Read some tips for buying healthier foods to reduce fat, sugar and salt, which are associated with a higher risk for obesity, heart attack and diabetes.

Want to eat better? Grocery shop like a cardiologist.

Susan Smyth, MD, PhD

Susan Smyth, MD, PhD

Written by Susan Smyth, MD, PhD, the medical director of the UK Gill Heart & Vascular Institute.

Many of us vowed to eat healthier foods in the new year but don’t know how to begin. Here are some tips for healthy grocery shopping that’ll help you reduce the amount of dietary fat, sugar and salt in your diet, which can help prevent obesity, heart attack, diabetes and other diseases.

Start in the produce section

Make your meal healthier by substituting foods with lots of color from natural sources (not artificial colors) for foods that are white or brown. Start in the produce section with fresh fruits and veggies, which are high in vitamins and fiber and low in fat. Be sure to check labels on processed foods like guacamole or prepared salads with dressing; they may contain high amounts of fat, sodium and/or sugar.

Tips for dairy and deli

In the dairy section, stick with low-fat options where possible. Beware of flavored yogurts, which can contain as much as half of the recommended daily allowance of sugar. Recent research indicates that eggs are fine in moderation, but check with your doctor first.

At the butcher shop, lean meats like chicken and fish are the healthiest options. Processed meats, like lunch meat or hot dogs, contain high amounts of sodium.

Choose wisely in the bakery

The bakery department can be tricky. While breads and other baked goods can have a place at your dinner table, the hidden sugars and sodium in bread might surprise you. Just two slices of packaged white sandwich bread may account for as much as a quarter of your recommended daily sodium intake. Instead, select breads made from whole grains, which can lower your LDL (bad cholesterol) and decrease the risk of diabetes by almost a third.

Spend less time in the interior aisles

The interior aisles of the grocery store are treacherous. Almost everything in a plastic wrapper is highly processed and loaded with fat, salt, sugar or all three. If you spend a lot of time in the middle aisles, do a lot of label-reading and look for healthier substitutes. Plain canned beans in water are a good choice, as are some nuts and dried fruit. Also, be aware of serving sizes per package: for example, canned soups are sometimes advertised as low sodium – but if the serving size is half a can, and you’re accustomed to eating a full can of soup, you’ll be getting double the dose of sodium.

Consider frozen options

In the frozen food aisle, frozen veggies without added sauces and fruits without added sugar can substitute for fresh varieties. Choose low-fat ice cream over regular versions. And be very careful of frozen pizzas, dinners and snacks, which can be loaded with sodium.

Perhaps the easiest way to eat better is to make a grocery list that emphasizes naturally colorful foods – the more vegetables, the better — and stick to it.


Next steps:

Gill’s Moliterno named editor of prestigious cardiovascular journal

David Moliterno, MD, FACC

The American College of Cardiology has named Gill Heart Institute’s Dr. David J. Moliterno, the new editor-in-chief of JACC: Cardiovascular Interventions.

Moliterno is the Jack M. Gill Chair and professor of the Department of Internal Medicine at UK. He is also a member of the interventional cardiology faculty at the UK Gill Heart Institute. He has been involved with numerous investigational studies in cardiovascular medicine over the last two decades, with a primary research interest in acute coronary syndromes.

“Interventional cardiology is an ever-growing and exciting subspecialty in cardiovascular medicine that is essential to treating our sickest patients,” said Moliterno. “I am honored to be the next editor of  JACC: Cardiovascular Interventions at a time when so many important advancements are occurring in the field.”

JACC: Cardiovascular Interventions covers interventional cardiovascular medicine and is ranked among the top ten cardiovascular journals for its scientific impact.

Moliterno has been an active member of the ACC, including as a member of the Board of Governors, Strategic Education Committee, and the Interventional Section Leadership Council.

Moliterno’s term will begin in March.


Next steps:

Research shows genetics may cause people to crave salty foods. Salt is a major culprit of cardiovascular disease, and research like this can help treat it.

Craving salty foods? Blame your parents

Gia Mudd

Gia Mudd, UK College of Nursing

Written by Jennifer Smith, a doctoral student in the UK College of Nursing, and Gia Mudd-Martin, an associate professor in the UK College of Nursing.

A sprinkle over a baked potato or a teaspoon to flavor a pot of chili might seem innocent to the average dieter, but salt is a major culprit of cardiovascular disease in America. Some people have a proclivity for sweet foods, such as candy, confectionery treats or ice cream. Others, however, need salty foods to satiate their palates, often snacking on potato chips, making meals of foods high in preservatives or supplementing recipes with extra doses of salt.

Leading research from UK Nursing

Science is showing a person’s desire for salty foods might be ingrained in his or her genetic makeup. A recent study conducted by our research team at the UK College of Nursing indicated that genetic variations in taste perception might influence dietary patterns associated with cardiovascular disease. Our team examined the TAS2R38 gene variant, which influences bitter taste. In a sample of more than 400 people at high risk for cardiovascular disease, we found that individuals with the enhanced bitter taste perception genotype were more likely to consume higher than the recommended amount of daily sodium than people without the genotype.

Further research to better understand this and other genetic influences on taste might one day allow healthcare providers to develop more targeted approaches to support reduced sodium intake in people who are genetically predisposed to consume salty foods. Our understanding of the genetic connection to dietary behavior will pave the way to more advanced practices and opportunities for prevention.

How you can manage salt intake

In the meantime, it is important to note that everyone should monitor salt and sodium intake to reduce risk of cardiovascular disease. The American Heart Association recommends eating no more than 2,300 milligrams of sodium per day and ideally limiting sodium to no more than 1,500 milligrams per day for most people. Research shows we can train our palates to adapt to a low-sodium diet. Here are a few tips:

  • Keep a journal of your salt intake so you know when you’re exceeding your limits.
  • Salt is hidden in many of the basic foods we purchase, including bread, cereal and canned soups. Start reading labels so you can pinpoint foods high in sodium.
  • Learn to cook with minimal amounts of salt and to instead flavor foods using herbs and spices.
  • Instead of buying packaged foods, which are typically packed with sodium and preservatives, opt for home-cooked meals that only need small portions of salt.

Salt lovers — don’t think you must deprive yourselves to prevent cardiovascular disease. By consciously managing the amount of salt in your diet, you will find you can still enjoy salty foods and sodium in smaller portions. Consider salty foods a treat, much like dessert.


Next steps:

  • Limiting salt is just one step you can take toward a more heart-healthy diet. Learn more about making better food choices.
  • You can make a difference by participating in a UK HealthCare research study. Learn more.
Clinical trials participant Tom Wall turned to the Gill Heart Institute to get his high blood pressure in check

Gill patient takes control of his health by joining clinical trial

Sixty-three-year-old Tom Wall had had enough.

His high blood pressure had persisted for more than 20 years. His diabetes was worsening. He’d gone from a prescription of just one drug, to two, then to three, and finally four. He’d taken early retirement from his job as a bank equipment repairman because he had trouble climbing into his van. Then, when he had trouble getting to his beloved garden at his farm in Nicholasville, he decided to take control.

“The garden is down the hill from the house, and I couldn’t get down there unless I rode my tractor,” Wall said. “I have a 5-year-old granddaughter, Avery, and I love to spend time with her. I know those drugs don’t work forever, and if I didn’t do something about my health, I wouldn’t be around to watch Avery grow up.”

Wall cut all sugar and carbs from his diet and did as much exercise as he could tolerate. He scoured the internet for information that could help him lose weight and get healthy. Over several months, Wall lost 100 pounds. He was able to come off his diabetes medicine, but his blood pressure remained stubbornly high.

“Consistently high blood pressure — also called hypertension — damages the tissues of the artery walls,” said Dr. Khaled Ziada, an interventional cardiologist at the UK Gill Heart Institute. “If left untreated, hypertension can lead to serious medical problems like stroke and even death, particularly in people who also smoke or have high cholesterol and/or diabetes, as Tom did.”

Resistant hypertension

Hypertension is a chronic condition in which the systolic blood pressure (the top number in the measurement that your health care provider gives you) exceeds 140 mmHg and/or the diastolic blood pressure (the bottom number) exceeds 90 mmHg.

Although it’s normal to experience minor fluctuations throughout the day, one in three Americans experience high levels of blood pressure (exceeding 140/90) even without activity or stress. Wall’s was 170/110 on good days, and as high as 200-210 on bad ones. Blood pressure that high is called a “hypertensive crisis.”

Ziada explains that patients can sometimes lower their blood pressure on their own by eating a balanced low-salt diet and adopting healthy lifestyle habits such as losing weight, exercising more, stopping smoking and reducing stress.

When these changes aren’t enough, there are numerous drug therapies that can be used separately or in combination to lower blood pressure. Sometimes, however, hypertension persists despite lifestyle changes and medications. Wall fell in this unfortunate group of people with what’s called “resistant hypertension.”

He returned to the internet for information.  Then, one day, he saw an ad for a clinical trial called SPYRAL at the Gill Heart Institute. He called the number immediately.

A new way to treat high blood pressure

The SPYRAL trial is exploring a novel approach to treat hypertension by manipulating the sympathetic nervous system signals that contribute to high blood pressure. The sympathetic nervous system regulates the vital functions of the body by connecting the brain to major organs such as the heart, kidneys and blood vessels. If the sympathetic nerves connecting the kidney to the brain are overactive, blood pressure rises.

SPYRAL uses a minimally invasive method to pulse small doses of energy through a catheter placed in the renal artery just outside the kidney itself, potentially decreasing the sensitivity of nerves lining the walls of the kidney arteries and reducing the signals that cause hypertension. There are only 24 sites testing SPYRAL worldwide; UK was one of the first 10 sites to be selected for this important research.

Wall’s blood pressure was too high to qualify for SPYRAL at first, so he worked with Dr. Ziada and his team to lower his systolic blood pressure to 150 before being eligible for inclusion in the study.

SPYRAL is what’s called a randomized, double-blind study, which means that only half of study participants actually receive the treatment while the other half receives a placebo, or “dummy” treatment. Furthermore, neither the patient nor the doctor who follows the patient knows who receives the treatment and who doesn’t. If initial data after 12 months indicates that SPYRAL does, in fact, lower blood pressure, the treatment will be offered to the patient in the study who initially received only placebo treatment.

According to Alexandra Hull, one of the SPYRAL study coordinators, being in a research study has benefits, even if you aren’t selected to receive the test treatment.

“The Gill has the most sophisticated heart care in this region, so when you come here you’re getting the best of the best,” she said.  “If you’re in a research study here, you might be selected to receive the test treatment, or you might not. But even if you’re not, you’re getting the best standard of care this region has to offer.”

Tom takes control of his health

In the meantime, Wall has returned to his farm, built a fort for his granddaughter, and continues to work towards his goal to lose another 50 pounds. He’s hopeful that he received SPYRAL the first time around, but if not he says he’ll jump at the chance to get it if it’s proven effective.

He also encourages everyone to take control of their own health and ask their doctor about new treatments that can help once all other options are exhausted.

“I appreciate the opportunity they’ve given me,” he said. “I don’t feel like a guinea pig at all, and everyone here has been great.”

Check out our video for more about Tom’s story and the clinical trials taking place at Gill.


Next steps:

  • For more information about the SPYRAL study, call 859-323-5259 or email h.shinall@uky.edu.
  • The Gill Cardiology Clinical Research Center facilitates research that impacts all aspects of heart health. Learn more about the center and view open and ongoing clinical trials.
The implantable WATCHMAN device may help reduce risk of stroke for those with atrial fibrillation.

New device may reduce risk of stroke for Afib patients

Written by Dr. John C. Gurley, director of the Structural Heart Program at UK HealthCare’s Gill Heart Institute.

Dr. John Gurley

Dr. John Gurley

A new implant device may be a breakthrough for reducing the stroke risk for atrial fibrillation (Afib) patients. The WATCHMAN Left Atrial Appendage Closure (LAAC) provides a new option for patients with non-valvular Afib, who may require an alternative to long-term use of blood thinners.

UK HealthCare was among the first centers in the world to implant the WATCHMAN as an investigational device through a clinical trial in 2005. The device is now FDA-approved in the U.S. and more widely available.

Those with Afib are at a higher risk for stroke

Currently, about 5 million Americans are diagnosed with atrial fibrillation, the most common cardiac arrhythmia, where the upper chambers of the heart (atrium) beat too fast and with irregular rhythm (fibrillation). But having an irregular heartbeat is not the only challenge facing these patients. The condition causes them to be at a higher risk of experiencing a stroke – in fact, five times more likely compared to those without atrial fibrillation.

Because the heart does not beat properly in atrial fibrillation patients, blood may not fully pump out of the heart, causing it to pool and then clot in a pouch in the heart’s left atrial appendage. In some cases, the blood clots can break loose and travel in the bloodstream to the brain, resulting in a stroke.

Along with putting patients at a greater risk of experiencing a stroke, these types of strokes caused by atrial fibrillation often are fatal or very disabling.

Finding a new way to treat Afib

In the past, the most common treatment to reduce the risk of stroke in these patients has been to have them take a blood-thinning medication called warfarin. However, despite their effectiveness, taking blood thinners for long periods of time can be difficult for patients because it isn’t always well-tolerated and it presents a significant risk for bleeding complications. Overall, about half of atrial fibrillation patients appropriate for warfarin go untreated because of their inability to tolerate or adhere to the medication.

For patients seeking an alternative to warfarin, the WATCHMAN implant offers a treatment option that could free them from the challenges of long-term blood-thinning therapy. The catheter-delivered heart implant is a one-time procedure that usually takes about an hour.

During the procedure, the implant is designed to close off the left atrial appendage to prevent blood clots from entering the bloodstream that potentially could cause a stroke for higher risk patients with non-valvular Afib.

Once the left atrial appendage is closed off, patients may, over time, be able to stop taking warfarin.


Next Steps

What is atrial fibrillation?

What is atrial fibrillation? Our expert Dr. Ted Wright explains.

In honor of Atrial Fibrillation Awareness Month, we sat down with the UK Gill Heart & Vascular Institute’s Dr. Ted Wright to discuss the condition, how it’s treated and what you can do if you have it.

Watch our conversation with Dr. Wright below.

Atrial fibrillation, also known as AFib, is a type of irregular heartbeat. If left untreated, it can increase a person’s risk for stroke and heart failure.

Dr. Ted Wright

Dr. Ted Wright

Dr. Wright is a heart surgeon at the UK Gill Heart & Vascular Institute. He is UK’s leading expert in atrial fibrillation treatment and is the only doctor in the region performing the Mini-MAZE procedure, a surgical treatment for people with the condition.


Check out the first video in our interview series below where Dr. Wright explains what AFib is and how it’s diagnosed. Be on the lookout for more highlights from our conversation with Dr. Wright in the coming days.


Next steps:

  • The UK Gill Heart & Vascular Institute is a leader in diagnosing and treating abnormal heart rhythms, including AFib. Learn more about Gill’s Heart Rhythm Program.
  • Check out our Q&A with Dr. Wright about heart disease and African-Americans.
Jim Lester was in end-stage heart failure, but a doctor from the same hometown helped him to trust in a heart procedure that eventually saved his life.

Hometown connection leads to life-saving heart procedure

Jim Lester encourages others to listen to his heart. As you adjust the stethoscope’s earpieces and lean in, you hear an electronic whir and zing reminiscent of a video game. The sound that startles others makes Lester laugh. Apparently this is not the first time he’s unleashed this parlor trick.

Just two weeks prior, Lester was gravely ill, in end-stage heart failure, the result of a lifetime of repeated heart attacks (three), blood clots (four) and a stroke. His ejection fraction – a measure of the heart’s ability to pump blood – was less than 20 percent. A healthy person’s EF sits in the 50 to 70 percent range.

Lester remembers the conversation with Alexis Shafii, his physician at the Gill Heart Institute. “Dr. Shafii was straight to the point,” Lester remembers. “He said that I had to have an LVAD in order to survive.”

A left ventricular assist device, or LVAD, is a mechanical device that helps a weakened heart pump blood. “An LVAD doesn’t replace the heart,” said Dr. Maya Guglin, medical director of Mechanical Circulatory Support at the UK Gill Heart Institute. “It just helps it do its job.” However, Guglin was cautious. Implanting an LVAD requires open heart surgery and a lifetime of maintenance. It’s not a good fit for every patient.

A common connection

Lester was afraid of surgery. He kept asking whether there were any pills that could help him instead of this strange-looking machine. Then he met Sarah Branam, one of the three LVAD coordinators at the Gill.

“The team asked me to do some education with Jim, since he was very standoffish about the idea of having an LVAD,” Branam said. “I started discussing with him what his fears were with the LVAD, I just wanted to help relieve his concerns. And I always say, ‘Where are you from?’ and when he said, ‘Maysville, Kentucky,’ I was like, ‘Well, funny thing, so am I!'”

They bonded instantly. Lester knew Branam’s “Papaw,” Clarence Branam, and then knew he could trust Sarah. She understood Lester’s fear of the unknown, but she could also share her experiences with many patients with LVADs.

“I got to see patients go from being in the ICU, and being as sick as they are, to see them with quality of life: the stamina, no oxygen tank, being able to walk farther, getting back to what they wanted to do… it was just amazing,” Branam explained.

“I was awful scared, but after talking to Sarah and finding out she comes from Maysville, why, everything leveled out,” Lester said tearfully. “This little thing came in, and she would answer any questions I had, and took all my fears away.”

Even better: Lester qualified for a clinical trial to implant a new version of an LVAD called HeartMate 3.

The power of advanced medicine through clinical trials

According to Guglin, the HeartMate 3 is a tremendous improvement from its predecessor with a longer battery life, smaller profile and engineering that minimizes the potential for complications like blood clots and GI bleeds.

“That the Gill was included in this major clinical trial was a coup for us,” Guglin said. “It’s a signal that the cardiology world recognizes our expertise, our professionalism and our teamwork.”

And, Guglin adds, this also helps fulfill the heart institute’s academic mission, since high-profile trials like that for the HeartMate 3 expose Gill trainees to the newest available technology – technology that could become standard treatment by the time they are in their own practice.

On Aug. 8, Lester was implanted with the HeartMate 3. Everyone noticed immediately how improved he was.

“The biggest thing I saw about Jim before the surgery was how hard he was struggling to breathe. And the day after the breathing tube was pulled out, he did not need supplemental oxygen,” Branam said.

“It felt like I was getting too much oxygen,” Lester laughs.

A new lease on life

After a couple of weeks of recovery and therapy, Lester was discharged. What will he do with this new lease on life?

“Well, I aim to go home, sit on my front porch, watch the traffic go up and down the street, and hug my wife,” Lester said.

Lester was the Gill’s first HeartMate 3 patient, but three others followed within 10 days. This phase of the trial is now closed, but the UK will be involved in the next phase, a “Continued Access Protocol” that permits all qualifying patients to receive the HeartMate 3 while FDA approval is pending.

Based on her initial involvement with the HeartMate 3 trial, Guglin has great hopes for the device.

“It’s an amazing feeling when you come to see the patient next morning after the surgery and their skin color is different and there is life in them,” she said. “And when they are being discharged 10 days or two weeks later it’s gratifying to see how much they improved on your watch because of the intervention you were able to offer.”


Next Steps

Sleep apnea occurs in about 18 million Americans, or about one in 15 people. If untreated, sleep apnea can lead to numerous problems, like hypertension.

If sleep apnea is disrupting your sleep, talk to your doctor

Written by Dr. Isabel Moreno-Hay, an assistant professor in the University of Kentucky College of Dentistry’s Orofacial Pain Clinic.

Dr. Isabel Moreno-Hay is an assistant professor in the University of Kentucky College of Dentistry’s Orofacial Pain Clinic.

Dr. Isabel Moreno-Hay

Unbearable snoring is often the reason sleep apnea is diagnosed. Sleep apnea occurs in about 18 million Americans, or about one in 15 people. The two types of this disorder are central and obstructive. Central sleep apnea is less common and is often associated with other conditions, like stroke. It occurs when the brain does not tell the muscles to breathe. Obstructive sleep apnea is more common, and it is caused by a repetitive (partial or complete) airway collapse which prevents air from reaching the lungs.

Sleep apnea can have negative consequences if it goes undiagnosed and untreated. It can cause chronic tiredness, which can lead to memory problems and trouble concentrating. Cardiovascular problems can also occur – the most common issue caused by sleep apnea is actually hypertension. Often times when a patient is not responding to medication for hypertension, it may be due to the disorder being undiagnosed. Additionally, the regulation of glucose levels can be negatively affected by lack of sleep, as this problem increases the risk of diabetes.

Who is most at-risk for sleep apnea?

A high Body Mass Index is the number one indicator: the higher the BMI, the greater the risk for obstructive sleep apnea. Having a large neck circumference is another indicator. Men are also at higher risk than women, except until women experience menopause, and their risk increases. Smokers are at increased risk, too. A large uvula and long soft palate, big tongue, deviated septum and enlarged tonsils can also cause the disorder.

Treatmenat options

In the 1950s, sleep behaviors started being studied and became part of medical care. In the 1970s, sleep clinics were developed so people could be monitored and diagnosed with sleep disorders. Today, sleep physicians are able to diagnose the disorder and decide on a course of treatment, which can sometimes include referral to a dentist.

The most common treatment option is a CPAP machine, a mask that patients wear to help keep the airway open with steady airflow. In other instances, oral appliances can be used to move the lower jaw forward to improve airflow. Sometimes the cause of the sleep apnea is enlarged tonsils, and one may have their tonsils surgically removed.

Additionally, behavioral modifications should accompany treatment options. For example, if a patient with sleep apnea is overweight, losing weight may help improve their condition. Quitting smoking or changing sleeping positions can also help.

Sleep is an incredibly important part of living a healthy life, and anything that gets in the way of a sound night of sleep needs to be addressed and remedied. Talk with your doctor if you think you are suffering from sleep apnea.


Next Steps

Philip A. Kern, MD, talks with Angelique Bell, who participated in a diabetes-related study he led.

Research participation leads to a life-saving personal discovery

On the first of May, 2015, Angelique Bell waited in a hair salon, reading the weekend section of the newspaper. She noticed an ad for a health research study that needed participants who had risk factors for diabetes. Since she met the criteria and had some time to pass, she decided to call about the study right then, from the salon chair. It was her 45th birthday.

“I don’t have diabetes, but I have a strong family history of diabetes and some of the risk factors, and I thought that the information from this study could be something that could benefit me in the future,” Bell said.

She didn’t expect, however, that her impromptu birthday decision to call about the study would potentially save her life.

An unexpected finding

As part of the screening for the study, Bell had to do blood work and an EKG — standard tests to get baseline health data. Her results, however, were anything but standard: they showed extremely low levels of potassium and an arrhythmia in her heart that could be fatal if not treated.

“When she came in, she was having a lot premature ventricular contractions, which is potentially dangerous because your heart could suddenly go into ventricular tachycardia or fibrillation, which can kill you,” said Dr. Philip A. Kern, director of the University of Kentucky Center for Clinical and Translational Science and principal investigator of the diabetes study in which Bell participated.

At the time Bell was taking two medications to help control her blood pressure. One medication was a diuretic, which, unknown to Bell, was causing her to lose too much potassium through her urine. The resulting potassium deficiency was causing the arrhythmia in her heart.

Kern and the research team sent Bell to the UK Gill Heart Institute for further evaluation and treatment. She was taken off the diuretic, had to wear a heart monitor for 48 hours, and received potassium supplements.

“I was 45 years old at the time and I had to wear this heart monitor. Three-fourths of my grandparents had heart attacks. My mother had congestive heart failure. So it was a scary,” Bell said. “I was relieved to find out that the condition had not gotten to a point of causing damage. A really serious problem was averted.”

The importance of participation

Once the arrhythmia was resolved, Bell, undeterred by her own health scare, went back to Kern and participated in the diabetes-related study that she had originally phoned about.

The study was not Bell’s first experience as a research participant, nor was it her last. She had previously participated in two asthma-related studies at other institutions, motivated by her own diagnosis as a child, and she subsequently volunteered again at UK as a healthy participant in a study examining how our bodies process fat intake. Through each experience she learned more about her own health.

“That is one of the good things about being in the study — a lot of times when people get in studies, they find out about other issues with their health,” she said. “There’s a pretty in-depth amount of testing done, and it could uncover something that wouldn’t be found in a routine exam.”

Bell was also familiar with health research through family members’ experiences. Her father participated in a longitudinal study on gout, and her uncle was a researcher with the Centers for Disease Control and Prevention (“he was very excited about science”). Exposure to both researcher and participant experiences has convinced Bell of the importance of empirical, evidence-based information, as well as the need for research participants.

“Having people around who do research, you see how important it is for them to get people in their studies so they have enough evidence,” she said.

She additionally emphasizes the importance of racial and gender diversity among research participants, in order to understand how health conditions and treatments affect people differently, but she simultaneously acknowledges the legacy of the infamous Tuskegee experiment conducted between 1932 and 1972. In the course of that study, hundreds of poor African-American men were knowingly left untreated for syphilis.

When the Tuskegee story was uncovered, it created an understandable distrust of health research, particularly among African-Americans. At the same time, however, the story initiated a host of stringent federal regulations enacted to protect research participants. In 1974, Congress passed the National Research Act and created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which developed guidelines for human subject protection, including the landmark Belmont Report.

Health research involving people is now “very highly regulated, with multiple layers of protection,” Kern said. Studies require a process of informed consent and communication of diagnosis, as well as reporting of the study results. Institutions like UK that conduct health research must have institutional review boards (which include community members) to review the plans for all studies. UK also has an Office of Research Integrity that can answer questions and support research participants.

“Because of Tuskegee I think a lot of African-Americans are leery of participating in research studies,” Bell said. “But if you don’t participate in the research then the data that relates to you is not there. Some things do have a genetic factor, and some things might affect people of African descent differently than people of European and Asian descent.”

Improving health for others

If there is residual distrust about health research, there is also a great deal altruism that motivates many people to participate. According to Roxane Poskin, participant recruitment manager at the UK CCTS, a large percentage of volunteers join studies as way to give back to society and contribute to discoveries that improve health for others and future generations.

This is particularly true for healthy participants, who don’t have a health condition they hope to address through a study but who are essential to research that broadens our understanding of what Kern calls “the basic mechanisms of disease and how the body works.” While participants receive information about their health and sometimes receive compensation for participating, they don’t always receive a direct health benefit for themselves.

“They want to be involved and help others even, if it doesn’t help them directly,” Poskin said. “If we didn’t have volunteers, we wouldn’t be able to accomplish research studies. Even the smallest things have been researched, like thermometers and crutches.”

Bell, who has spent her career in non-profit organizations (she currently works with Kentucky Refugee Ministries and ITNBluegrass), says she doesn’t personally know many people who participate in studies, but that she would encourage anyone to participate, either for their own benefit or to advance medical knowledge that could help others.

“We have to have evidence-based research,” she said. “And you get a lot more information about your health than you would in a normal physical.”


Next steps:

Blood thinners

Are the new blood thinner options right for you?

Written by George Davis, anticoagulation program pharmacist coordinator with UK HealthCare.

George Davis

George Davis

Blood thinners are commonly prescribed for prevention of stroke in patients with certain heart conditions or for treatment of blood clots. These drugs, also known as anticoagulants, can save lives for patients who have blood clots or are at high risk for them. However, the arrival of a new class of anticoagulants creates a confusing array of choices. Here are some basics to help you decide which medication is right for you.

All blood thinners cause an increased risk of bleeding – sometimes life-threatening – but that shouldn’t prevent doctors from prescribing it or patients from taking it. One-third of U.S. patients with atrial fibrillation, or afib, who need anticoagulation aren’t receiving it, according to a recently published major study.

With a 50-year track record, warfarin is the traditional option. For patients well managed on warfarin, it can be safe and effective. However, warfarin requires some trial and error to determine the most effective dose while minimizing bleeding hazards, initially requiring frequent (every few days to weekly) lab monitoring (called INR) and can be affected by factors like age, diet and other medications you are taking.

In the last five years, there have been four direct oral anticoagulants (DOACs) approved in the United States: apixaban, dabigatran, edoxaban and rivaroxaban. When compared to warfarin in major clinical trials, these DOACs were equally effective and demonstrated a lower incidence of major bleeding. DOACs have other advantages, including no need for routine lab monitoring, fewer drug and diet interactions, and more predictable dosing.

But DOACs still can cause bleeding and patients should routinely see a health care provider to check for compliance, drug interactions, and any changes in kidney or liver function, since DOACs can have some associated adverse effects. Additionally, DOACs are more expensive than warfarin, although manufacturers offer assistance programs to qualified patients that can help defray costs.

If a patient on the DOAC dabigatran experiences severe bleeding, a recently approved drug can help reverse that, and an antidote for the other three DOACs may be available soon.

While DOACs are effective, patients already taking warfarin shouldn’t automatically switch to a DOAC, especially if they are tolerating warfarin well.

Now more than ever, if your doctor wants you to begin taking a blood thinner, discussing the different options available is important. This discussion can educate you about the benefits of preventing blood clots versus risk of bleeding.

As always, don’t ever stop or make changes to any medication you’ve been prescribed without telling your health care provider.

George Davis is the anticoagulation program pharmacist coordinator with UK HealthCare Pharmacy Services and the UK Gill Heart Institute, and associate adjunct professor at the University of Kentucky College of Pharmacy.


Next steps: