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Don’t use sugar substitutes for weight loss, World Health Organization advises | CNN

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CNN
—

Don’t use sugar substitutes if you are trying to lose weight, according to new guidance from the World Health Organization.

The global health body said a systematic review of the available evidence suggests the use of non-sugar sweeteners, or NSS, “does not confer any long-term benefit in reducing body fat in adults or children.”

“Replacing free sugars with non-sugar sweeteners does not help people control their weight long-term,” said Francesco Branca, director of WHO’s department of nutrition and food safety. “We did see a mild reduction of body weight in the short term, but it’s not going to be sustained.”

The guidance applies to all people except those with preexisting diabetes, Branca said. Why? Simply because none of the studies in the review included people with diabetes, and an assessment could not be made, he said.

The review also indicated that there might be “potential undesirable effects” from the long-term use of sugar substitutes such as a mildly increased risk of type 2 diabetes and cardiovascular diseases.

However, “this recommendation is not meant to comment on safety of consumption,” Branca said. “What this guideline says is that if we’re looking for reduction of obesity, weight control or risk of noncommunicable diseases, that is unfortunately something science been unable to demonstrate,” he said. “It’s not going to produce the positive health effects that some people might be looking for.”

Non-sugar sweeteners are widely used as an ingredient in prepackaged foods and beverages and are also sometimes added to food and drinks directly by consumers. WHO issued guidelines on sugar intake in 2015, recommending that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. Following that recommendation, interest in sugar alternatives intensified, the review said.

“This new guideline is based on a thorough assessment of the latest scientific literature, and it emphasises that the use of artificial sweeteners is not a good strategy for achieving weight loss by reducing dietary energy intake,” said nutrition researcher Ian Johnson, emeritus fellow at Quadram Institute Bioscience, formerly the Institute of Food Research, in Norwich, United Kingdom.

“However, this should not be interpreted as an indication that sugar intake has no relevance to weight-control,” Johnson said in a statement.

Instead, one should cut back on using sugar-sweetened drinks, and try to use “raw or lightly processed fruit as a source of sweetness,” Johnson added.

Dr. Keith Ayoob, scientific adviser for the Calorie Control Council, an international association representing the low-calorie food and beverage industry, told CNN via email the WHO’s “insistence on focusing only on prevention of unhealthy ‎weight gain and non-communicable diseases is at the very least, misguided.”

Robert Rankin, president of the Calorie Control Council, said “low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases.”

The guidance is meant for government health organizations in countries who may wish to use the scientific analysis to implement policy changes for their citizens, Branca said.

“That will likely depend on the way that which sweeteners are consumed in a specific country,” he said. “For example, in a country where consumption patterns are high, those countries might decide to take action in a way or another.”

A total of 283 studies were included in the review. Both randomized controlled trials, considered the gold standard of research, and observational studies were included. Observational studies can only show an association, not direct cause and effect.

Results from randomized trials found the use of non-sugar sweeteners had a “low” impact on reducing body weight and calorie intake when compared with sugar, and no change in Intermediate markers of diabetes such as glucose and insulin, according to the report.

Observational studies also found a low impact on body weight and fat tissue, but no change in calorie intake. However, those studies found a low increase in risk for type 2 diabetes, high blood pressure, stroke, heart disease and death from heart disease, the report noted. A very low risk was also found for bladder cancer and an early death from any cause.

WHO said that the recommendation was “conditional” because the identified link between sweeteners and disease outcomes might be confounded by complicated patterns of sweetener use and the characteristics of the study participants.

In an emailed statement, the International Sweeteners Association, an industry assocation, said “it is a disservice to not recognise the public health benefits of low/no calorie sweeteners and is disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality.”

However, observational studies that follow people over time are important, Branca said. “To show that overweight people can reduce their body weight requires a long-term study. And we’re not seeing that impact from the research we have.”

The recommendation included low or no calorie synthetic sweeteners and natural extracts, which may or may not be chemically modified, such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives and monkfruit, the report said.

“Stevia and monkfruit are newer sweeteners so so there’s less published research in the scientific literature,” Branca said. “However they probably work in the body with a similar physiological mechanism as other sweeteners. We cannot say they are different from the others based on the data we have — they play the same role.”

Many people consider stevia products to be more “natural,” since they are derived from the stevia plant. Some natural and artificial sweeteners add bulking sugars to their products to cut their sweetness and add bulk to the product for baking.

A recent study by researchers at the US-based Cleveland Clinic found erythritol — used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products — was linked to blood clotting, stroke, heart attack and early death.

People with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, the study found.

Just as many people have learned to eat and cook without salt, they can learn to reduce their dependence on free sugars and non-nutritive sweetners, Branca said.

“We need to target children in early life,” he said. “For example, why do parents typically use sweeteners as a reward for children and after almost every meal? We need to recommend to parents to avoid building that sweetness Interest in young children — that’s a very important action to take.”

Even if you are a true sugar “addict,” the good news is that you can tame your sweet tooth, registered dietitian Lisa Drayer said in an article for CNN. She provides the following steps:

Train your taste buds. If you gradually cut back on sugar — including artificial sweeteners — and include more protein and fiber-rich foods in your diet, that can help you crave less sugar, Drayer said.

“When we consume protein and fiber, it slows the rise in blood sugar if we consume it with a sugar-containing food. It can help satisfy us and help us reduce our sugar intake as well,” she said in a previous interview.

Choose no-sugar-added foods and avoid all sugar-sweetened drinks. For example, choose whole-grain cereal or Greek yogurt with no sweeteners. The sugar-sweetened drinks to take off your grocery list should include sodas, energy drinks, sports drinks and fruit punch. Choose water instead.

“If you like sweet carbonated beverages, add a splash of cranberry or orange juice to seltzer or try flavored seltzers. You can also flavor your own waters with fruit slices for natural sweetness or try herbal fruit teas,” Drayer said.

Drink coffee and tea with no or fewer sugars. Be careful at coffee shops, Drayer suggested. All those lattes and flavored coffees can have as much sugar as a can of soda, or more.

Enjoy fruit for dessert. Try cinnamon baked apples, berries or grilled peaches instead of cookies, cake, ice cream, pastries and other sweet treats, Drayer said.

Watch for stealth sugars. Added sugars are often present in foods that you might not think of as “sweet,” like sauces, breads, condiments and salad dressings, Drayer said.

“Pre-packaged sauces — like ketchup, BBQ sauce and tomato sauce — tend to be some of the biggest offenders of hidden added sugars in the diet,” Kristi King, senior pediatric dietitian at Texas Children’s Hospital and a national spokesperson for the Academy of Nutrition and Dietetics, told Drayer in a prior interview.

Check nutrition facts labels. All foods and beverages must list the amount and kind of sugar on the label.

Added sugars can go by other names such as “agave, brown sugar, corn sweetener, corn syrup, dextrose, evaporated cane juice, fructose, fruit juice concentrate, fruit nectar, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, maple syrups, raw sugar, sucrose, trehalose and turbinado sugar,” Drayer said.

The higher up these added sugars are on the ingredients list, the greater the amount of added sugar in the product, she said.

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Up to 60% of stroke survivors may develop cognitive decline within a year | CNN

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CNN
—

Up to 60% of all stroke survivors develop memory and thinking problems within a year, and one-third go on to develop dementia within five years, according to a new American Stroke Association scientific statement.

“The numbers are staggering, right?” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

“This is a call to action to up our game and focus on prevention,” said Freeman, who was not part of the scientific committee who prepared the statement.

An estimated 9.4 million American adults — about 3.6% of the US adult population — report having had a stroke, according to 2023 statistics from the American Heart Association.

“Cognitive impairment is an often under-reported and under-diagnosed but yet very common condition stroke survivors frequently deal with,” said Dr. Nada El Husseini, an associate professor of neurology at Duke University Medical Center in Durham, North Carolina, in a statement.

About 40% of the survivors of stroke have mild cognitive impairment that does not meet the diagnostic criteria for dementia. Mild or not, the mental difficulties can seriously affect quality of life, said El Husseini, who chaired the writing committee for the statement.

“Cognitive impairment after stroke ranges from mild impairment to dementia and may affect many aspects of life, such as remembering, thinking, planning, language and attention, as well as a person’s ability to work, drive or live independently,” El Husseini said.

Cognitive impairment is most common within the first two weeks after a stroke, the statement said. Mental decline may go hand in hand with other conditions associated with a stroke such as behavioral and personality changes, depression, physical disability and disruption in sleep, all of which can contribute to a lower quality of life.

The American Stroke Association’s statement did offer some good news: About 20% of people who experience mild cognitive impairment after a stroke fully recover their cognitive function, typically within the first six months.

People are at higher risk for strokes if they have atrial fibrillation, an irregular heartbeat that sufferers often describe as a quiver, flutter or flip-flop of the heart in the chest. Those with uncontrolled high cholesterol or high blood pressure are also at high risk, as are people who smoke or use drugs or alcohol. Being diabetic or obese can be risk factors, too.

Ischemic strokes, caused by a clot in the blood vessels that feed blood to the brain, account for 87% of all strokes, according to the statement. Brain bleeds caused by a rupture of a weak vessel in the brain, called hemorrhagic strokes, are much less common, accounting for some 13% of all strokes.

The following are signs of a stroke, according to the National Institute of Neurological Disorders and Stroke:

Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.
Sudden confusion, trouble speaking or difficulty understanding speech.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or lack of coordination.
Sudden severe headache with no known cause.

Other, less commons symptoms include dizziness, disorientation, nausea, memory loss or vomiting.

Any of the warning signs may last only a few moments and then disappear, which could mean the person is having a minor stroke or a transient ischemic attack, or TIA. Any symptom should not be ignored, experts say, as it can signal a more serious stroke to come.

“One might call a TIA a ‘lucky stroke’ because it’s less serious, but it really is a sentinel event,” Freeman said.

It’s never too late for prevention, but serious effort is needed after even mild stroke to “extinguish the fire if you will, with aggressive change and aggressive medication therapy when appropriate,” Freeman added.

“It should push people to make very drastic lifestyle changes: Eat better, exercise more, go on the appropriate statins or aspirins or whatever their doctor suggests are appropriate so that their risk is as low as possible,” he said.

Damage to the brain occurs when some cells stop getting oxygen and die, while other brain cells may die due to bleeding in the brain. As a result, permanent brain damage can occur within minutes to hours, according to the institute. “Some brain cells die quickly but many linger in a compromised or weakened state for several hours,” it said.

Immediate medical attention is key to lessening the impact of a stroke. Learning the symptoms of a stroke using the acronym FAST can help identify the signs quickly, according to the US Centers for Disease Control and Prevention.

F — Face: Ask the person to smile. Does one side of the face droop?
A — Arms: Ask the person to raise both arms. Does one arm drift downward?
S — Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T — Time: If you see any of these signs, call 911 right away.

Be sure to capture the time when any symptom first appears, the CDC advises, to help medical personnel determine the best course of treatment.

Additional strokes only worsen potential cognitive decline, the scientific statement said, so prevention is key. Stroke risk factors, such as hypertension, high cholesterol and type 2 diabetes, should be treated, as should atrial fibrillation.

Keeping high blood pressure under control has been linked to a reduction in risk for additional strokes as well as mild cognitive impairment, the statement said.

“Stroke survivors should be systematically evaluated for cognitive impairment so that treatment may begin as soon as possible after signs appear,” El Husseini said.

“Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for post-stroke cognitive impairment,” she said. “We hope to see big enough clinical trials that assess various techniques, medications and lifestyle changes in diverse groups of patients that may help improve cognitive function.”

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Senator John Fetterman’s hospitalization for depression has raised awareness of the condition. Our medical analyst explains what it is and how it’s treated | CNN

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Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.

CNN
—

Sen. John Fetterman of Pennsylvania is continuing to receive treatment for depression at Walter Reed Medical Center in Bethesda, Maryland, after checking himself into the hospital on February 15. His office has said he has experienced depression “off and on” during his life, but that his condition “only became severe in recent weeks,” necessitating inpatient care.

Fetterman’s disclosure, widely praised by mental health advocates, has prompted many people to ask questions about the often misunderstood illness: What is depression and what are the symptoms? What are its risk factors? How can one distinguish clinical depression from feeling sad? How common is major depressive disorder? What treatments are available and when is hospitalization needed? And how can someone who needs help find assistance?

To guide us through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also chair of the advisory board for Behavioral Health Group, a network of outpatient opioid treatment and recovery centers around the United States. Previously, she served as Baltimore’s health commissioner and chaired the board of Behavioral Health System Baltimore, a nonprofit organization that oversaw mental health services in the city.

CNN: What is depression, and what are its symptoms?

Dr. Leana Wen: Major depressive disorder, colloquially referred to as depression or clinical depression, is a common illness. It is a serious mental health condition characterized by a persistently low or depressed mood and a loss of interest in activities that previously brought a person joy. Other symptoms include a lack of energy, feelings of guilt or worthlessness, an inability to concentrate, appetite changes, sleep disturbances or suicidal thoughts. These symptoms often affect someone’s ability to function at work, at home, and in social interactions.

CNN: How can one distinguish clinical depression from feeling sad? How is a diagnosis made?

Wen: It’s very common to feel down from time to time; many people experience periods of sadness, especially when facing challenging life situations. But this is different from major depressive disorder, for which there are specific diagnostic criteria including depressed mood or lack of interest in normal activities causing social or occupational impairment, and other specified symptoms such as problems with sleep, eating, concentration, energy or self-worth. These symptoms must persist for at least two weeks for a diagnosis of major depressive disorder to be made.

Screening for major depressive disorder generally begins with a physical examination by a health care provider. Often, laboratory tests are done to rule out other ailments, such as hypothyroidism and vitamin deficiency. There are questionnaires that can help screen for depression and aid your physician or other provider with the diagnosis.

CNN: How common is major depressive disorder?

Wen: An estimated 21 million adults in the United States had at least one major depressive disorder episode lasting at least two weeks in 2020, according to the US Substance Abuse and Mental Health Services Administration. This is about 8.4% of all US adults. The prevalence is higher among girls and women compared to boys and men (10.5% compared to 6.2%). The age group with the highest prevalence is young adults 18-25 years old (17%).

The lifetime prevalence of major depressive disorder is even higher; some studies estimate it affects on average 12% of people in the US, but that it could be as high as 17%. That’s 1 in every 6 people.

CNN: What are risk factors for depression?

Wen: There are several different types of risk factors. One is a recent change in life circumstances. The death of a loved one, getting a divorce, losing a home or a job and other major upheavals can increase risk. Other behavioral health conditions, such as anxiety and substance use disorders, are also associated with depression.

A recent illness can increase the risk of major depressive disorder, too. Serious chronic conditions such as heart disease, cancer, multiple sclerosis and dementia are associated with higher rates of depression.

Senator John Fetterman on Capitol Hill in Washington, D.C., on February 14, 2023.

There is a link, too, between stroke and depression; about a third of people who have had a stroke suffer some depressive symptoms.

Senator Fetterman suffered a stroke in May 2022, during his Senate campaign. That could have increased his risk for a depressive episode, especially as, according to his office, he has had episodes of depression in the past.

CNN: What treatments are available, and when is hospitalization needed?

Wen: It’s very important to note that effective treatments are available for major depressive disorder. Initial treatment includes anti-depressant medications and psychotherapy. Sometimes, lifestyle modifications and social supports can also help.

Most patients can be managed effectively with outpatient treatment, meaning that they do not need to be hospitalized. But there are circumstances under which someone may need inpatient treatment in the hospital. A patient could have worsening symptoms and may be suicidal, for instance. They could also have several other medical conditions and may need medication adjustments that are best provided in a hospital setting.

(These refer generally to patients who require hospitalization for major depressive disorder, and not specifically to Senator Fetterman, for whom such detailed medical information is not known and should not be presumed.)

Other individuals can be treated well on an outpatient basis and still from time to time, require inpatient care. This is not dissimilar to how we manage other medical conditions. Patients with diabetes, for example, may be doing well with oral medication then need to switch to insulin. Sometimes, they may have complications that require hospitalization. I think it’s important for us to think about major depressive disorder and other mental health conditions the same as we would physical health conditions.

CNN: How can someone who needs help find assistance?

Wen: For those with a trusted health care provider, a good place to start is to speak with that person. Your physician or other provider can help with the initial assessment, often can make the diagnosis and either begin treatment or refer to someone else who can.

If your primary care provider is delayed in making a referral to a mental health specialist or treating you themselves, you should follow up and emphasize the importance of getting care. Many workplaces and universities offer resources, and there are online telehealth services that could provide some care while you are pursuing referrals through your physician. Local and state health departments often provide some treatment options as well.

In addition, the federal government last year launched the 988 hotline that provides 24/7, free and confidential support for people experiencing emotional distress. The 988 hotline is a network of local and regional hotlines that can refer people and help them get information about where to seek treatment in their area. People can — and should — call or text this number if they are experiencing a mental health crisis.

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Elite athletes with genetic heart disease can safely return to play with diagnosis and treatment, early study suggests | CNN

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CNN
—

In a new study, most elite athletes with a diagnosed genetic heart disease did not experience serious or fatal symptoms of their condition, such as sudden cardiac death. The research suggests it can be “feasible” and “safe” for athletes to continue to participate in their sport.

Among a sample of 76 elite athletes with a genetic heart disease who had competed or are still competing in either Division I university or professional sports, 73 out of the 76 did not experience a cardiac event triggered by their disease during the study period, according to researchers behind a late-breaking clinical trial presented Monday at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.

Among those elite athletes with a genetic heart disease, 40 of them – 52% – were asymptomatic, the study abstract finds.

Over the years, researchers have become more aware of alarming reports about elite athletes experiencing heart problems, or even suddenly collapsing during games.

“For athletes with genetic heart conditions, and I would add non-athletes, the tragedies occur when we don’t know of their condition,” said Dr. Michael Ackerman, a genetic cardiologist at Mayo Clinic in Rochester, Minnesota, who was a senior author of the new research. “When we know of their condition, and we assess the risk carefully and we treat it well, these athletes and non-athletes, they can expect to live and thrive despite their condition.”

The new research has not yet been published in a peer-reviewed journal, but the findings suggest that many athletes with a genetic heart disease can decide with their health care professionals on whether to continue competing in their sport and how to do so safely, instead of being automatically disqualified due to their health conditions.

“In sports, historically, we’ve been paternalistic and de-emphasize patient preference and risk tolerance, but we know that athletes come from all walks of life. They are intelligent and when there’s scientific uncertainty, their values should be incorporated in medical decision-making,” Dr. J. Sawalla Guseh, cardiologist at Massachusetts General Hospital, who was not involved in the new study, said during Monday’s scientific session.

“Shared decision-making when done well can have very favorable outcomes,” he said.

Elite basketball, hockey, soccer and football players, were among the 76 athletes included in the new study, conducted by researchers at Mayo Clinic and other institutions in the United States. They wrote in their study abstract that this is the first study to their knowledge describing the experience of athletes competing at the NCAA Division I level or in professional sports with a known genetic heart disease that puts them at risk of sudden cardiac death.

The athletes in the study were cleared for return-to-play at either a NCAA Division I school or at the professional level. They were studied over an average of seven years, and all had been diagnosed with a genetic heart disease in the past 20 years, being treated at either Mayo Clinic, Morristown Medical Center, Massachusetts General Hospital or Atrium Health Sports Cardiology Center.

“Only three of them had a breakthrough cardiac event, which means after they were diagnosed and treated, they were still having an event,” said Katherine Martinez, an undergraduate student at Loyola University in Baltimore, who helped conduct the research as an intern in the Mayo Clinic’s Windland Smith Rice Sudden Death Genomics Laboratory.

Fainting was the most common event, and one athlete received a shock with an implantable cardioverter defibrillator, or ICD. None of the athletes died.

“The majority of these athletes went on to continue their career with no events at all,” Martinez said. But most of the athletes in the study – 55 of them, or 72% – were initially disqualified from competing by their primary provider or institution after their diagnosis. Most ultimately opted to return to play with no restrictions after undergoing comprehensive clinical evaluations and talking with their doctors.

While each sports league has its own set of rules, historically, some people diagnosed with a genetic heart disease that puts them at an increased risk for sudden cardiac death have been restricted from competitive sports, the researchers wrote in their study abstract.

“Just because you were given this diagnosis, doesn’t mean that your life, your career, the future that you see for yourself is over, but taking a second opinion from an expert who knows what they’re doing and is comfortable with shared decision-making is the next step,” said Martinez, who worked on the new research alongside her father, Dr. Matthew Martinez, director of Atlantic Health System Sports Cardiology at Morristown Medical Center and an author of the new research.

Regarding the new study, “the take-home message is, if you have one of these findings, seek out an expert who’s going to help you identify a safe exercise plan for you and determine what level you can continue to safely participate in,” he said. “This is the next best step – the next evolution – of how we manage athletes with genetic heart disease.”

Leaving their sport due to a genetic heart disease can be “very destructive” for athletes who have devoted their lives to excelling in competitions, said Dr. Lior Jankelson, director of the Inherited Arrhythmia Program at NYU Langone Heart in New York, who was not involved in the new research.

Yet he added that these athletes still need to consult with their doctors and be watched closely because some genetic diseases could be more likely to cause a serious cardiac event than others.

The new study highlights that “the majority of athletes with genetic heart disease could probably – after careful, meticulous expert risk-stratification and care strategy – participate in sports,” Jankelson said. “But at the same time, this is exactly the reason why these patients should be cared only in high-expertise genetic cardiology clinics, because there are other conditions that are genetic, that could respond very adversely to sports, and have a much higher risk profile of developing an arrhythmia during intense activity.”

Separately, the NCAA Sports Science Institute notes on its website, “Though many student-athletes with heart conditions can live active lives and not experience health-related problems, sudden fatality from a heart condition remains the leading medical cause of death in college athletes.”

For athletes with a genetic heart disease, their symptoms and their family history of cardiac events should be considered when determining their risks, said Dr. Jayne Morgan, a cardiologist with Piedmont Healthcare in Atlanta, who was not involved in the new research.

“Certainly, there is concern with elite athletes competing and whether or not they are being screened appropriately,” Morgan said. But she added that the new research offers “some understanding” to the mental health implications for athletes with a genetic heart disease who may be required to step away from a competitive sport that they love.

“This study, I think, begins to go a long way in identifying that we may not need to pull the trigger so quickly and have athletes step away from something that they love,” Morgan said.

The new study is “timely” given the recent national attention on athletes and their risk of sudden cardiac death, Dr. Deepak Bhatt, director of Mount Sinai Heart in New York City, who was not involved in the research, said in an email.

“These are some of the best data showing that the risk of return to play may not be as high as we fear,” Bhatt said about the new research.

“Some caveats include that the majority of these athletes were not symptomatic and about a third had an implantable defibrillator,” he added. “Any decision to return to the athletic field should be made after a careful discussion of the potential risks, including ones that are hard to quantify. Input from experts in genetic cardiology and sports cardiology can be very helpful in these cases.”

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She flatlined three times, lost both legs and had a failing heart. Yet she told doctors she’s ‘the luckiest person on this planet’ | CNN

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CNN
—

Her smile is bright, cheery, sometimes goofy and always contagious. But pictures can’t completely capture her upbeat, positive vibe. At 21, Claire Bridges has a mature spirit that amazes those who love her as well as the doctors who had to operate on her heart and remove both legs to save her life.

“She had a will to live, perseverance and a sort of twinkle in her eye — I tell all my patients that’s half the battle,” said Dr. Dean Arnaoutakis, a vascular surgeon at the University of South Florida Health in Tampa who amputated Bridges’ legs after complications from Covid-19.

“Most people would be despondent and feel like life had cheated them,” said Dr. Ismail El-Hamamsy, a professor of cardiovascular surgery at the Icahn School of Medicine at Mount Sinai in New York City, who operated on Bridges’ heart.

“But she told me, ‘I feel like I’m the luckiest person on this planet. I have my whole life ahead of me. I can have kids, a future, so many things to look forward to.’

“There was not once that I looked into her eyes that I didn’t feel her positiveness was true and genuine,” he said. “Claire’s story is one of just incredible resilience and positivity.”

Bridges left the hospital on her 21st birthday, more than two months after being admitted. Here she is with her brother Will.

In January 2022, Bridges was a 20-year-old model with her own apartment, a gaggle of friends and a part-time job as a bartender in St. Petersburg, Florida. She was a vegan and “exceptionally healthy,” according to her mother, Kimberly Smith.

When she caught Covid-19 that month, no one expected her be hospitalized. She was fully vaccinated and boosted.

But Bridges had been born with a common genetic heart defect: aortic valve stenosis, a mutation of the valve in the heart’s main artery, the aorta. Instead of having three cusps, or flaps, that let oxygen-rich blood flow from the heart into the aorta and to the rest of the body, people with aortic valve stenosis are often born with just two. The condition makes the heart work extremely hard to do its job, often causing breathlessness, dizziness and fatigue.

“I could work out and stuff, but I could never play sports,” she told CNN. “I couldn’t run. I couldn’t overexert myself.”

Her mom added, “We could really tell she began to learn her limits as she got older — she would get out of breath, stop and take a break.”

Before her surgeries, Bridges enjoyed roller-skating.

Whether due to her heart or another unknown reason, Covid-19 hit Bridges hard. Her health quickly spiraled out of control.

“Extreme fatigue, cold sweats — progressively every single day it would get harder to try to eat or drink anything,” she recalled. “Then one day my mom found me unresponsive and rushed me to the hospital. I flatlined three times that night.”

Bridges was put on dialysis, a ventilator and an exterior pump for her failing heart. She slipped into psychosis.

“I was thinking that everyone was trying to kill me, but I was holding on,” she said, adding that she then saw a bright light and her late grandfather.

“He was sitting on a bench, fishing, and he was wearing a baseball cap,” she said. “Then I saw my parents through a window. I don’t know if I actually did or if it was in my delusion, but I thought, ‘I can’t leave them like this.’ And my body just literally wouldn’t give up.”

While Bridges’ spirit battled on, doctors struggled to save her life. Her organs began to shut down, further weakening her frail heart. Blood wasn’t reaching her extremities, and tissues in both legs began to die.

Surgeons tried to save as much of her legs as possible. First, they opened tissue in both legs to reduce swelling, then amputated one ankle. Finally, there was no choice: Both legs had to be removed.

Doctors gathered around her bed to break the news.

“I remember looking up at them and saying, ‘Well, thank you for saving my life. And oh, can I have bionic legs?’ ” Bridges said.

“Everyone was totally shocked that she was taking it so well,” Smith recalled about her daughter. “But my entire family knew that if this tragedy had to happen to any of us, it would be Claire who would handle it the best. Upbeat and positive, that’s Claire.”

Bridges had a successful modeling career before she contracted Covid-19.

Losing her legs was only part of Bridges’ struggle back to health. “There were so many things that she could have died from while she was in the hospital,” Smith said.

Malnourished, Bridges was put on a feeding tube. She vomited, rupturing part of her small intestine, and “nearly bled out,” Smith said. To save her, doctors had to do an emergency transfusion — a dangerous procedure due to her weak heart.

“She almost died while getting the emergency transfusion because they had to pump the blood in so fast,” Smith said. “Then the next day she bled again, but they caught it in time.”

Bridges developed refeeding syndrome, a condition in which electrolytes, minerals and other vital fluids in a malnourished body are thrown out of balance when food is reintroduced, causing seizures, muscle and heart weakness, and a coma in some cases. Without quick treatment, it can lead to organ failure and death.

In another blow, her hair began to fall out, likely due to the loss of proper nutrition. Her family and friends came to her rescue.

“I knew that the only way to stop me from sobbing every time I pulled chunks of hair out of my head was to just get rid of it all,” Bridges said. “I told my brother Drew I was thinking about shaving my head, and without missing a beat, he immediately looked at me and said, ‘I’ll shave mine with you.’

“Then it snowballed into everyone telling me they would shave their heads, too,” Bridges said with a smile. “It was actually an extremely sweet, fun and freeing time — plus I’ve always wanted to shave my head, so I got to cross it off my bucket list!”

First row (from left): Luba Omelchenko, a friend, and Claire Bridges.
Second row (from left): Andy Beaty, a friend; Jaye Scoggins, Beaty's mother; Anna Bridges-Brown, Claire's sister; and Kimberly Smith, Claire's mother.
Third row: Kristen Graham, a friend who shaved everyone's heads.

Bridges credits her friends and family — along with members of the community who organized fundraisers or reached out on social media — for her upbeat attitude throughout the ordeal.

“I am very blessed to have such an amazing family and also friends and people in my community that are like family,” she said. “People I didn’t know, people that I haven’t spoken to since elementary school or high school were reaching out to me.

“Yes, I allowed myself to grieve, and there were dark days. But honestly, my friends and my family surrounded me with so much love that I never had a second to really think negatively about my legs or how I look now.”

Bridges’ heart presented another hurdle: Already frail before her prolonged illness, it was now severely damaged. She needed a new valve in her aorta, and soon.

“We always knew Claire would need an open-heart surgery at some point,” her mother said. “Doctors wanted her as old as possible before they replaced the valve because the older you are, the bigger you are, and there’s less chance of needing another operation soon after.”

Bridges with her modeling agent, Kira Alexander. Bridges lost nearly 70 pounds during her hospitalization.

Her doctors reached out to Mount Sinai’s El-Hamamsy, an expert in a more complicated form of aortic valve replacement called the Ross procedure.

“Anybody who has an anticipated life expectancy of 20 years or more is definitely a potential candidate for the Ross,” El-Hamamsy said, “and it’s a perfect solution for many young people like Claire.”

Unlike more traditional surgeries that replace the malfunctioning aortic valve with a mechanical or cadaver version, the Ross procedure uses the patient’s own pulmonary valve, which is “a mirror image of a normal aortic valve with three cusps,” El-Hamamsy said.

“It’s a living valve, and like any living thing, it’s adaptable,” the surgeon said. “It becomes like a new aortic valve and performs all the very sophisticated functions that a normal aortic valve would do.”

The pulmonary valve is then replaced with a donor from a cadaver, “where it matters a little less because the pressures and the stresses on the pulmonary side are much lower,” he said.

Bridges with Dr. Ismail El-Hamamsy, the surgeon who replaced the failed valve in her heart.

The use of a replacement part from the patient’s own body for the aortic valve also eliminates the need for lifelong use of blood thinners and the ongoing risk of major hemorrhaging or clotting and stroke, El-Hamamsy said. And because the new valve is stronger than the malfunctioning valve it replaces, patients aren’t as likely to need future surgeries.

“Ross is the only replacement operation for the aortic valve that allows patients to have a normal life expectancy,” he said, “and a completely normal quality of life with no restrictions, no modifications to their lifestyle and a very good durability of the operation.”

The Ross procedure is more technically challenging than inserting a tissue valve or a mechanical valve, “some of the simplest operations that we as cardiac surgeons would ever do,” El-Hamamsy said.

Because the operation takes a high level of technical skill, it’s only available in a few surgical facilities at this time.

“It requires dedicated surgeons who want to commit their practice to the Ross procedure and who have the technical skills and expertise to do that,” he added. “Patients need to know they should be undergoing the surgery in a Ross-certified facility.”

When El-Hamamsy first met Bridges in a video call last spring, he wasn’t sure he would be able to do the surgery. Only 127 pounds before she got sick, Bridges had lost nearly 70 pounds during her hospitalization.

“She was so emaciated. There was no way I could take her into the operating room the way she was,” El-Hamamsy said. “I never expected that she would recover so quickly and keep her amazingly positive mentality.”

Slowly, over many months, Bridges fought her way back to health. In rehab, she began to learn to walk with prosthetic lower limbs. As she got stronger, she has continued one of her favorite activities — rock climbing.

Bridges climbs a rock wall using prosthetic limbs.

“At six months, I could hardly recognize her — she had gained weight back, her skin had fully healed over at the amputation sites, and she was a completely different-appearing person to the malnourished and debilitated girl I had met in the hospital,” said Arnaoutakis, the vascular surgeon.

The heart operation was successfully done in December. Today, Bridges is in the middle of cardiac rehabilitation and looking forward to being fitted for prosthetic blades — J-shaped, carbon-fiber lower limbs that will allow her to run on a track for the first time in her life.

She’s also returned to modeling, proud to show the world how well she has survived.

Bridges has returned to modeling after her surgeries.

El-Hamamsy isn’t surprised. “I told her from the day I met her on that Zoom, ‘It will be such a privilege to look after you because you’ve inspired me. I’ve never met a young person with this level of maturity and outlook on life.’

“I still think of Claire every once in a while when I bump into difficulty with life or whatever. It’s a reminder that happiness and positivity is a choice. Claire made that choice.”

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Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

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CNN
—

Bempedoic acid may be an alternative for people who need to lower their cholesterol but can’t or won’t take statins, according to a large study published Saturday in the New England Journal of Medicine.

Statins are the most commonly prescribed cholesterol-lowering drugs that help lower what’s known as the “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol in the blood; more than 90% of adults who take a cholesterol-lowering medicine use a statin, according to the US Centers for Disease Control and Prevention.

Statins are considered safe and effective, but there are millions of people who cannot or will not take them. For some people it causes intense muscle pain. Past research has shown anywhere between 7% and 29% of patients who need to lower cholesterol do not tolerate statins, according Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study.

“I see heart patients that come in with terrible histories, multiple myocardial infarction, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Nissen said. “We do need alternatives for these patients.”

Doctors have a few options, including ezetimibe and a monoclonal antibody called a proprotein convertase subtilisin/kexin type 9, or PCSK9 inhibitors for short.

Bempedoic acid, sold under the name Nexletol, was designed specifically to treat statin-intolerant patients. The FDA approved it for this purpose in 2020, but the effects of the drug on heart health had not been fully assessed until this large trial. The new study was funded in part by Esperion Therapeutics, the maker of Nexletol.

For the study, which was presented Saturday at the American College of Cardiology’s Annual Scientific Session with the World Congress of Cardiology, Nissen and his colleagues enrolled 13,970 patients from 32 countries.

All of the patients were statin intolerant, typically due to musculoskeletal adverse effects. Patients had to sign an agreement that they couldn’t tolerate statins “even though I know they would reduce my risk of a heart attack or stroke or death,” and providers signed a similar statement.

The patients were then randomized into two groups. One was treated with bempedoic acid, the other was given a placebo, which does nothing. Researchers then followed up with those patients for up to nearly five years. The number of men and women in the trial were mostly evenly divided, and most participants, some 91%, were White, and 17% were Hispanic or Latino.

The drug works in a similar way that statins do, by drawing cholesterol out of a waxy substance called plaque that can build up in the walls of the arteries and interfere with the blood flow to the heart. If there is too much plaque buildup, it can lead to a heart attack or stroke.

But bempedoic acid is only activated in the liver, unlike a statin, so it is unlikely to cause muscle aches, Nissen said.

In the trial, investigators found that bempedoic acid was well-tolerated and the percent reduction in the “bad” cholesterol was greater with bempedoic acid than placebo by 21.7%.

The risk of cardiovascular events – including death, stroke, heart attack and coronary revascularization, a procedure or surgery to improve blood flow to the heart – was 13% lower with bempedoic acid than with placebo over a median of 3.4 years.

“The drug worked in primary and secondary prevention patients – that is, patients that had had event and patients who were very high risk for a first event. There were a lot of diabetics. These were very high risk people,” Nissen said. “So the drug met its expectations and probably did a lot better than a lot of people thought it would do.”

In the group that took bempedoic acid, there were a few more cases of gout and gallstones, compared with people who took a placebo.

“The number is small, and weighing that against a heart attack, I think most people would say, ‘OK I’d rather have a little gout attack,’ ” Nissen said.

Bempedoic acid had no observed effect on mortality, but that may be because the observation period was too short to tell if it had that kind of impact. Earlier trials on statins showed the same; it was only after there were multiple studies on statins that scientists were able to show an impact on mortality.

Dr. Howard Weintraub, a cardiologist at NYU Langone Health who did not work on this study, said that while he knows some people will not consider a medication successful unless it reduces mortality, he thinks that is short-sighted.

“I think there’s more to doing medicine then counting body bags,” Weintraub said.”Preventing things that can be life changing, crippling, and certainly change your quality of life forever going forward, and your cost of doing things going forward, I think is a good thing.”

He was pleased to see the results of this trial, especially since the people in this study are often what he called “forgotten individuals” – the millions who could benefit from lowering their cholesterol, but can’t take statins.

“It’s not like their LDL was 180 or 190 or 230, their LDL was 139. This is about average in our country,” Weintraub said. He said often doctors will just tell those patients to watch their diet, but he thinks this suggests they would benefit from medication.

“Both groups primary and secondary prevention got benefit, which I think is impressive with the modest amount of LDL reduction,” Weintraub said.

There are some limitations to this trial. It was narrowly focused on patients with a known statin intolerance. Nissen said the trial was not designed to determine whether bempedoic acid could be an alternative to statins.

“Statins are the gold standard. They are the cornerstone. The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” Nissen said.

Bempedoic acid is a much more expensive drug than a statin. There are generic versions of statins and some cost only a few dollars. Bempedoic acid, on the other hand, has no generic alternative and a 30-day supply can cost more than $400, according to GoodRx.

“I think what insurance companies need to recognize that even though this drug is going to cost more than statins, having a heart attack or a stroke or needing a stent is expensive. A 23% reduction in (myocardial infarctions) is a considerable reduction,” Weintraub said.

In an editorial in the New England Journal of Medicine that accompanied the study, Dr. John H. Alexander, who works in the division of cardiology at Duke Clinical Research Institute, Duke Health, Durham said that doctors should take these results into consideration when treating patients with high cholesterol who can’t take statins.

“The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events,” Alexander wrote.

Dr. Manesh Patel, a cardiologist and volunteer with the American Heart Association who was not a part of the study, said that providers are already prescribing bempedoic acid for some patients, but with this new research, he thinks they will quickly be used with more statin-intolerant patients.

“We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health. And so we need as many different arrows in our quiver to try to get that done,” Patel said.

Heart disease is the No. 1 killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the CDC. About 697,000 people in the US died from heart disease in 2020 alone – about the same number as the population of Oklahoma City.

“Given the number of people that are eligible for statins, which are tens of millions of patients already, the number of people who cannot tolerate statins is in the millions,” Nissen said. “This is a big public health problem and I think we’ve come up with something that directly addresses this.”

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11 minutes of daily exercise could have a positive impact on your health, large study shows | CNN

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Sign up for CNN’s Fitness, But Better newsletter series. Our seven-part guide up will help you ease into a healthy routine, backed by experts.

CNN
—

When you can’t fit your entire workout into a busy day, do you think there’s no point in doing anything at all? You should rethink that mindset. Just 11 minutes of moderate-to-vigorous intensity aerobic activity per day could lower your risk of cancer, cardiovascular disease or premature death, a large new study has found.

Aerobic activities include walking, dancing, running, jogging, cycling and swimming. You can gauge the intensity level of an activity by your heart rate and how hard you’re breathing as you move. Generally, being able to talk but not sing during an activity would make it moderate intensity. Vigorous intensity is marked by the inability to carry on a conversation.

Higher levels of physical activity have been associated with lower rates of premature death and chronic disease, according to past research. But how the risk levels for these outcomes are affected by the amount of exercise someone gets has been more difficult to determine. To explore this impact, scientists largely from the University of Cambridge in the United Kingdom looked at data from 196 studies, amounting to more than 30 million adult participants who were followed for 10 years on average. The results of this latest study were published Tuesday in the British Journal of Sports Medicine.

The study mainly focused on participants who had done the minimum recommended amount of 150 minutes of exercise per week, or 22 minutes per day. Compared with inactive participants, adults who had done 150 minutes of moderate-to-vigorous aerobic physical activity per week had a 31% lower risk of dying from any cause, a 29% lower risk of dying from cardiovascular disease and a 15% lower risk of dying from cancer.

The same amount of exercise was linked with a 27% lower risk of developing cardiovascular disease and 12% lower risk when it came to cancer.

“This is a compelling systematic review of existing research,” said CNN Medical Analyst Dr. Leana Wen, an emergency physician and public health professor at George Washington University, who wasn’t involved in the research. “We already knew that there was a strong correlation between increased physical activity and reduced risk for cardiovascular disease, cancer and premature death. This research confirms it, and furthermore states that a smaller amount than the 150 minutes of recommended exercise a week can help.”

Even people who got just half the minimum recommended amount of physical activity benefited. Accumulating 75 minutes of moderate-intensity activity per week — about 11 minutes of activity per day — was associated with a 23% lower risk of early death. Getting active for 75 minutes on a weekly basis was also enough to reduce the risk of developing cardiovascular disease by 17% and cancer by 7%.

Beyond 150 minutes per week, any additional benefits were smaller.

“If you are someone who finds the idea of 150 minutes of moderate-intensity physical activity a week a bit daunting, then our findings should be good news,” said study author Dr. Soren Brage, group leader of the Physical Activity Epidemiology group in the Medical Research Council Epidemiology Unit at the University of Cambridge, in a news release. “This is also a good starting position — if you find that 75 minutes a week is manageable, then you could try stepping it up gradually to the full recommended amount.”

The authors’ findings affirm the World Health Organization’s position that doing some physical activity is better than doing none, even if you don’t get the recommended amounts of exercise.

“One in 10 premature deaths could have been prevented if everyone achieved even half the recommended level of physical activity,” the authors wrote in the study. Additionally, “10.9% and 5.2% of all incident cases of CVD (cardiovascular disease) and cancer would have been prevented.”

Important note: If you experience pain while exercising, stop immediately. Check with your doctor before beginning any new exercise program.

The authors didn’t have details on the specific types of physical activity the participants did. But some experts do have thoughts on how physical activity could reduce risk for chronic diseases and premature death.

“There are many potential mechanisms including the improvement and maintenance of body composition, insulin resistance and physical function because of a wide variety of favorable influences of aerobic activity,” said Haruki Momma, an associate professor of medicine and science in sports and exercise at Tohoku University in Japan. Momma wasn’t involved in the research.

Benefits could also include improvement to immune function, lung and heart health, inflammation levels, hypertension, cholesterol, and amount of body fat, said Eleanor Watts, a postdoctoral fellow in the division of cancer epidemiology and genetics at the National Cancer Institute. Watts wasn’t involved in the research.

“These translate into lower risk of getting chronic diseases,” said Peter Katzmarzyk, associate executive director for population and public health sciences at Pennington Biomedical Research Center in Baton Rouge, Louisiana. Katzmarzyk wasn’t involved in the research.

The fact that participants who did only half the minimum recommended amount of exercise still experienced benefits doesn’t mean people shouldn’t aim for more exercise, but rather that “perfect shouldn’t be the enemy of the good,” Wen said. “Some is better than none.”

To get up to 150 minutes of physical activity per week, find activities you enjoy, Wen said. “You are far more likely to engage in something you love doing than something you have to make yourself do.”

And when it comes to how you fit in your exercise, you can think outside the box.

“Moderate activity doesn’t have to involve what we normally think of (as) exercise, such as sports or running,” said study coauthor Leandro Garcia, a lecturer in the school of medicine, dentistry and biomedical sciences at Queen’s University Belfast, in a news release. “Sometimes, replacing some habits is all that is needed.

“For example, try to walk or cycle to your work or study place instead of using a car, or engage in active play with your kids or grand kids. Doing activities that you enjoy and that are easy to include in your weekly routine is an excellent way to become more active.”

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Stem cell therapy may reduce risk of heart attack and stroke in certain heart failure patients, study shows | CNN

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CNN
—

Cell therapy, involving adult stem cells from bone marrow, has been shown to reduce the risk of heart attack and stroke in severe heart failure patients, according to a new study.

A single administration of adult stem cells directly into an inflamed heart, through a catheter, could result in a long-term 58% reduced risk of heart attack or stroke among heart failure patients with reduced ejection fraction, meaning they have a weakened heart muscle, suggests the study, published Monday in the Journal of the American College of Cardiology.

The study is being called the largest clinical trial of cell therapy to date in patients with heart failure, a serious condition that occurs when the heart can’t pump enough blood to meet the body’s needs.

“We followed these patients during several years – three years – and what we found was that their hearts got stronger. We found a very significant reduction in heart attack and stroke, especially in the patient that we measured in their blood that they had more inflammation going on,” said the study’s lead author Dr. Emerson Perin, a practicing cardiologist and medical director at The Texas Heart Institute in Houston.

“That effect, it was there across everyone, but for the patient that had inflammation, it was even more significant,” Perin said. “And there also is evidence that we had a reduction in cardiovascular deaths.”

The therapy involves injecting mesenchymal precursor cells into the heart. These particular stem cells have anti-inflammatory properties, which could improve outcomes in heart failure patients since elevated inflammation is a hallmark feature of chronic heart failure.

More than 6 million adults in the United States have chronic heart failure, and most are treated with drugs that address the symptoms of the condition. The patients included in the new study were all taking medications for heart failure, and the new research suggests that cell therapy can be beneficial when used in conjunction with heart failure drugs.

“You can imagine, we keep everybody going and doing better with the medicine. And now we have a treatment that actually addresses the cause and quiets everything down. So, this line of investigation really has a great future and I can see that, with a confirmatory trial, we can bring this kind of treatment into the mainstream,” Perin said.

“We can treat heart failure differently,” he said. “We have a new weapon against heart failure and this study really opens the door and leads the way for us to be able to get there.”

The new study – sponsored by Australian biotechnology company Mesoblast – included 565 heart failure patients with a weakened heart muscle, ages 18 to 80. The patients were screened between 2014 and 2019 and randomly assigned to either receive the cell therapy or a placebo procedure at 51 study sites across North America.

The patients who received the cell therapy were delivered about 150 million stem cells to the heart through a catheter. The cells came from the bone marrow of three healthy young adult donors.

The researchers, from The Texas Heart Institute and other various institutions in the United States, Canada and Australia, then monitored each patient for heart-related events or life-threatening arrhythmias.

Compared with the patients who received a sham procedure, those treated with the stem cell therapy showed a small but statistically significant strengthening of the muscle of the heart’s left pumping chamber within a year.

The researchers also found that the cell therapy decreased the risk of heart attack or stroke by 58% overall.

“This is a long-term effect, lasting an average of 30 months. So that’s why we’re so excited about it,” Perin said.

Among patients with high inflammation in their bodies, the combined reduced risk of heart attack or stroke was even greater, at 75%, the researchers found.

“These cells directly address inflammation,” Perin said.

“They have little receptors for these inflammatory substances – some of them are called interleukins, and there’s other kinds,” he said. “When you put them into an inflamed heart, it activates the cells and the cells go, ‘Wow, we need to respond. This house is on fire. We need to put out the fire.’ And so they then secrete various anti-inflammatories.”

The researchers wrote in their study that their findings should be considered as “hypothesis generating,” in that they show this cell therapy concept could work, but clinical trials would be needed to specifically confirm the effects of these stem cells on heart attack, stroke and other events. It is still unclear for how long the effects of the stem cell therapy last beyond 30 months and whether patients will need more stem cell injections in the future.

Overall, there were no major differences between the adverse events reported among the patients who received the cell therapy compared with those in the control group, and the researchers reported no major safety concerns.

“We’ve made an enormous step to be able to harness the real power of adult stem cells to treating the heart,” Perin said. “This trial really is a signal of a new era.”

For more than a decade, scientists have been studying potential stem cell therapies for heart failure patients – but more research is needed to determine whether this treatment approach could reduce the amount of hospitalizations, urgent care events or complications among patients with heart failure.

The new study didn’t find that, said cardiologist Dr. Nieca Goldberg, medical director of Atria New York City and clinical associate professor of medicine at NYU Grossman School of Medicine, who was not involved in the latest study.

What the new study did find is that “there may be a population of people that could benefit from the stem cell therapy, particularly people who have inflammation,” Goldberg said.

“It’s actually an interesting therapy, an interesting thing to consider, once more research substantiates its benefit. Because in heart failure, there’s multiple things going on and, particularly for the inflammatory component, this could be an interesting treatment,” she said. “It might have some role in heart failure patients with inflammation.”

The therapy’s effects on heart attack or stroke risks “were positive,” Dr. Brett Victor, a cardiologist at the Cardiology Consultants of Philadelphia, who was not involved in the study, said in an email.

“Specifically, patients who received the stem cell therapy were less likely to have a heart attack or stroke over the next 2.5 years, especially among those who were found to have a high degree of systemic inflammation as measured by a laboratory test,” Victor said in the email, adding that this represents how heart failure has a significant inflammatory component.

Those “positive signals” likely will be evaluated more in subsequent studies, Victor said.

“Current therapies for heart failure including lifestyle modifications, a growing list of excellent medications, and device therapies will continue to be the standard of care for treatment in the near-term,” he said. “I suspect that this trial will continue to move the field forward in studying cardiac cell therapy as we continue to look for ways to not just treat, but actually find a cure for this disease.”

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Zero-calorie sweetener linked to heart attack and stroke, study finds | CNN

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CNN
—

A sugar replacement called erythritol – used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products – has been linked to blood clotting, stroke, heart attack and death, according to a new study.

“The degree of risk was not modest,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

“If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a two-fold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes,” Hazen said.

Additional lab and animal research presented in the paper revealed that erythritol appeared to be causing blood platelets to clot more readily. Clots can break off and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke.

“This certainly sounds an alarm,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research.

“There appears to be a clotting risk from using erythritol,” Freeman said. “Obviously, more research is needed, but in an abundance of caution, it might make sense to limit erythritol in your diet for now.”

In response to the study, the Calorie Control Council, an industry association, told CNN that “the results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages,” said Robert Rankin, the council’s executive director, in an email.

The results “should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events,” Rankin said.

The European Association of Polyol Producers declined to comment, saying it had not reviewed the study.

Like sorbitol and xylitol, erythritol is a sugar alcohol, a carb found naturally in many fruits and vegetables. It has about 70% of the sweetness of sugar and is considered zero-calorie, according to experts.

Artificially manufactured in massive quantities, erythritol has no lingering aftertaste, doesn’t spike blood sugar and has less of a laxative effect than some other sugar alcohols.

“Erythritol looks like sugar, it tastes like sugar, and you can bake with it,” said Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.

“It’s become the sweetheart of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added. “Some of the diabetes-labeled foods we looked at had more erythritol than any other item by weight.”

Erythritol is also the largest ingredient by weight in many “natural” stevia and monkfruit products, Hazen said. Because stevia and monkfruit are about 200 to 400 times sweeter than sugar, just a small amount is needed in any product. The bulk of the product is erythritol, which adds the sugar-like crystalline appearance and texture consumers expect.

The discovery of the connection between erythritol and cardiovascular issues was purely accidental, Hazen said: “We never expected this. We weren’t even looking for it.”

Hazen’s research had a simple goal: find unknown chemicals or compounds in a person’s blood that might predict their risk for a heart attack, stroke or death in the next three years. To do so, the team began analyzing 1,157 blood samples in people at risk for heart disease collected between 2004 and 2011.

“We found this substance that seemed to play a big role, but we didn’t know what it was,” Hazen said. “Then we discovered it was erythritol, a sweetener.”

The human body naturally creates erythritol but in very low amounts that would not account for the levels they measured, he said.

To confirm the findings, Hazen’s team tested another batch of blood samples from over 2,100 people in the United States and an additional 833 samples gathered by colleagues in Europe through 2018. About three-quarters of the participants in all three populations had coronary disease or high blood pressure, and about a fifth had diabetes, Hazen said. Over half were male and in their 60s and 70s.

In all three populations, researchers found that higher levels of erythritol were connected to a greater risk of heart attack, stroke or death within three years.

But why? To find out, researchers did further animal and lab tests and discovered that erythritol was “provoking enhanced thrombosis,” or clotting in the blood, Hazen said.

Clotting is necessary in the human body, or we would bleed to death from cuts and injuries. The same process is constantly happening internally, as well.

“Our blood vessels are always under pressure, and we spring leaks, and blood platelets are constantly plugging these holes all the time,” Hazen said.

However, the size of the clot made by platelets depends on the size of the trigger that stimulates the cells, he explained. For example, if the trigger is only 10%, then you only get 10% of a clot.

“But what we’re seeing with erythritol is the platelets become super responsive: A mere 10% stimulant produces 90% to 100% of a clot formation,” Hazen said.

“For people who are at risk for clotting, heart attack and stroke – like people with existing cardiac disease or people with diabetes – I think that there’s sufficient data here to say stay away from erythritol until more studies are done,” Hazen said.

Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had revealed only a correlation, not causation.

“As the authors themselves note, they found an association between erythritol and clotting risk, not definitive proof such a link exists,” Jones, who was not involved in the research, said in a statement.

“Any possible (and, as yet unproven) risks of excess erythritol would also need to be balanced against the very real health risks of excess glucose consumption,” Jones said.

In a final part of the study, eight healthy volunteers drank a beverage that contained 30 grams of erythritol, the amount many people in the US consume, Hazen said, according to the National Health and Nutrition Examination Survey, which examines American nutrition each year.

Blood tests over the next three days tracked erythritol levels and clotting risk.

“Thirty grams was enough to make blood levels of erythritol go up a thousandfold,” Hazen said. “It remained elevated above the threshold necessary to trigger and heighten clotting risk for the following two to three days.”

Just how much is 30 grams of erythritol? The equivalent of eating a pint of keto ice cream, Hazen said.

“If you look at nutrition labels on many keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol. You’ll find a typical pint has somewhere between 26 and 45 grams in it,” he said.

“My co-author and I have been going to grocery stores and looking at labels,” Hazen said. “He found a ‘confectionery’ marketed to people with diabetes that had about 75 grams of erythritol.”

There is no firm “accepted daily intake,” or ADI, set by the European Food Safety Authority or the US Food and Drug Administration, which considers erythritol generally recognized as safe (GRAS).

“Science needs to take a deeper dive into erythritol and in a hurry, because this substance is widely available right now. If it’s harmful, we should know about it,” National Jewish Health’s Freeman said.

Hazen agreed: “I normally don’t get up on a pedestal and sound the alarm,” he said. “But this is something that I think we need to be looking at carefully.”

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Is your school equipped to save a life? Here’s how you’ll know | CNN

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—

When 24-year-old Buffalo Bills safety Damar Hamlin collapsed on the field from cardiac arrest during the January 2 game against the Cincinnati Bengals, millions of people witnessed a remarkable resuscitation in real time on live television.

As a trauma neurosurgeon myself, I was in awe of the dozens of medical professionals – athletic trainers, doctors and EMTs – who put their years of training into action within seconds. The immediate recognition that this wasn’t a routine injury and the speedy administration of CPR and defibrillation saved his heart, his brain and his life. Six weeks later, we now hear Dr. Thomas Mayer, the medical director of the NFL Players Association, say “I guarantee you that Damar Hamlin will play professional football again.”

The rescue response was awesome to watch and reflected the remarkable resources and planning that go into every game played in the NFL. As a parent, though, I couldn’t help but wonder what would’ve happened if Hamlin faced this when he was still in high school. What if it would’ve happened to any of my three teenage kids at their school? Would they have been saved as well?

Sudden cardiac deaths are rare in young people, but you may be surprised to know that the US Centers for Disease Control and Prevention estimates that there are about 2,000 such deaths in people under the age of 25 every year.

While the overall number of cardiac arrests has stayed largely consistent, there is no question that school safety efforts – and cardiac arrest survival rates – have improved over the years. Florida was the first state to enact laws requiring automated external defibrillators, or AEDs, in schools in 1999, and there are now 20 states, along with the District of Columbia, with similar mandates, according to the American College of Cardiology. Even in most of the states with no requirement on the books, AEDs are available in the majority of schools.

Most venues with more than 200 people – large businesses, stadiums, casinos and concert halls – are required to have AEDs as well, but there has been a major focus on schools in recent decades, considering that about 20% of the US population is on school grounds at any one time. In the past quarter-century, we went from hardly any AEDs being present in schools to a remarkable awareness of the lifesaving potential they hold. That increased awareness and attention to defibrillators and CPR has directly resulted in more athletes surviving, says Dr. Jonathan Drezner, director of the University of Washington Medicine Center for Sports Cardiology and team physician for the Seattle Seahawks.

He points out that when he began investigating sudden cardiac arrest in young athletes in the early 2000s, survival rates hovered around 11%. A more recent study of young athletes from 2014 to 2018 found that survival rates have climbed to an average of 68%. That’s an improvement of more than 500% in less than two decades.

Still, we can and must do better, especially at the high school level. While there is increased awareness and availability of AEDs, none of that matters if the lifesaving device can’t be accessed within two to three minutes.

As part of a CNN investigation, we wanted a detailed understanding not just of AED availability in schools but of real-life accessibility. Speed matters when someone has suddenly dropped due to cardiac arrest. The best estimates are that every minute without defibrillation reduces survival by up to 10%.

That’s why Dr. Victoria Vetter, a cardiologist with the Cardiac Center at Children’s Hospital of Philadelphia, told us that “just having an AED is not sufficient.”

“You need to make sure that there is an accessible AED that is not locked in the nurse’s office or in some back office,” Vetter said.

The American Heart Association recommends that defibrillators be placed within a two- to three-minute walk. Unfortunately, even in schools that have diligently purchased devices – typically at a cost of $1,000 to $2,000 – too many of them are not readily accessible.

One small study of secondary public schools in Ohio and southeast Michigan found that in more than 70% of the 24 public schools surveyed, the devices simply couldn’t be reached in time. Another study of schools in Oregon found that people in just half of the schools surveyed could access the devices within four minutes of a field or arena. In Vermont, 81% of the state’s 74 schools had defibrillators near athletic fields or arenas; half of the time, the AEDs were kept in the main office, with the nurse or in the lobby.

As part of our investigation, we defined AED access as knowing where the AEDs are in case of emergency. But it is essential to make sure they are always fully charged and that drills are regularly run to ensure people know how to use them.

“We have fire drills in schools generally, every month. We have active shooter drills. But we do not in most schools have sudden cardiac arrest drills,” Vetter said.

Nationally, she said, just a handful of states require schools to practice cardiac emergency plans.

Many people have held up the NFL’s cardiac response as the gold standard: quick action and accessibility. Watching the remarkable 30-person team of professionals who saved Hamlin, many would argue that most high schools don’t have the resources to employ dozens of medical professionals.

But it doesn’t take an army to save a life.

“A single person can save a young athlete’s life if they promptly recognize cardiac arrest, call for help, start CPR and someone gets the AED,” said the Seahawks’ Drezner. “The treatment algorithm really is that simple.”

For many schools, that person would be an athletic trainer, the medical professional on the field.

And yet, in about a third of the nation’s high schools, there is no access to athletic trainers at all.

“You have to ask yourself: When those athletes get injured, who’s addressing those injuries? Who’s there to provide the emergency action plan in case something like this happens?” asked Kathy Dieringer, president of the National Athletic Trainers’ Association.

Drezner’s work has found that the survival rate from cardiac arrest for young athletes nearly doubled to over 80% when an athletic trainer was present or an AED was used. Part of the reason is that schools with athletic trainers were also the ones most likely to have emergency plans and AEDs. As things stand now, schools least likely to have athletic trainers are in urban or rural areas, and the schools most likely to have them are in the suburbs, areas that tend to have higher incomes.

“If I were a parent, I would ask those questions,” Dieringer said. “Where are the AEDs in my school? Are they accessible, and does someone know how to use them if they’re needed?”

Sudden cardiac arrest is a leading cause of death in young competitive athletes, with one study finding as many as one death every three days in youth sports.

One of those deaths was 16-year-old Matthew Mangine Jr., a soccer player at St. Henry District High School in Erlanger, Kentucky. In 2020, Matthew collapsed on the soccer field.

“There were five AEDs at the school that night, and one wasn’t brought to him,” his father, Matthew Mangine Sr., told the local news. “That night, his initial shock came from EMS. They arrived roughly 12 minutes after he was down.” Matthew died an hour later at the hospital.

John and Luann Ellsessar also know that pain well. They lost their 16-year-old son, Michael, on the football field when he went into cardiac arrest during a game in 2010. “There was no ambulance or AED on the field, and it took 15 minutes for the squad to arrive,” John told CNN. “If that ambulance is arriving 15 minutes later, he’s already 150% gone.” John recalls that the doctors at the hospital worked on Michael for 45 minutes before pronouncing him dead.

Many schools have AEDs on campus, but often, they're hard to find quickly.

Fortunately, this wasn’t the story for Peter Laake. In 2021, the star lacrosse player was already on the varsity team as a freshman at Loyola Blakefield in Towson, Maryland. Peter was hit on the left side in what was apparently a normal play, but what followed wasn’t normal at all. Peter told me he blacked out and collapsed on the field.

Jeremy Parr, the school’s athletic trainer, said he immediately went to Peter’s side and checked for a pulse.

“With no pulse, no breathing, we needed to get the AED and EMS activated as soon as possible,” Parr told me when I spoke with him recently.

CPR was started, and in Peter’s case, the AED data showed that his heart was beating again within two to three minutes.

Within three weeks, Peter was back on the field.

It’s an example of how things should work and could work in all schools.

Training in CPR for all staff, athletic and educational. Availability and accessibility of AEDs with regular drills to make sure execution is flawless. An emergency action plan that is posted and reviewed.

As a parent, you can and should ask about all of this yourself. After witnessing what happened to Hamlin, I did just that with the athletic department at my own children’s school.

In a world where we have many complicated problems, saving someone’s life is possible with the knowledge and resources we have right now. With a plan, it is easy. We often prioritize buses, fields and athletic equipment, but cardiac safety must also be at the top of the list.

As Parr told me, when the unthinkable happens, “every athlete deserves the chance to survive.”

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