Loosening the Belts

Finding Relief for the South's Health Problems

By Gail Short

sp2013 belt

These belts are no fashion statements. Cinched across the heart of the South, bands of a deep, ugly red mark counties with higher than normal rates of heart disease, diabetes, stroke, and several other dangerous health conditions. 

The causes are numerous and interconnected, including diets high in fats and calories, sedentary lifestyles, and declining but still significant tobacco use. In many cases, Alabama has some of the worst statistics in the South. But UAB clinicians and researchers are at the heart of efforts to find solutions in the field and in the lab.


Stroke

The problem: “The South has about 50 percent more deaths from stroke than other regions of the country,” says UAB biostatistician George Howard, Dr.P.H. That is about 20,000 extra strokes every year, he says. “Having a stroke costs about $140,000. Multiply that by 20,000 extra strokes, and you end up with about $3 billion in extra public health burden a year.” 

Prevention:Unraveling the color barrier and other stroke mysteries

Howard is the principal investigator for REGARDS (Reasons for Geographic and Racial Differences in Stroke), a massive national study sponsored by the National Institutes of Health. Researchers over the years have posed many theories as to why the stroke belt exists, including everything from diet and micronutrients in the drinking water to genetics and the high prevalence of hypertension, diabetes, and obesity in the region. But until researchers and physicians find the cause, Howard says, it will be difficult to formulate appropriate and effective interventions. 

Important clues lie in the racial disparities in Southern stroke risk. Blacks between the ages of 45 and 65 (the timeframe covered by the REGARDS study) are about three times more likely to have a stroke than their white counterparts, Howard says. In one recent finding, REGARDS investigators revealed that blacks appear to be more sensitive to high blood pressure than whites. At blood pressures above 140 mmHg, black participants had a 400 percent higher chance of having a stroke than white participants. A rise of 10 millimeters in blood pressure led to a 24 percent increase in stroke risk among black participants, but only an 8 percent increase among white participants.

Treatment: “Ultrabuster” improves clotbusting treatment 

UAB’s Comprehensive Stroke Research Center is testing a way to boost the effectiveness of the clotbusting drug tissue plasminogen activator (tPA) by combining it with ultrasound directed at the affected brain region. In earlier clinical trials at UAB, the combination therapy broke up twice as many clots as tPA alone, says neurologist Andrei Alexandrov, M.D., the center’s director. Now the goal is to create a new treatment option that is safe and effective for emergency room use.


Heart Disease

The problem: A 2011 study led by Ali Ahmed, M.D., M.P.H., in the UAB Division of Gerontology, Geriatrics, and Palliative Care, found that the heart failure death rate in Alabama, Mississippi, Arkansas, Oklahoma, Louisiana, and Georgia was 69 percent higher than the national average. 

Prevention:Reducing the education gap 

Heart disease is the leading cause of death in Alabama. UAB epidemiology chair Donna Arnett, Ph.D., who also is the current president of the American Heart Association (AHA), blames several factors, including poor diet and low levels of physical activity. “Also there’s a socioeconomic and knowledge gap here in the South about the causes of heart disease and how important it is to maintain your health over the course of your life,” Arnett says. As president of the AHA, she has emphasized the importance of education, basing efforts around the organization’s Life’s Simple Seven campaign, which encourages people to get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.  

Treatment: In search of new therapies 

UAB recently established the Comprehensive Cardiovascular Center, where clinicians and researchers collaborate to develop biological therapies, regenerative cardiovascular medicines, and new surgical techniques that could someday prevent or reverse heart disease, says the center’s director, Sumanth D. Prabhu, M.D. UAB Hospital is the first in Alabama to offer the Edwards Lifesciences SAPIEN transcatheter heart valve replacement system (TAVR) for patients with aortic stenosis. The minimally invasive treatment is most useful for patients who are too frail for open-heart surgery. 

While hypertension can be controlled with medication, it’s not effective in all patients. David Calhoun, M.D., medical director of UAB’s Vascular Biology and Hypertension Program, is principal investigator for a clinical trial to test a minimally invasive treatment for lowering blood pressure called renal denervation. The procedure involves threading a catheter through the arteries that lead to the kidneys, and then delivering high-energy radio frequencies to burn nerves in the arteries that control blood pressure. 


Diabetes

The problem: The American Diabetes Association says one in three individuals born in Alabama after the year 2000 will develop diabetes in his or her lifetime. “This is something that impacts every citizen in Alabama, whether they have diabetes or not,” says W. Timothy Garvey, M.D., director of the UAB Diabetes Research and Training Center. It costs about $6,000 a year to take care of a patient with diabetes, compared to about $2,000 a year for patients who don’t have the disease, Garvey says. “Those numbers go a long way toward explaining the “increasing costs of health-care delivery,” he notes. 

Prevention: Making connections to control the disease

In 2012, the American Academy of Family Physicians Foundation selected Birmingham to launch a community-based diabetes management program called Cities for Life. The program will connect diabetes patients and people at risk for getting the disease to existing health and wellness resources in Birmingham. The goal is to help local residents control their blood sugar and lead healthier lives. (For more, see the website www.mydiabetesconnect.com.) The program’s partners include the UAB Department of Family and Community Medicine, the UAB Diabetes Research and Training Center’s Community Engagement Core, the YMCA of Greater Birmingham, family medicine practices in Birmingham, and a health education and wellness facility called UAB HealthSmart.

Treatment: Slowing diabetes with a blood pressure drug

Anath Shalev, M.D., director of UAB’s Comprehensive Diabetes Center, and her team have published studies suggesting that a commonly used high blood pressure medication may slow the advance of diabetes. The team made the discovery while trying to develop a drug that would inhibit a protein called TXNIP. Excess TXNIP signaling causes beta cells, which produce insulin in the pancreas, to self-destruct. Shalev and her team discovered that a calcium channel blocker limits the expression of TXNIP and prevented the death of beta cells. The UAB scientists are now working with the Alabama Drug Discovery Alliance to screen 300,000 molecules in hopes of finding possible candidates for creating targeted drug therapies. 

 

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