...page 14

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Legal Matters U.S. Supreme Court Rules on Vaccine Mandates From OSHA and CMS

Lilian Davis, J.D. Isaac Caverly, J.D. Polsinelli, PC

he United States Supreme Court recently issued two much-anticipated opinions concerning the Occupational Safety and Health Administration’s Emergency Temporary Standard on vaccination and testing (“OSHA ETS”) and the CMS Medicare and Medicaid Programs Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (“CMS Vaccine Mandate”). I. In a 6-3 ruling, the Supreme Court stayed the OSHA ETS from taking effect pending resolution of the case in the U.S. Court of Appeals for the Sixth Circuit. In the per curiam opinion,

the Supreme Court stated that the challengers to the OSHA ETS “are likely to succeed on the merits of their claim that the Secretary of Labor lacked authority to impose the mandate.” The Supreme Court further held that the OSHA ETS is not authorized by the Occupational Safety and Health Act. The Court noted that Occupational Safety and Health Administration had never adopted a broad public health regulation before. The “lack of historical precedent” and the broad authority to implement the regulation was a “telling indication” that the OSHA ETS is beyond the agency’s authority. For now, the OSHA ETS is stayed pending resolution of the case in the United States Circuit Court for the Sixth Circuit. As such, this case will now return to the Sixth Circuit where the court will hear the case on its merits, and not just for preliminary relief. Bottom Line: At this time, employers do not need to require their workforce to be vaccinated or to get tested in compliance with the OSHA ETS.

II. In a 5-4 ruling, the Supreme Court stayed temporary injunctions of the CMS Vaccine Mandate issued by the U.S. District Courts for the Eastern District of Missouri and the Western District of Louisiana. In stark contrast to the ruling concerning the OSHA ETS, the Supreme Court opined that the CMS Vaccine Mandate fell within the authorities that Congress conferred upon the Secretary of Health and Human Services. The Supreme Court further held that the CMS Vaccine Mandate was not arbitrary and capricious. Now that the temporary injunctions issued by the U.S. District Courts for the Eastern District of Missouri and

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the Western District of Louisiana have been stayed, covered employers in all states should take steps, or continue to take steps, to comply with the CMS Vaccine Mandate. Bottom Line: Employers subject to the CMS mandate must comply. CMS released guidance to State Survey Agency Directors concerning the CMS Vaccine Mandate (“Guidance”) in late December 2021 in an effort to help companies comply. Under the Guidance, by January 27, 2022, facilities must have: • Policies and procedures in place to ensure that all facility staff, regardless of clinical responsibility see Legal Matters...page 14

February 2022

Houston Medical Times

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Tuberculosis Vaccine Could Assist Future COVID-19 Vaccine Development Research Findings Suggest Strategy to ‘Complement and Extend’ the Protection Offered by Existing COVID-19 Vaccines

espite unprecedented efforts to develop COVID-19 vaccines in record time amid the global pandemic, SARS-CoV-2 continues to spread rapidly with the emergence of new variants, such as delta and omicron, making the development of new therapeutic strategies critically important. Preliminary studies early in the pandemic found evidence that countries with Bacillus Calmette-Guérin (BCG) vaccination programs, which fights tuberculosis, could be associated with a reduced number and/or severity of COVID-19 cases. While clinical trials are ongoing to further investigate, a University of Houston computational biology researcher is reporting cross reaction between the two illnesses that might help explain what could be driving immunity brought on by the BCG vaccination. “The protection against SARS-CoV-2 induced by BCG vaccination may be mediated by

February 2022

cross-reactive T cell lymphocytes, which recognize peptides displayed by class I Human Leukocyte Antigens (HLA-I) on the surface of infected cells,” reports Dinler Amaral Antunes, assistant professor of computational biology and a corresponding author of the work published in the journal Frontiers in Immunology. The researchers from UH, Pontifical Catholic University of Rio Grande do Sul and Rice University, implemented a large-scale computational screening to identify potential targets with biochemical similarities between the two illnesses. T cell lymphocytes develop from stem cells and help protect the body from infection. T cell responses to SARS-CoV-2 are vital for helping resolve viral infections and protecting against reinfection by providing long-lasting immunity. Peptides are chains of amino acids connected to one another which can be derived from proteins of the virus, as well as

from proteins of the host. HLAs are receptors that display these peptides to the immune system. The research team screened over 13.5 million possible cross-reactive peptide pairs from BCG and SARS-CoV-2. The analysis produced a large dataset of cross-reactive clusters, which ultimately led to the identification of 40 peptide pairs with potential cross-reactivity with BCG peptides. The top 40 list includes SARS-CoV-2-derived peptides GEAANFCAL, GEVITFDNL and FIAGLIAIV which have been independently shown to induce T cell response, Interferon Gamma (INF-γ) production and lymphocyte proliferation in COVID-19 patients. INF-γ is a critical component of immunity against viral and some

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bacterial infections. “In addition, multiple peptides from our top 40 list have been reported to induce T cell activation in recent studies analyzing aspects of cellular immunity in COVID-19 patients,” said Antunes. “The development of peptide-based vaccines targeting coronaviruses and presenting cross-reactivity with existing pools of memory T cells, could be an interesting strategy to complement and extend the protection conferred by existing COVID-19 vaccines.” 

Houston Medical Times

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Oncology Research Taking Care of Your Mental Health During Cancer and COVID-19 By Kendra Burke, LCSW, Texas Oncology– Deke Slayton Cancer Center

here are no words to fully describe living with cancer. Fighting cancer can affect every area of your life – from work, to relationships, to the activities you freely enjoyed before you were diagnosed. All of that takes a toll on your emotional well-being. Now, add living with the COVID-19 pandemic, and these challenges become compounded and potentially overwhelming. In a recent study by the National Institutes of Health, more than 70% of cancer patients surveyed reported pandemic-related mental health challenges. Underscoring this trend, the American Cancer Society reported one in four people with cancer suffer from major or clinical depression. But there are ways to cope –

T US

E EN

specific steps you can take to protect their emotional health. Consider these suggestions for caring for your mental health and discerning when it’s time to reach out for the support you need. Prioritize your emotional well-being. There is no blueprint for living with cancer during a global pandemic; however, getting “back to the basics” of what makes you feel fulfilled and rested is a great place to start. Take small steps to reduce stress and improve your outlook on life while still following COVID-19 safety guidelines: • Schedule safe interactions with loved ones such as going on a walk, sitting on a patio, or video calls. • Practice positivity by writing out and hanging favorite quotes around your home. • Join an online cancer support group to build community and share experiences. • Cope with stress in healthy ways like getting enough sleep, eating balanced meals, or exercising when you feel up to it. • Spend time on hobbies you enjoy like painting, playing music, or

reading. Take a break from or limit the amount of time you spend each day reading or watching the news and engaging with social media (put your phone down!). • Set short and long-term goals of things you want to accomplish. Take satisfaction in checking items off your list and having something to look forward to. Watch for the signs. It’s normal to feel fear, frustration, or sadness at times while living with a cancer diagnosis, but sometimes these feelings can move from manageable, to unrelenting, to overwhelming. It’s important to recognize when what you’re feeling is not going away or is •

getting out of hand. If you or someone you care for is struggling with consistent anxious, worried thoughts or feeling overwhelming sadness that makes it difficult to get out of bed or do normal daily tasks for several days in a row, it’s time to seek help. Get the support you deserve. Sometimes our own best efforts to protect our mental health are not enough. Mental health conditions like anxiety or depression can be treated in several ways, including talk therapy and medication. Reach out to your healthcare provider to discuss how you’re feeling and build a plan together see Oncology Research...page 14

PROUD TO SERVE HOUSTON’S MEDICAL CENTER The new dual-branded Hilton Garden Inn and Home2 Suites, located in the heart of the medical center, combines convenience with state-ofthe-art amenities. Designed to serve medical professionals and the surrounding community, we offer fully furnished extended-stay suites, over 3,000 square feet of flexible meeting space and complimentary shuttle service. • 500-car parking garage • Full-service bar and restaurant • State-of-the-art fitness center • 24-hour business center • On-site guest self-laundry facilities

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Mental Health Repeated Exposure to Major Disasters Has Long-Term Mental Health Impacts Study Finds That Houston Residents Who Experienced Two Or More Hazardous Events in The Past Five Years Had a Reduction In Mental Health Scores By Tim Schnettler

epeated exposure to major disasters does not make people mentally stronger. A recent study from the Texas A&M University School of Public Health shows the opposite is true: individuals who had repeated exposure to major disasters showed a reduction in mental health scores. Additionally, the research team found that the more experience the individuals had with such events, the lower their mental health was. “We discovered the reverse of the adage ‘what does not kill you makes you stronger,’” said the study’s lead author Garett Sansom, DrPH, research assistant professor in the Department of Environmental & Occupational Health at the School of Public Health. Sansom and a team of Texas A&M researchers studied individuals from the Houston area, which is susceptible to hurricanes and flooding

February 2022

as well as industrial emergencies. The results of the study were published recently in the journal Natural Hazards. From 2000 to 2020, the state of Texas—one of the most prone to natural disasters—experienced 33 Federal Emergency Management Agency (FEMA) declared major disasters. Many of these—hurricanes, winter weather, drought and flooding— impacted the Houston area. The area has also been impacted by emergencies such as explosions and chemical releases at nearby industrial facilities. According to the research team the combination of natural disasters and emergencies from industrial facilities presents a unique opportunity to observe the impacts. “There is an unfortunate truth that many communities that reside along the Gulf Coast are at the nexus of exposures from natural and

anthropogenic, or human-caused, hazards,” Sansom said. The team used a 12-item short form health survey to gather information. The survey assessed cumulative impacts from exposure to evaluate changes over time, producing a composite score for both mental (MCS) and physical (PCS) health. The majority of the respondents reported that they experienced many hazardous events over the past five years. Hurricanes and flooding (96.35 percent) were the events experienced the most, followed by industrial fires (96.08), chemical spills (86.84) and tornados (79.82). The team found that when individuals experienced two or more

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events over the past five years, their MCS averages fell below the expected national levels. “Mental health is often overlooked in responding to and preparing for hazard exposures,” Sansom said. “However, in order to reach community resilience efforts, mental conditions need to be accounted for.” The results of the study help to reveal the long-term mental impact hazards can have. More importantly, they underscore the need for public health interventions targeted toward these individuals as well as the communities where they reside.

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Page 8

Hospital News Behavioral Test for Hamsters Could Lead to Better Covid-19 Vaccines, Therapeutics

behavioral test for hamsters can be used as a fast and simple indicator of how efficient vaccines or therapeutics are against SARS-CoV-2 infections, researchers at the University of Texas Medical Branch (UTMB) have found. In a study published Jan. 12 in Scientific Reports from Nature, UTMB researchers describe how they developed a behavioral test to determine anosmia—the loss of the sense of smell—for hamsters

that were infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). “This test may contribute to the speedy testing of antivirals and potentially to the development of therapeutics to help aid those suffering from anosmia related to COVID-19,” said Dr. Slobodan Paessler, a virologist who was one of the corresponding authors of the study. Additional authors were Rachel Reyna, Megumi Kishimoto‐

Urata, Shinji Urata, Tomoko Makishima, and Junki Maruyama. The study found a moderately strong correlation between the level of a loss of smell and the thickness of the olfactory epithelium—the tissue in the nasal cavity that is involved in the sense of smell. That same tissue was severely damaged when infected. The study found a correlation between infected hamsters that recovered their sense of smell and the repair of the nasal cavity tissue. Researchers hid a cookie in the corner of a cage of each hamster infected with SARS-CoV-2. Then they timed how long it took each hamster to find its cookie. Those with thicker olfactory epithelium could smell quicker. Those that couldn’t find the cookies had a severe loss of smell. “This food-searching behavioral test can act as a simple and effective screening method in a hamster model for various therapeutics for SARS-CoV-2-related anosmia,” the study stated.

HCA Houston Healthcare Southeast Names Jonathan Clarke, M.D. As New Chief Medical Officer

CA Houston Healthcare Southeast is pleased to announce the appointment of Jonathan Clarke, M.D. as chief medical officer (CMO), effective January 1, 2022. Clarke most recently served as chief clinical executive at Oxford VR, an Optum Ventures portfolio company, delivering technology leveraged behavioral healthcare services via virtual reality. Previously, Clarke served as a regional medical director for Envision Healthcare in Dallas, Texas. In this role, he led significant improvements in sepsis, STEMI (ST-Elevation Myocardial Infarction, commonly known as a heart attack) and stroke quality

February 2022

measures while simultaneously reducing throughput. He held multiple hospital committee leadership positions and led accreditation and reaccreditation of chest pain, stroke and trauma programs. “Dr. Clarke is an accomplished veteran, physician leader, healthcare executive and entrepreneur who brings a diverse set of experiences and perspectives to the role,” said Jeanna Bamburg, chief executive officer of HCA Houston Healthcare Southeast. “I am thrilled to have him join our senior leadership team and look forward to the contributions he will make to help us continue to deliver

Jonathan Clarke, M.D.

innovative, patient-centered care for the communities we serve.” Clarke earned his medical degree from the University of Miami Miller School of Medicine in 2002. Following additional training in aerospace physiology, he was designated a U.S. Naval Flight Surgeon in 2003 and served with the U.S. Marine Corps in Iraq. He completed his residency in emergency medicine at Naval Medical Center Portsmouth in

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Virginia in 2009. Following residency, Clarke served as an emergency physician in Helmand, Afghanistan during the Battle of Sangin. He transferred to the U.S. Air Force Reserve in 2014, where he is also a designated flight surgeon, and continues to serve as an inactive reservist. Clarke is board-certified in emergency medicine and is a Fellow of the American College of Emergency Physicians (FACEP).

Houston Medical Times

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How to Achieve Your Medical Career Goals By Phillip Miller Merritt Hawkins

hat does it take to achieve goals in your medical career? It involves more than just having a vision and working as hard as you possibly can. You’ll need to define specifically what you want to accomplish, garner support and develop a multi-step plan for achieving those goals Then you need to take those important first steps, continually check your progress and make adjustments when necessary. Ensure goals are clear and attainable Assuming you have already assessed your current work situation and decided that it is time to develop goals for your physician career, the hard work begins as you set about achieving those goals. A good place to start is by verifying that your goals are “SMART

becoming more valuable to my current organization, or in the job market. I will talk to a physician recruiter for more insights, if needed. Relevant: I will participate in professional development opportunities (name specific ones when possible) to build my skills and demonstrate my contribution to the organization. Timely: I will achieve this salary increase within 18 months. These goals and statements should be written down, and reviewed frequently. Develop a support system Whether you are concentrating on the next step in your career or have some long-term goals you are striving toward, it’s important to remember that success is rarely a solo endeavor. You’ll want to share your career goals with your family and loved ones, who can provide some perspective, input

ADVANCE YOUR

goals” that allow you to assess your progress and recognize true success in your career. The SMART acronym refers to the fundamental practices needed to achieve a set of goals. Each career goal should be: • Specific • Measurable • Achievable • Relevant • Time-bound An example of a career goal for physicians might be, “To grow in my medical specialty to increase my salary.” It becomes a SMART goal when you make statements that fulfill these five attributes, such as: Specific: I will increase my annual earnings by 20 percent. Measurable: I will work with my supervisor to ensure I am meeting expectations. I will also document my progress and note any milestones throughout the year. Achievable: I will confirm that my physician salary goal is within reason for my specialty, and can be achieved by

and encouragement. You’ll also want to find some professional colleagues and/or a mentor who can be a good sounding board and provide more specific guidance in how to achieve your goals. If your goals are more immediate, your colleagues may even know someone with a job opening, or can point you to a physician recruiter or career consultant who has helped them in the past. Physicians also need to engage in professional networking beyond their current workplaces, which can occur in a variety of ways. It helps to stay in touch with former classmates from med school or co-workers and supervisors at previous jobs. You can also develop contacts through your healthcare network, a medical association, professional conferences or workshops, or through professional groups on social media like Doximity. Take the necessary steps

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Page 10

The Circadian Clock in Heart Failure

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isrupting circadian rhythms, which change naturally on a 24-hour cycle, has been implicated in heart disease, but it is unclear how it leads to the condition. A research team at Baylor College of Medicine and collaborating institutions investigated the function of the protein Rev-erba/ß, a key component of the circadian clock, on heart disease development in animal models and human patients. The team reports in the journal Circulation that Rev-erba/ß in cardiomyocytes mediates a normal metabolic rhythm that enables the cells to prefer lipids as a source of energy during the animal’s resting time, daytime for mice. Removing Rev-erba/ß disrupts this rhythm, reduces the cardiomyocytes’ ability to use lipids in the resting time and leads to progressive dilated cardiomyopathy and lethal heart failure.

and its activity is associated with fat and sugar metabolisms. “The heart responds differently to different sources of energy, depending on the time of the day,” explains co-corresponding author Dr. Lilei Zhang, assistant professor of molecular and human genetics and of molecular physiology and biophysics at Baylor. “In the resting phase, which for humans is at night and for mice in the day, the heart uses fatty acids that are released from fats as the main source of energy. In the active phase, which is during the day for people and at night for mice, the heart has some resistance to dietary carbohydrates. We found that without Rev-erba/ß, hearts have metabolic defects that limit the use of fatty acids when resting, and there is overuse of sugar in the active phase.” “We suspected that when Rev-erba/ß knockout hearts cannot

“We studied how the Rev-erba/ß gene influenced the metabolism of the heart by knocking it out specifically in mouse cardiomyocytes,” said co-corresponding author Dr. Zheng Sun, associate professor of medicine, section of endocrinology, diabetes and metabolism and of molecular and cellular biology at Baylor. “Lacking the gene resulted in progressive heart damage that led to heart failure.” To learn how Rev-erba/ß mediated its effects, the team analyzed gene and protein expression and a comprehensive panel of metabolites and lipids, during both the awake and sleep hours. They found that the Rev-erba/ß gene is highly expressed only during the sleep hours,

burn fatty acids efficiently in the resting phase, then they don’t have enough energy to beat. That energy deficiency would probably lead to changes in the heart that resulted in progressive dilated cardiomyopathy,” said Sun, a member of Dan L Duncan Comprehensive Cancer Center. To test this hypothesis, the researchers determined whether restoring the defect in fatty acid use would improve the condition. “We know that fatty acid use can be controlled by lipid-sensing metabolic pathways. We hypothesized that if we fed the Rev-erba/ß knockout mice more

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MD Anderson and Eisbach Bio Announce Strategic Collaboration to Develop Medicines Targeting Epigenetic Machinery In Oncology

he University of Texas MD Anderson Cancer Center and Eisbach Bio GmbH today announced a strategic research collaboration to jointly discover and develop precision oncology drugs that target synthetic lethal engines key to tumor genome evolution. The agreement aligns the drug discovery and development expertise of MD Anderson’s Therapeutics Discovery division with the innovative discovery platform and allosteric assay technology of Eisbach to generate medicines that selectively disrupt

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in tumor suppressor genes have been notoriously difficult to treat in the past,” said Timothy A. Yap, M.B.B.S., Ph.D., associate professor of Investigational Cancer Therapeutics and medical director of the Institute for Applied Cancer Science (IACS) at MD Anderson. “However, growing clinical evidence with PARP inhibitors demonstrates that targeting synthetic lethality is a promising strategy in certain cancer types, and we look forward to continued progress in this space.” Eisbach and MD Anderson

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genome replication and DNA repair in cancers harboring defined genetic alterations. “Modern genomics has revealed synthetic lethal targets in certain cancers with tumor suppressor gene mutations, and Eisbach has developed tools to pinpoint precisely where these targets are vulnerable at the molecular level,” said Adrian Schomburg, Ph.D., chief executive officer of Eisbach. “We are excited to collaborate with MD Anderson to develop innovative targeted therapies that exploit these unique vulnerabilities.” Synthetic lethality is a phenomenon in which cancer cells with mutations in certain pathways are hypersensitive to drugs targeting related pathways. Notably, defects in certain DNA damage repair pathways – common to many cancer types – render cancer cells dependent on processes that reorganize the cancer genome. “Cancers harboring mutations

will leverage their complementary expertise to jointly identify targets and develop small-molecule therapies that can shut off specific epigenetic processes, thereby disrupting genome control selectively in tumor cells while sparing normal tissues. With its proprietary assay platform, Eisbach is uniquely capable of identifying and targeting molecular vulnerabilities in this machinery through allosteric mechanisms. “Our platform identifies the unique activation mechanisms of molecular machines essential for cancer cell growth,” said Andreas Ladurner, Ph.D., chief scientific officer at Eisbach. “With this insight, we are able to develop targeted drugs that selectively interfere with the ignition of the engines that tumor cells have come

see Collaboration...page 14

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The Framework St. Luke’s Health—The Woodlands Hospital Expands Performance Medicine Outpatient Therapy

t. Luke’s Health—The Woodlands Hospital (The Woodlands Hospital) celebrated the grand opening of a newly expanded performance medicine outpatient therapy space located at 17450 St Lukes Way, Suite 180, The Woodlands. The expansion opens the door for new services for outpatient neurological rehabilitative care in support of the Comprehensive Stroke Program at The Woodlands Hospital. The clinic features over 6,000 square feet of space and offers state-of-the-art therapy equipment with private and semi-private therapy and exam space. Services include physical therapy, occupational therapy, and speech therapy. In addition to supporting the stroke program, the new rehab space will also support orthopedic and oncology patients at The Woodlands Hospital. “Today we celebrated the completion of the expansion of the performance medicine rehabilitation

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Age Well, Live Well Taking Care of Your Heart By Chelsea Couch Texercise Program Coordinator

ebruary is American Heart Month, which is a great time to learn about how to keep your heart healthy. People 65 and older are much more likely to suffer a heart attack or stroke and to develop coronary heart disease than younger people. The good news is there are things you can do to keep your heart healthy. Nutrition is an important part of heart health. The American Heart Association recommends a diet with a wide variety of fruits and vegetables, healthy sources of protein, minimally processed foods, and minimal salt and sugar intake. To make shopping for heart healthy foods easier, look for the heart check (red heart with white checkmark) on food items. This represents the food has been certified by AHA as heart healthy. Visit the U.S. Department of Agriculture’s MyPlate

Circadian Clock Continued from page 10 lipids, maybe the lipid-sensing pathways would be activated, override the defect and consequently the heart would be able to derive energy from lipids,” Sun explained. The researchers fed Rev-erba/ß knockout mice one of two high-fat diets. One diet was mostly high-fat. The other was a high-fat/high-sucrose diet, resembling human diets that promote obesity and insulin resistance. “The high-fat/high-sucrose diet partially alleviated the cardiac defects, but the high-fat diet did not,” Sun said. “These findings support that the metabolic defect that prevents the heart cells from using fatty acids as fuel is causing the majority of the cardiac

website (myplate.gov) for more healthy eating recommendations for healthy aging. Engaging in regular physical activity is another lifestyle behavior important for heart health. The U.S. Health and Human Services Physical Activity Guidelines recommend older adults get at least 150 minutes (30 minutes per day, five days per week) of moderate physical activity. Regular cardio-based physical activity can improve the heart’s blood flow in the small vessels around it, where fatty deposits can cause blockages over time. The Texas Health and Human Services Texercise initiative has a variety of free resources that engage older Texans in healthy lifestyle behaviors, including physical activity and healthy eating habits. Texercise provides a variety of fact sheets highlighting topics such as sodium reduction, keeping fitness fun, tobacco cessation, etc. as well as four exercise videos that older

Texans can follow along with at home. Visit www.texercise.com to learn more. Other preventive behaviors that can assist in keeping your heart healthy include: • Quitting and avoiding tobacco products (smoking, vaping, etc.) • Practicing stress reduction strategies (taking slow deep breaths, go for a walk, practicing mindfulness, etc.) • Getting adequate sleep (7–8 hours

dysfunction we see in the Rev-erba/ß knockout mice. Importantly, we also show that correcting the metabolic defect can help improve the condition,” Zhang said. Clinical implications in obesity paradox and chronotherapy “There are three clinical implications from this work,” Sun said. ”First, we analyzed the molecular clock function in heart tissues of patients with dilated cardiomyopathy who had received heart transplants to explore whether the clock function was associated with the severity of cardiac dilation in humans. Tissue samples were taken at different times of the day and the ratio of the gene expression of the circadian genes Rev-erba/ß and Bmal1 was calculated providing a chronotype. We found that the heart chronotype

correlates with the severity of cardiac dilation.” “The second implication is that obesity and insulin resistance, long-known clinical risk factors for heart failure, can be paradoxically protective against heart failure, within a certain time window, probably by providing fatty acids in the resting phase,” Sun said. Finally, the researchers explored the possibility of pharmacologically manipulating fatty acid and sugar metabolism to improve the condition. They found that while medications can help restore the altered metabolic pathways, it was important to give the drugs aligned with the internal circadian rhythm of the corresponding metabolic pathways. If the drugs were given out-of-sync with the pathway they

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per night) Getting regular checkups with your primary care provider HHS has other resources to support older Texans with healthy aging, including: • The Supplemental Nutrition Assistance Program assists people with buying the food they need for good health. To learn more about SNAP, visit yourtexasbenefits.com. • Area Agencies on Aging provide older adults, their families and caregivers with nutrition services, like home and congregate meals as well as evidence-based fitness programs. To connect with the nearest AAA call Texas HHS at 800-252-9240. • Aging and Disability Resource Centers are part of the No Wrong Door System and help streamline access to long-term services and support for the whole family. To learn more, call Texas HHS at 855-937-2372. •

were intended to restore, the treatment did not improve the cardiac condition.” These findings highlight the importance of chronotherapy, the scheduling of medications according to the circadian rhythm, not just in this study, but for many other medications. “Of the top 100 most prescribed drugs in the U.S., at least half of them have a target that is connected to a circadian rhythm,” Zhang said. “This indicates that for these drugs to be effective, they need to be taken in a time-specific way. Unfortunately, they are not. We want to emphasize the importance of taking the circadian rhythm into consideration when scheduling medications.”

February 2022

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Heart Attack

Continued from page 1 maintaining high cardiovascular health from birth – called primordial prevention – should be the new

Legal Matters

Continued from page 3 or patient or resident contact are vaccinated for COVID-19; and • 100% of staff have received at least one dose of COVID-19 vaccine, or have a pending request for, or have been granted qualifying exemption, or identified as having a temporary delay as recommended by the CDC. A facility that is above 80% and has a plan to achieve a 100% staff vaccination rate by February 28, 2022 would not be subject to additional enforcement action. Facilities that do not meet these parameters could

Oncology Research Continued from page 4 to treat your symptoms. It takes courage to prioritize your mental health. But there’s no time like the present to make a commitment to care for your emotional well-being

Career Goals

Continued from page 9 Once you’ve affirmed that your goals are achievable and you have shared them with your support team, you’ll need to take those first proactive steps. Feeling hesitant? Just start with the basics, and progress from there. Let’s say your goal is to find a

Collaboration Continued from page 11 to rely upon. These drugs are safe and selective by design.” Eisbach will collaborate with the team at IACS, a drug discovery engine focused on developing novel small-molecule therapeutics. IACS is a core component of MD Anderson’s Therapeutics Discovery division, an integrated team of researchers, February 2022

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foundation of cardiovascular health. “Primordial prevention is the only way for us to break the current stagnation and re-invigorate the decline in cardiovascular events and deaths,” Lloyd-Jones said. “It means we don’t just try to prevent disease by

modifying risk factors; we also try to prevent the development of risk factors in the first place.”

be subject to additional enforcement actions depending on the severity of the deficiency and the type of facility (e.g., plans of correction, civil monetary penalties, denial of payment, termination, etc.). By February 28, 2022, covered facilities must have: • Policies and procedures in place to ensure that all facility staff, regardless of clinical responsibility or patient or resident contact are vaccinated for COVID-19; and • 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple-dose vaccine series), or have been granted a qualifying

exemption, or identified as having a temporary delay as recommended by the CDC, A facility that is above 90% and has a plan to achieve a 100% staff vaccination rate within 30 days would not be subject to additional enforcement action. Facilities that do not meet these parameters could be subject to additional enforcement actions depending on the severity of the deficiency and the type of facility (e.g., plans of correction, civil monetary penalties, denial of payment, termination, etc.). Finally, facilities failing to maintain compliance with the 100% standard by March 28, 2022 may be subject to enforcement action. 

every day and invite others alongside you to lend their support during your cancer journey. Kendra Burke, LCSW, is a licensed clinical social worker at Texas Oncology–Deke Slayton Cancer Center, Houston Memorial City, Katy, and Sugar Land. A patient’s care team at Texas Oncology includes licensed clinical social workers, who are mental health

professionals that assist with a wide range of issues related to oncology care. They provide emotional support through individual counseling and support groups and help connect patients to services and resources in their community such as disability services, supplemental Medicaid programs, and medication assistance programs. For more information, visit TexasOncology.com.

new physician job within the next 6 to 12 months. If that’s the case, you’ll need to: • Update and optimize your physician resume or curriculum vitae • Update your social media profiles • Reach out to your professional network to ask for leads • Talk to a physician recruiter about your options and value in the job market

•

physicians and drug development experts working to advance impactful new therapies. “Our Therapeutics Discovery team is committed to developing the next generation of cancer treatments that address significant unmet needs in oncology,” said Philip Jones, Ph.D., vice president of Therapeutics Discovery and head of IACS at MD Anderson. “By focusing on epigenetic machinery in our collaboration with Eisbach, we are hoping to advance additional much-needed therapeutic options that

can improve patients’ lives.” Under the terms of the agreement, Eisbach and MD Anderson will jointly determine the appropriate pathway for future development and possible commercialization on any therapies that show promise in laboratory studies. 

Apply for positions that match your current and future goals • Prepare for job interviews and possible contract negotiation Each goal for your medical career can be broken down into a series of steps and timelines. But don’t let the process overwhelm you. If you have trouble keeping yourself on schedule, ask a colleague or family member to help keep you accountable.

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Page 15

WHOSE INTERESTS does your malpractice insurer have at heart?

Yet another Texas medical liability insurer has transitioned from focusing on doctors to focusing on Wall Street. This leaves you with an important question to ask: Do you want an insurer that’s driven by investors? Or do you want an insurer that’s driven to serve you—one that’s already paid $120 million in awards to its members when they retire from the practice of medicine? Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.

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February 2022

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GET BACK INTO THE GROOVE WITH THESE TIPS MOVE TO THE GROOVE FOR MENTAL WELL-BEING

TAKE CENTER STAGE FOR WOMEN’S HEART HEALTH Wear red and give to help women create the healthy habits they need to have their best chance at life

One of the keys to better health and mental well-being is getting back into the rhythm of an active lifestyle.

Give now.

Start today.

STAY ON BEAT WITH YOUR BLOOD PRESSURE Self-measure and manage your blood pressure to prevent strokes and heart attacks.

Know your numbers.

LEARN HOW TO 2-STEP Hands-Only CPR is a two step process that may save someone after cardiac arrest.

Learn the steps.

DON’T MISS A BEAT. GIVE UP TOBACCO & VAPING. Cigarette smoking is the leading preventable cause of death in the United States.

Quit today.

February 2022

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