Beyond diet and exercise: Improving heart health for those at greatest risk

James Liao

UChicago Medicine cardiology fellow Corey Tabit, MD, MBA, MPH, (left) with James Liao, MD, Harold Hines, Jr. Professor of Medicine and Section Chief of Cardiology at the University of Chicago Medicine.

According to recent American Heart Association (AHA) estimates, heart disease in the U.S. is increasing at an alarming pace. By 2035, AHA projects that 131 million Americans, about 45 percent of the total population, will have at least one health problem related to heart disease.

The costs of this disease—in medical care, lost wages, reduced quality of life—will be staggering, doubling from last year's estimated $555 billion to a whopping $1.1 trillion."

Researchers and clinicians at the University of Chicago Medicine are determined to bend that trajectory. "Since the recent announcement of The Duchossois Family Institute: Harnessing the Microbiome and Immunity for Human Health, our best strategy is a major investment in prevention," says James Liao, MD, Harold Hines, Jr. Professor of Medicine and Section Chief of Cardiology at the University of Chicago Medicine.

He and his team are exploring a variety of methods, including big data analytics, individualized patient education, microbiome studies, and lipids research, to improve cardiovascular health for people most vulnerable to disease, on Chicago's South Side and across the country.

Using Statistics to Keep People Well

The book (and movie) Moneyball showed that statistics can uncover opportunities often overlooked. During his cardiology fellowship at the University of Chicago Medicine, Corey Tabit, MD, MBA, MPH, wanted to mine the hospital's extensive medical records to see if he could find factors that would predict patients at significantly increased risk for heart failure.

Working with a student at the Pritzker School of Medicine, Tabit engaged a broader team, intensively mentored by Dan Adelman, PhD, Charles I. Clough, Jr. Professor of Operation Management at the Booth School of Business, which included statisticians, business experts, and entrepreneurs. The immediate goal was to devise an algorithm that could predict patients in the hospital most likely to be readmitted within 30 days for heart failure.

Using data on over 7,000 patients, the team evaluated dozens of variables and over 1,000 possible algorithms. The most reliable turned out to be a very simple formula using only eight "yes/no" (rather than numeric) data points-all available when the patient was admitted to the hospital.

Armed with this "early warning system," hospital staff could personalize treatment to reduce the chances of heart failure from the moment a patient is admitted. Nurses, pharmacists, nutritionists, therapists, and social workers now work with patients at elevated risk to educate them intensively on how to manage their heart condition healthily at home. And the program is working, with an 80 percent reduction in readmissions.

Tabit and colleagues are now considering how to broaden both their goals and the data they are using. By applying machine-learning to a broader array of data (perhaps collected from social media, phone apps, Google searches, and travel patterns) they hope to identify factors that increase-or even better, decrease-the risk of other types of cardiac problems or events, heading these off before they arise.

The Microbiome and Cardiac Health

Through a partnership with Eugene Chang, MD, Martin Boyer Professor of Medicine and renowned gastroenterologist, Tabit is also part of a team exploring the influence of the microbiome-the trillions of bacteria and viruses that inhabit our gut and skin-on heart health.

Working together with Liao, the team's immediate focus is on reducing the risks of gastrointestinal bleeding in patients who use Left Ventricular Assist Devices (LVAD), a lifesaving treatment for heart failure that can cause this complication. In their sights is a clinical trial that employs butyrate, a by-product of microbe metabolism produced in Chang's lab, to see this decreases the potential hazards of LVADs. Chang, Liao, and Tabit plan to expand their cardiovascular research on the effects of the microbiome far past the limited number of people who require LVADs.

Studies over the past decade show how changes in gut microbiota exert a large influence on obesity, type 2 diabetes-and cardiovascular disease, including congestive heart failure, hypertension, and atherosclerosis. The team's longer-term goal is to identify the microbial factors that contribute to cardiovascular disease and, more importantly, protect against it.

Micromanaging Lipids

Triglycerides are molecules essential for storing energy in our bodies. However, increased levels have been linked to many vascular diseases. It is now becoming clear that some people have a genetic "misprint" in a protein called APOA5, an important catalyst in regulating triglyceride levels. Ineffective or reduced APOA5 can put people at unexpectedly increased risk of heart disease.

University of Chicago preventive cardiologist Michael Davidson, MD, and research associate John Ancsin, PhD, have been looking at ways to proactively address this issue. Ancsin has developed synthetic molecules that mimic the activity of APOA5 in mouse models. The next step is developing convenient, relatively inexpensive diagnostic tests that can both diagnose the effects of high triglyceride levels and identify specific sources, all with one drop of blood. Within hours, these assays can provide physicians the data necessary to make specific diagnoses, select the most appropriate treatments, and suggest additional tests which would provide value-keeping those at risk healthy and enjoying their lives.

As both life expectancies and the costs of medical care increase, keeping people well is more critical than ever for our communities and our entire country. University of Chicago researchers are enthusiastically embracing every opportunity to deliver a vigorous, healthy longevity for many more people.