Monday, June 10, 2024

 

Clinical trial shows promising results in a two-drug combination that curbs methamphetamine use



UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES




A clinical trial on a two-drug therapy for methamphetamine use disorder reduced use of the highly addictive drug for up to 12 weeks after initiation of treatment, UCLA-led research suggests.

Participants in the ADAPT-2 clinical trial who received a combination of injectable naltrexone plus extended-release oral bupropion (NTX+BUPN) had a 27% increase in methamphetamine-negative urine tests, indicating reduced usage. By contrast, the placebo group had an 11% increase in negative tests.

The study will be published in the peer-reviewed journal Addiction.

“These findings have important implications for pharmacological treatment for methamphetamine use disorder. There is no FDA-approved medication for it, yet methamphetamine-involved overdoses have greatly increased over the past decade,” said Dr. Michael Li, assistant professor-in-residence of family medicine at the David Geffen School of Medicine at UCLA and the study’s lead author.

Methamphetamine use has continued growing over the years around the world, increasing from 33 million people in 2010 to 34 million in 2020. Overdose deaths from the drug have jumped fivefold in the US from 2012 to 2018, and are followed by Canada and Australia in increases.

To curb the ongoing crisis, the National Institute on Drug Abuse (NIDA) Clinical Trials Network has supported various trials, including the ADAPT-2 trial, to test the effects of different pharmacological treatments for methamphetamine use disorder. ADAPT-2 was carried out from May 23, 2017 to July 25, 2019 across the eight trial sites that included UCLA. It included 403 participants, with 109 assigned to the drug combo group and the rest to the placebo group in the first stage.

The latest findings are the second stage of the multi-site trial. The earlier stage had demonstrated that the two-drug combination worked at six weeks, but the unanswered question was whether the intervention remained efficacious over a longer period.

In the second stage, the researchers conducted urine tests on the participants at weeks seven and 12, and again post-treatment at weeks 13 and 16 comparing the group on NTX+BUPN with the placebo group.

There is a need for further research to determine whether the drug treatment effect lasts longer than 12 weeks and yields further methamphetamine use reductions, the researchers write.

“Prior stimulant use disorder treatment trials suggest that change in use is gradual (consistent with our findings), unlikely to result in sustained abstinence in a typical 12-week trial, and dependent on treatment duration,” they write. “This warrants future clinical trials to quantify changes in MA use beyond 12 weeks and to identify the optimal duration of treatment with this medication.”

Study co-authors are Brendon Chau, Thomas Belin, and Steven Shoptaw of UCLA, and Thomas Carmody, Manish Jha, Elise Marino, and Dr. Madhukar Trivedi of the University of Texas.

The study was funded by awards from the National Institute on Drug Abuse of the U.S. National Institutes of Health (UG1DA020024, K01DA051329, UG1DA013035, UG1DA040316, UG1DA013727, and UG1DA015815), the U.S. Department of Health and Human Services under contract numbers HHSN271201500065C (Clinical Coordinating Center, the Emmes Company) and HHSN271201400028C (Data and Statistics Center, the Emmes Company), the U.S. National Institute of Mental Health (K23MH126202) and the O’Donnell Clinical Neuroscience Scholar Award from the University of Texas, Southwestern Medical Center.

RACIST MEDICINE U$A

Older, poorer, Black, Medicaid beneficiaries less likely to be placed on liver transplant lists


Study finds disparities in access to liver transplantation occur before wait listing



Peer-Reviewed Publication

REGENSTRIEF INSTITUTE





INDIANAPOLIS – A new, healthy liver offers the best survival for patients with early-stage liver cancer. But a new study, led by Katie Ross-Driscoll, PhD, MPH, of Regenstrief Institute and Indiana University School of Medicine Department of Surgery, has identified disparities in liver transplant referral and evaluation, which must precede waitlisting, for these potentially lifesaving procedures.

While other studies have demonstrated disparities in placement on organ waitlists, the new study is one of the first to examine the transplant process prior to liver transplant waitlisting -- following patient progress along the continuum immediately after liver cancer diagnosis.

“Undergoing a transplant, which is the only cure for liver cancer, requires patients to navigate a very complex process after diagnosis,” said Dr. Ross-Driscoll. “If referred to a transplant center, the patient needs to follow up on the referral and then complete a comprehensive medical and psychosocial evaluation. After this evaluation, transplant centers will decide whether or not to place patients on the deceased donor waiting list. We examined progress through the steps prior to placement on the waiting list and found that different factors predicted whether these pre-transplant steps are completed.”

  • Factors associated with whether or not a patient received a referral from their physician to a transplant center after diagnosis of liver cancer:
    •  Age: the older the patient (up to age 70, the cutoff age for transplant eligibility) the less likely they were to receive a referral.
    •  Insurance type: Patients who had Medicare, Medicaid or other non-private insurance types were less likely to receive a referral than patients with private insurance. 
  • Of those patients who were referred to a transplant center:
    • Black patients were less likely than White patients to initiate a transplant evaluation.
    • Patients who lived in higher poverty neighborhoods were less likely to initiate the evaluation than patients who lived in lower poverty neighborhoods. 
  • Of those patients who initiated the medical and psychosocial evaluation, those who had Medicaid insurance were about half as likely to complete all necessary steps of the evaluation process as patients with private insurance.

“These findings indicate patients with liver cancer who are older (but under the cutoff age for eligibility), poorer, Black or Medicaid beneficiaries are less likely than others to make it through the early steps of the transplant process,” said Dr. Ross-Driscoll. “While our results are based on cancer registry data from patients referred to Georgia’s two transplant centers, we believe that our findings are potentially relevant across the United States. Future studies are needed to understand how barriers might vary across transplant centers.”

“There are very few studies documenting the steps prior to liver transplant waitlisting, and these results suggest the need to collect pre-waitlisting data nationally to inform where interventions should be targeted to improve equity in access to liver transplantation, said co-author Rachel Patzer, PhD, MPH., Regenstrief Institute president and CEO.

Liver cancer is one of the fastest growing cancers in the United States and shows no indication of slowing down. As liver cancer becomes more prevalent, understanding pathways to care for these patients becomes more important.

Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia” is published in the peer-reviewed journal Cancer Research Communications. This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health.

Authors and affiliations:

Katherine Ross-Driscoll 1 2 3Arrey-Takor Ayuk-Arrey 2Raymond Lynch 4Lauren E McCullough 3 5Giorgio Roccaro 6Lauren Nephew 7Jonathan Hundley 8Raymond A Rubin 8Rachel Patzer 1 9

  • 1Division of Transplantation, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
  • 2Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana.
  • 3Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia.
  • 4Division of Transplantation, Department of Surgery, Pennsylvania State University School of Medicine, Hershey, Pennsylvania.
  • 5Winship Cancer Institute, Emory University, Atlanta, Georgia.
  • 6Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
  • 7Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana.
  • 8Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia.
  • 9Regenstrief Institute, Indianapolis, Indiana

Katie Ross-Driscoll, PhD, MPH

In addition to her role as a research scientist with Regenstrief Institute, Katie Ross-Driscoll, PhD, MPH, is an assistant professor of surgery at Indiana University School of Medicine. She is a health services researcher and epidemiologist focused on organ transplantation.

Rachel Patzer, PhD, MPH

In addition to her roles as president and CEO and research scientist with Regenstrief Institute, Rachel Patzer, PhD, MPH, serves as the Leonard Betley Professor of Surgery at Indiana University School of Medicine and an adjunct professor at IU Richard M. Fairbanks School of Public Health. Dr. Patzer is an epidemiologist and health services researcher with a strong focus on healthcare access, quality of healthcare delivery and outcomes. Her research centers on such key areas as disparities, social determinants of health, community-based participatory research, predictive analytics, healthcare quality and health policy evaluations. She has been instrumental in reshaping the national organ transplantation paradigm, advocating for a population health approach to inform quality measures, policies and equitable solutions.

 

Novel Genetic Clock discovers oldest known marine plant



Seagrass clone in the Baltic Sea is more than 1400 years old




HELMHOLTZ CENTRE FOR OCEAN RESEARCH KIEL (GEOMAR)





Using a novel genetic clock, a team of researchers from Kiel, London, Oldenburg, and Davis, California, has determined the age of a large marine plant clone for the first time. This seagrass clone from the Baltic Sea dates back to the migration period 1400 years ago. The newly developed clock can be applied to many other species, from corals and algae to plants such as reeds or raspberries. The scientists publish their work today in the journal Nature Ecology and Evolution.

“Vegetative reproduction as an alternative mode of reproduction is widespread in the animal, fungal, and plant kingdoms,” explains research leader Dr Thorsten Reusch, Professor of Marine Ecology at the GEOMAR Helmholtz Centre for Ocean Research Kiel. These so-called “clonal species” produce genetically similar offspring by branching or budding and often reach the size of a football field or more. However, these offspring are not genetically identical. Previous work by a team led by GEOMAR researchers had already shown that somatic mutations accumulate in vegetative offspring, a process similar to cancer. Now, a team led by Prof. Dr Reusch, Dr Benjamin Werner (Queen Mary University London, QMUL), and Prof. Dr Iliana Baums (Helmholtz Institute for Functional Marine Biodiversity at the University of Oldenburg, HIFMB) has used this mutation accumulation process to develop a novel molecular clock that can determine the age of any clone with high precision.

Researchers at the University of Kiel, led by Professor Reusch, applied this novel clock to a worldwide dataset of the widespread seagrass Zostera marina (eelgrass), ranging from the Pacific to the Atlantic and the Mediterranean. In Northern Europe in particular, the team found clones with ages of several hundred years, comparable to the age of large oak trees. The oldest clone identified was 1402 years old and came from the Baltic Sea. This clone reached this advanced age despite a harsh and variable environment. This makes the eelgrass clone older than the Greenland shark or the Ocean Quahog, which live only a few hundred years.

These new age and longevity estimates for clonal species fill an important knowledge gap. Particularly in marine habitats, many fundamental habitat-forming species such as corals and seagrasses can reproduce vegetatively, and their clones can become very large. The continuous production of small, genetically identical but physically separated shoots or fragments from the parent clone means that age and size are decoupled in these species. The new study now provides a tool to date these clones with high accuracy. “Such data are, in turn, a prerequisite for solving one of the long-standing puzzles in conservation genetics, namely why such large clones can persist despite variable and dynamic environments,” says Thorsten Reusch.

Once a high-quality eelgrass genome was available, work could begin. Another key factor in the study was that colleagues at the University of California, Davis (UC Davis) had kept a seagrass clone in their culture tanks for 17 years, which served as a calibration point. “This paper shows how interdisciplinary interactions between cancer evolutionary biologists and marine ecologists can lead to new insights,” says Dr. Benjamin Werner, Lecturer in Mathematics and Cancer Evolution at QMUL, who focuses on the somatic evolution of tumours which also develop clonally. Prof. Dr. Iliana Baums, molecular ecologist at the HIFMB, adds: “We can now apply these tools to endangered corals to develop more effective conservation measures, which we urgently need as unprecedented heat waves threaten coral reefs.”

“We expect that other seagrass species and their clones of the genus Posidonia, which extend over more than ten kilometres, will show even higher ages and thus be by far the oldest organisms on Earth,” says Thorsten Reusch. These will be the next objects of study.

Benefits of failure are overrated


Success follows failure less often than expected, study finds



AMERICAN PSYCHOLOGICAL ASSOCIATION





The platitude that failure leads to success may be both inaccurate and damaging to society, according to research published by the American Psychological Association. 

Researchers conducted 11 experiments with more than 1,800 participants across many domains and compared national statistics to the participants’ responses. In one experiment, participants vastly overestimated the percentage of prospective nurses, lawyers and teachers who pass licensing exams after previously failing them. 

“People expect success to follow failure much more often than it actually does,” said lead researcher Lauren Eskreis-Winkler, PhD, an assistant professor of management and organizations at Northwestern University. “People usually assume that past behavior predicts future behavior, so it’s surprising that we often believe the opposite when it comes to succeeding after failure.”
   
In some experiments, participants wrongly assumed that people pay attention to their mistakes and learn from them. In one field test, nurses overestimated how much their colleagues would learn from a past error. The research was published online in the Journal of Experimental Psychology: General

“People often confuse what is with what ought to be,” Eskreis-Winkler said. “People ought to pay attention and learn from failure, but often they don’t because failure is demotivating and ego-threatening.”

While telling people they will succeed after failure may make them feel better, that mindset can have damaging real-world consequences, Eskreis-Winkler said. In one experiment, participants assumed that heart patients would embrace healthier lifestyles when many of them don’t. 

“People who believe that problems will self-correct after failure are less motivated to help those in need,” Estreis-Winkler said. “Why would we invest time or money to help struggling populations if we erroneously believe that they will right themselves?” 

However, people may recalibrate their expectations when given information about the negligible benefits of failure. In two experiments, participants were more supportive of taxpayer funding for rehabilitation programs for former inmates and drug treatment programs when they learned about the low rates of success for people using those programs.
 
“Correcting our misguided beliefs about failure could help shift taxpayer dollars away from punishment toward rehabilitation and reform,” Eskreis-Winkler said. 

Article: “The Exaggerated Benefits of Failure,” Lauren Eskreis-Winkler, PhD, Northwestern University; Katilin Woolley, PhD, Cornell University; Eda Erensoy, BA, Yale University; and Minhee Kim, BA, Columbia University, Journal of Experimental Psychology: General, published online June 10, 2024.

Contact: Lauren Eskreis-Winkler, PhD, may be contacted at lauren.eskreis-winkler@kellogg.northwestern.edu
 

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA’s membership includes over 157,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve lives.

 

 

New study helps explain how elderly individuals react differently to COVID-19 than young people


Findings underscore that age is an important risk factor for the severity of COVID-19


BOSTON UNIVERSITY SCHOOL OF MEDICINE





(Boston)—The COVID-19 pandemic resulted in over 700 million infections and 7 million deaths worldwide. While age is recognized as a risk factor for severe COVID-19, the reasons for this are not yet fully understood. 

A new study by researchers at Boston University Chobanian & Avedisian School of Medicine suggests that the immune response of lung endothelial cells, which line the blood vessels, is too low during the early stage of COVID-19 infection as demonstrated in a preclinical model. Additionally, the researchers analyzed all genes expressed in purified endothelial cells, which had never been done before.

 

“The susceptibility to SARS-CoV-2 infection increases proportionally with age, placing older individuals at a significantly higher risk of developing severe COVID-19. Therefore, gaining insight into age-dependent pathological changes during SARS-CoV-2 infection is imperative for effectively safeguarding vulnerable populations,” said corresponding author Markus Bosmann, MD, associate professor of medicine, pathology & laboratory medicine at the school.
 

The researchers used four groups of endothelial cell conditions with susceptibility to SARS-CoV-2. The first two groups, consisting of young and old models, remained uninfected as controls. The other two groups, also young and old, were infected with SARS-CoV-2. Endothelial cells from all sets of conditions were isolated after two days, and their transcriptomes (their expressed genes) were analyzed and classified as biological programs of the host response. The clinical severity of infection was monitored and found to be more severe with advanced age.

 

According to Bosmann, a suppressed immune landscape is a key driver of age-associated endothelial dysfunction during COVID-19. “While these findings currently do not have immediate implications for treating COVID-19, targeting these immune pathways in endothelial cells may have prognostic and therapeutic benefits although further studies, including dissecting these functional changes at a single-cell level, are needed,” he adds.

 

These findings appear online in the journal Frontiers in Immunology.

Funding for this study was provided by the National Institutes of Health 1UL1TR001430 (to MB and SS), the National Institutes of Health 1R01HL141513 (to MB), the National Institutes of Health 1R21ES032882, 1K22AI144050 (to FD), Aniara Diagnostica (Coagulation Research Grant 2020–2021 to SS), a Boston University Start-up fund (to FD), a Peter Paul Career Development Professorship (to FD), and utilized a Ventana Discovery Ultra autostainer and Vectra Polaris whole slide scanner that were purchased with funding from National Institutes of Health grants S10OD026983 & S10OD030269 (to NC). FD and DK were also supported by a National Institute of Health Transition Award (K22 AI144050) and a T32 training grant in immunology (T32AI007309), respectively. CR acknowledges funding from the Forschungsinitiative Rheinland-Pfalz and ReALity (project MORE), the BMBF Cluster4Future CurATime (project MicrobAIome; 03ZU1202CA). CR was awarded a Fellowship from the Gutenberg Research College at Johannes Gutenberg-University Mainz. CR is a member of the Center for Translational Vascular Biology (CTVB), the Research Center for Immunotherapy (FZI), and the Potentialbereich EXPOHEALTH at the Johannes Gutenberg-University Mainz.

Note to Editor:

Authors MB and FD were funded by ARCA Biopharma for another project on COVID-19. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

 

Association found between media diet and science-consistent beliefs about climate change



ANNENBERG PUBLIC POLICY CENTER OF THE UNIVERSITY OF PENNSYLVANIA





In a paper titled “The Politicization of Climate Science: Media Consumption, Perceptions of Science and Scientists, and Support for Policy,” published May 26, 2024, in the Journal of Health Communication, researchers probed the associations between media exposure and science-consistent beliefs about climate change and the threat it posed to the respondent.

Expanding on earlier work associating Fox News consumption with doubts about the existence of human-caused climate change, a team of scholars affiliated with the Annenberg Public Policy Center (APPC) found that exposure to Fox News and far-right media was negatively associated, and centrist and science media exposure positively associated, with belief in anthropogenic climate change, perceptions of the personal threat posed by climate change, and support for a carbon tax.

The research team included Yotam Ophir, Assistant Professor of Communication at the University at Buffalo, State University of New York, and a distinguished research fellow and former postdoctoral fellow at APPC; Dror Walter, Assistant Professor of Digital Communication at Georgia State University and an APPC distinguished research fellow; APPC’s Annenberg Health and Risk Communication Institute director Patrick Jamieson; and APPC director Kathleen Hall Jamieson.

“The results of this study suggest that climate science scholars and advocates should pay more attention to the complex media diets of individuals and specifically of partisans to better understand the possible influence of messages and narratives about climate science and scientists circulating in the American media environment,” the authors wrote.

Prior research in this area focused primarily on centrist media and Fox News, even as the media choices available to people grew more varied.

In short, says Ophir, the lead author of the new study, “a lot of research was asking people if they watch Fox News and if they believe in climate change. But there’s more to the story.”

For this study, the researchers asked people about their use of far-right, Christian, alternative health, and science media in addition to mainstream media (liberal, centrist, and conservative). To assess climate beliefs, the researchers asked participants whether they thought climate change poses a personal threat to them – “One of the challenges with climate change is that people don’t feel vulnerable. There is some vagueness to the impact,” says Ophir – and whether they support a carbon tax. “We wanted to go beyond just acceptance of the science into behavioral intentions,” says Ophir.

Finally, in addition to asking about perceptions of climate change, the researchers asked people about their perceptions of science and scientists in general. “We wanted to see if some of the relationship between media use and climate beliefs comes from undermining science at large,” explains Ophir. The study found that perceptions of science and scientists mediated the relationship between exposure to media and a set of dependent variables, including belief in anthropogenic climate change, risk perception, and support for a carbon tax.

Among the team’s findings are that far-right media have an even stronger relationship with rejection of the scientific consensus around climate change than do more mainstream conservative outlets like Fox News. They also found that exposure to right-wing media in general is associated with lower perceptions of threat from climate change and lower likelihood of supporting a carbon tax.

“Consumption of right-wing media is associated not only with your views on climate change,” says Ophir. “It is associated with more negative views of the scientific endeavor as a whole, and that affects your views on climate change.”

The findings have important implications for how climate science scholars and advocates move forward trying to understand resistance to climate science and policy, and crafting messages aimed at countering that resistance.

The study draws on data from the Annenberg Science and Public Health survey (ASAPH) and was funded by the Annenberg Health and Risk Communication Institute endowment of the Annenberg Public Policy Center of the University of Pennsylvania.

 

Support for American Heart Association leads to century of bold progress



The American Heart Association Founders Day 2024 celebrates 100 years of success fighting heart disease and stroke; heart disease deaths cut in half since founding



Business Announcement

AMERICAN HEART ASSOCIATION




DALLAS, June 9, 2024 — On June 10, 1924, a small group of dedicated physicians gathered at The Drake Hotel in Chicago to establish the American Heart Association. At the time, heart disease was considered a death sentence, there was no treatment, no hope. These founders believed that better understanding of heart disease would lead to treatments and lives saved.

They were right. Now, 100 years later, the American Heart Association has grown from those humble beginnings to become the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. At nearly 40 million-strong, volunteers, donors, advocates, staff and other supporters from around the world are leading the Association’s mission to be a relentless force for a world of longer, healthier lives.

“As we mark the American Heart Association’s centennial, we recognize monumental accomplishments in the fight against heart disease and stroke,” said Nancy Brown, chief executive officer of the American Heart Association. “Supported by efforts led by the Association, death rates from heart disease have been cut in half in the past 100 years. Deaths from stroke have been cut by a third since the creation of the American Stroke Association in 1998. Our historical timeline of the American Heart Association’s work highlights the accomplishments made since our founding, including spearheading groundbreaking research and advocacy initiatives to fight cardiovascular disease and pioneer life-saving interventions.”

The achievements of the American Heart Association over the past century have already resulted in more than $5.7 billion invested in cardiovascular scientific research – the largest investment outside of the federal government – made possible by the passion of community-based volunteers, donors and employees. Numerous top cardiovascular and cerebrovascular scientists throughout the world are linked with the American Heart Association as recipients of awards that recognize scientific excellence. Fifteen researchers funded by the Association have won Nobel Prizes, confirming that the American Heart Association is a leader in cardiovascular disease research.

“Reaching the Association’s bold goals is made possible because of like-minded individuals and organizations who share in the vision of better health,” said Marsha Jones, volunteer board chair of the American Heart Association. “Donors have pledged support of their time, talent and funds as Second Century campaign donors, providing the essential resources needed to sustain and expand the Association’s vital programs and initiatives such as Heart Walk, Go Red for Women® and Nation of Lifesavers. We are forever grateful for this support.”

The full list of Second Century donors can be viewed here.

"As heart disease continues to be the leading cause of death worldwide, we realize that our work is not yet finished," Jones said. "The American Heart Association is encouraging every individual, company, school and community to unite in transforming the future of health – not just for ourselves, but for our loved ones and the places we live, work and play. Today and every day, we have the opportunity to improve health and inspire hope for the future everyone deserves."

The Association will continue to lead breakthroughs in science and technology, improve health care and advocate for federal, state and local policies to drive healthier lifestyles.  

“As we close out our first 100 years and begin the next, our recent report on risk factor trends and economic projections show that our work is more important than ever," Brown said. "We understand that we can't achieve our bold goals alone and are deeply grateful to the community for their passion and commitment in supporting our mission. At the American Heart Association, our future is about improving yours.”

The Association is debuting “24 – a short film from the Heart” to commemorate the century of progress. View the film, learn more about accomplishments in the first 100 years of the American Heart Association and find how you can make a difference by participating in the Second Century campaign at heart.org/centennial

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.orgFacebookX or by calling 1-800-AHA-USA1.