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LOWN CARDIOVASCULAR RESEARCH FOUNDATION

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Time and Tenacity Pay Off: Dr. Vikas Saini Joins the Lown Foundation as President
BERNARD LOWN, M.D. When I envisioned the position of President of the Lown Cardiovascular Research Foundation 15 years ago, I had a definite idea of what the position would entail and what kind of individual would be best suited for this crucial role.
I realized that the Lown group needed a full-time individual dedicated to leading our research efforts. While clinicians can seed new ideas and precisely identify what needs to be studied, the hectic pace of a busy patient practice severely limits the time and energy available for research. Sustaining and expediting an investigation requires significant dedicated time, clear focus and diverse skills. I also realized that the individual we call to lead must be a clinician-cardiologist. Not just any cardiologist, but one who really understands and is in tune with the myriad of medical concerns our group encounters. The individual, ideally, should possess the unique quality of research intelligence the ability to identify, from the multitude of problems, the ones that are both central to our mission and readily solvable. The individual should be able to appreciate what is special about the Lown group. He or she must comprehend our philosophy and commitment to the primacy of medicine as a calling. To share such fundamentals not only in abstract theory but also in its practical application would require someone who had trained in our post-doctoral fellowship program. Dr. Vikas Saini is such a person. Twenty-five years ago, from the moment he drove me from the Baltimore airport for my lecture at the Johns Hopkins Hospital, I recognized his unique qualities. Accepting my offer to join our fellowship program, Vikas proved to be a stellar student. Upon his completion of the program, I offered him a job as the director of research. He declined the offer and went on to pursue a diverse, innovative, and successful medical career. Over the past two decades, I periodically tried to tempt Vikas to return to the Foundation, but my efforts were rebuffed. Today, I delight in reporting that time and tenacity have been rewarded. Vikas has agreed to join with us as the President of the Lown Cardiovascular Research Foundation. He will also be a full partner in the clinical practice. Vikas complements all those who have helped sustain our vision over the years. During his fellowship, he worked closely with Dr. Thomas Graboys, who was elected President Emeritus of the Lown Foundation at the Boards June meeting and remains an active part of the Foundation. Vikas joining us is a vote of confidence, an affirmation of the Lown groups potential. This is a very auspicious time. Never before has our practice of patient-focused care been as widely confirmed. We belong in the mainstream. Vikas has the leadership qualities, the finely honed intellect, and the superb work ethic to take us there. He is highly gifted and remarkably endowed for the challenges we confront.

inside

valentines day
BRIAN BILCHIK, M.D.

heart health and anxiety

CHARLES M. BLATT, M.D.

meet vikas saini, M.D.

heart2heart run

news in brief

Valentines Day Storm Reveals True Strength of Heart Social activity, not just physical activity, important for heart health
BRIAN BILCHIK, M.D.
Valentines Day 2007. The storm that forecasters had been predicting for days had arrived. Freezing rain had begun to fall in Boston. Roads were rapidly becoming ice rinks. The phone rang. It was my patient, Ms. J., stating that she would be a few minutes late. So? Let me explain. Ms. J. is 94 years young and volunteers at Childrens Hospital, as a rent-agranny. She fosters healing by touching and sharing, providing warmth and companionship for children who are hospitalized, alone, and frightened. The significance of her call is not that she was going to be late, but rather that she was coming at all, and from where. She was the only patient who did not cancel her appointment that morning. And she drove herself from Childrens Hospital to the Lown Center for her visit. While even the post office doesnt always deliver in inclement weather any more, and florists couldnt deliver many of the all-important Valentines bouquets leaving profits and some would-be sweethearts out in the cold, the children at the hospital who call Ms. J. Granny received their dose of loving care right on schedule that day. Whats a little freezing rain when there are Granny rounds to complete? I admire many of my patients but Ms. J. is in a category all her own. Her story is encouraging and inspiring. It also emphasizes an important yet often overlooked ingredient necessary for heart health: social activity. As cardiologists, we want to promote good health not only to sustain longevity, but also to improve quality of life. We regularly advise our patients about healthy habits, lifestyle modification, nutritional food choices, and physical activity. We often ignore the importance of social activity. Loneliness is a significant challenge and risk factor for shortening life expectancy as we get older. Being alone or lonely may exacerbate cardiac and other risk factors. Being active in your community, volunteering, or even working part time will help develop and maintain a personal and essential sense of worth. It will also create an important connection to the world and those around you. One often quoted study shows the connection between owning a dog and living longer. The sense of companionship, purpose and relevance in your world makes a real difference. While not everyone can have, or even wants a pet, there are other ways to achieve the connections and sense of purpose. Beyond taking care of oneself, contributing to the community, even in a small way, enhances not only longevity but also quality of life. If you dont know how or where to start, Im sure Ms. J. can show you the way.

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Heart Health and Anxiety

CHARLES M. BLATT, M.D.
A long-standing subject of scientific and research interest at The Lown Foundation has been to understand the impact of our patients psychological and emotional state on their heart health. If a physician asks a patient, Why did the heart attack occur when it did? the answer is usually not a reflection on high blood pressure or cholesterol. Rather, patients tend to report, I was under such stress or I was terribly anxious before the heart attack. The general public does not require any scientifically rigorous study to intuitively recognize the importance of the emotional state and the heart, but our cardiology colleagues do. We have engaged in long-term research efforts seeking to better understand the important link between the brain and the heart. As previously reported, our study of over 850 patients with coronary artery disease started in 1992 and continues today. This project has proven to be a unique and valuable source of information, which weve shared with the medical community through presentations at national and international meetings and with the publication of numerous scientific and peer-reviewed papers. Most recently, the study yielded significant findings, which resulted in landmark research work and appeared in the May 22, 2007 issue of the Journal of the American College of Cardiology (JACC). The project, Anxiety Worsens Prognosis in Patients with Coronary Artery Disease, was recognized as one of the most important studies of this issue and made national and international headlines. The research reported on 516 patients with coronary disease who filled out an extensive questionnaire once a year. This information provided a measurement of the patients level of anxiety. From the data collected, we were able to divide the participants into two groups. One group showed low levels of anxiety and the second set exhibited high levels of anxiety. Carefully following our patients over a course of several years, we were able to assess the trend of their emotional state. The analysis revealed that if a patients anxiety level starts high and then declines over several years of follow up, their risk of a heart attack is substantially lower than the patient whose anxiety level rises during that time. These findings were independent of whether the individual had high blood pressure, diabetes, or high cholesterol, or whether the individual smoked cigarettes. Furthermore, we found that the risk of having a heart attack doubled for those patients whose anxiety scores rose during the study. A single assessment of a patients anxiety did not predict an increased risk for a heart attack it was the fact that we were able to assess patients repeatedly that provided this unique insight into the effect of anxiety on the occurrence of heart attacks. What lesson do we draw from these results? At the Lown Center we have always emphasized the importance of putting patients at ease while treating heart disease. We have always felt that reducing the patients anxiety about their cardiac and other medical issues would improve their overall heart health. Although we have emphasized exercise and proper medications to control blood pressure and cholesterol levels, we have also emphasized the importance of spending time with patients. We focus on getting to know patients as human beings first, learning and understanding what makes them anxious, and then doing what we can within the doctor-patient relationship to help dispel that anxiety. We believe that these principles are the very essence of good doctoring. And now we have the evidence to confirm that those patients who experience a decline in anxiety have a dramatic reduction in the risk of having a heart attack or dying from their coronary disease. We all intuitively know the value of being less anxious and of the benefits of a calm state of mind for our physical well being. Now we have firm evidence that a reduction in anxiety also helps the patient effectively manage coronary disease.

Meet Vikas Saini, M.D.

Scientific inquiry, medicine and strong convictions have guided Dr. Vikas Saini his whole life. Saini, who was born in the small town of Hoshiarpur in Punjab, India and moved to the United States when his parents enrolled in graduate school at Ohio State University, was a budding scientist at the age of 4. He spent many weekends at that time helping his mother record data in her experiments on cholesterol metabolism in mice. As a teenager at a Toronto prep school, Saini spoke out as a conscientious objector to the schools mandate that all students serve in the cadet corp. He finished first in his class and was accepted to Princeton at the age of 16. After graduating from Princeton, Saini enrolled in medical school at Dalhousie University in Halifax, Nova Scotia. There, he helped organize independent seminars in social medicine for students. Between his second and third years, Saini took a year off to collaborate with Montefiore Hospital in an occupational health research project, detailing workplace exposure to chemicals at a pharmaceutical plant. He returned to medical school and graduated in 1980 with honors. Saini completed his medical residency at Baltimore City Hospitals where his interest in cardiology was

encouraged by Johns Hopkins then chief of cardiology, Dr. Myron Weisfeld whose enthusiastic support was critical in Sainis receiving a Mellon Fellowship. At the time, Saini planned a career in cardiology and public health at John Hopkins. Then, he met Dr. Bernard Lown the keynote speaker for the first symposium on nuclear war at Johns Hopkins sponsored by the Physicians for Social Responsibility (PSR). Saini, who had served as chapter president for two years, met their guest at the airport. After the initial meeting, Saini, who had a strong interest in researching the physiology of mind-body interactions, wanted to study for six months under Lown to learn experimental techniques for his John Hopkins fellowship. Lown declined. The only way Lown would accept Saini in his lab was for him to agree to come as a fellow. Saini accepted the offer and left Johns Hopkins for Boston. He recalls, I was attracted by the allure of working in an illustrious lab that had made history in cardiology. The prospect of developing a sound scientific basis for psychosocial factors in cardiovascular disease was compelling. But the true revelation was the heady atmosphere created by the unique combination of

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scientific inquiry with sound clinical judgment. The humanism and clinical acumen exemplified by Tom Graboys and the other associates, and the sharp critical judgment of Dr. Lown, were a potent formative experience for any physician-in-training lucky enough to be under their guidance. I saw in their example the possibility for the first time, of truly being committed to first-rate clinical care, first-rate science, but most importantly to sympathetic alliance with the patient. I had finally found myself as a physician. Since his Lown fellowship, Saini co-founded Aspect Medical Systems with Nassib Chamoun, whom he met as a graduate student at Lown. He was named Aspects first vice president of research & development, and he served on its board of directors. Saini later opened and operated a busy private medical practice on Cape Cod. He became a founding partner of The Cardiovascular Specialists in Hyannis, MA. He founded and led Cape Physicians LLC, a physicians network for insurance contracts. Soon after, he merged it into Primary Care, LLC, which

was the largest network of independent primary care providers in Massachusetts and was recently acquired by New England Medical Center. Considering his new position at Lown, Saini said, Im looking forward to the opportunity of leading the Foundation into the new century. The skyrocketing costs of health care, the burgeoning epidemic of obesity worldwide with its implications for future diabetes and heart disease, and the veritable tsunami of technology in the clinic, all require a sustained and passionate commitment of time, human energy, and financial resources in order to achieve an optimal program of care. We must promote an intense focus on prevention, a critical scrutiny of technology at the right place and the right time and innovative models of communication and care delivery. In all this, our lodestars must be unquestioned scientific integrity and a biased view in favor of the patient.

2007 Heart2Heart Run: A Model of Dedication

CAROLE A. NATHAN AND LAUREN PHILLIPS-THORYN
On April 16, 2007, the day of the 111th Boston Marathon, Lown Cardiovascular Center patient Bill Nawn and friend Sean Luitjens prepared for the wind and rain. Instead of umbrellas, they grabbed their running shoes. At 4:45 a.m., Nawn and Luitjens began the first half of the Heart2Heart double marathon a 26.2-mile run to Hopkinton and a race back to the city. The days leading up to the Marathon were filled with the ominous warnings of a coming storm and predictions of the ferocious weather that Bill and Sean would confront in order to run 52.4 miles and raise funds for the Lown Cardiovascular Research Foundation. This was the fourth and most difficult Heart2Heart Run that Nawn has completed for the Foundation in his quest to raise awareness of heart health and disease prevention. Although Dr. Craig Vinch and Foundation business manager, Bob Kiessling, were there to provide motivation and support at 4:30 a.m., Nawn had to rely on his own willpower when an injury sidelined Sean at the 23rd mile. The slippery pavement and dangerously strong winds contributed more adversity to the strenuous challenge. Despite the treacherous conditions, Nawn arrived in Hopkinton in about four hours. There, he was able to dry his clothes, change his shoes, stretch, and refuel at the home of Carole Nathan, Lown Foundations executive director. The entire Lown Center was rooting for Nawn to complete his 52.4 miles; and he entered his sanctioned Boston Marathon corral at 10 a.m. wearing the low-qualifying number of 6336. The way back seemed longer than 26.2 miles but the weather was better, said Nawn. He set an even pace on his return run into Boston and, after 3 hours and 53 minutes, he crossed the official Finish Line. He attributes much of the success of the run to the encouragement and support from his family in particular his wife, Mary. [She] was able to jump in [to the race] to help me through the last six miles I absolutely couldnt have done it without her. He added, This was the toughest H2H Run so far, but [its] always worth it. Thats what keeps the motivation going. Although the 2007 Heart2Heart Run and 111th Boston Marathon may be over, our run-raising is not. If you would like to make a contribution in honor of Bill Nawn, Mary Nawn, Sean Luitjens, or the Heart2HeartRun, please visit the website: www.h2hrun.org or contact Lauren Phillips-Thoryn at the Lown Cardiovascular Research Foundation.

Lown Foundation in the News

Research led by Dr. Charles M. Blatt, former Developing World fellow Dr. Woldercherkos Shibeshi, and epidemiologist Dr. Yinong Young-Xu, has been published in The Journal of the American College of Cardiology (JACC). The study, Anxiety Worsens Prognosis in Patients with Coronary Artery Disease, 516 reports on more than 500 patients with coronary disease who were part of the ongoing long-term research project that began in 1992 and continues today. Participants were divided into two groups one with low levels of anxiety, the other with high levels. The research showed that patients who started the study with high anxiety levels and reduced them during the study period lowered their risk of a heart attack compared to the patients whose anxiety levels rose during the study time period. The article, recognized as one of the most important studies of the connection between heart health and anxiety, attracted worldwide attention and coverage from major media outlets including The Washington Post, CNN, Reuters, International News Network (Pakistan), Peoples Daily Online (China), Science Daily, Sydney Morning Herald (Austrailia), WebMD, Health24 (South Africa), United Press International, Earthtimes. org, MedIndia (India), TheHeart.org, Regina Leader-Post (Canada), HeartZine (UK), SpiritIndia.com, The Telegraph.co.uk (UK), Newswise, HealthDay News, Scienceblog.com, eurekalert.org, News-Medical.net (Austrailia), PakTribune.com (Pakistan), Medical News Today (UK), Medscape, 24dash.com (UK), South Asian Womens Forum (India), and Forbes. Locally, Dr. Blatt shared the studys findings and implications in an interview with Bostons CBS affiliate, WBZ CH 4. (Story p. 2 ) A taped message from Dr. Bernard Lown was presented in Iran during the April 15-21 meeting of the Isfahan Healthy Heart Program (IHHP). The IHHP aims to increase disease awareness, encourage heart healthy behaviors, disseminate medical information, affect public policies, and delay the onset of diseases through a community-based approach. Dr. Thomas B. Graboys was promoted to clinical professor of medicine at Harvard Medical School in April 2007. Dr. Brian Z. Bilchik participated in the U.S. Centers for Disease Controls National Forum for the Prevention of Heart Attack and Stroke in Washington D.C. in April 2007. Dr. Bilchik is vice chair of the Forums Communication Implementation Group (CIG), which is developing a long-range strategic communication plan supporting the National Action Plan for the Prevention of Heart Attack and Stroke. Dr. Bernard Lowns memoir, tentatively titled A Prescription for Survival: Out of the Nuclear Shadow has been accepted by Berrett Koehler Publications of San Francisco for release in 2008. The book chronicles Dr. Lowns personal account of the intense years from 1980 to 1985 when, at the height of U.S.-Soviet tensions, Dr. Lown and his Soviet colleague, Dr. Eugene Chazov co-founded the International Physicians for the Prevention of Nuclear War (IPPNW). The organization exploded into a powerful force of 200,000 physician members worldwide, earning Dr. Lown the Nobel Peace Prize. The book is a tumultuous adventure of how doctors helped change the course of history by steering the two superpowers away from a nuclear confrontation. The world volume rights of Dr. Thomas B. Graboys book Losing Control: A Physicians Memoir of Life, Love, and Loss Battling Parkinsons has been acquired by Sterling Publishing Company. This memoir will explore the impact of Parkinsons and its incipient dementia on his identity as a doctor, a husband and lover, an athlete, a father and grandfather. It will also deal with his learning to become a patient in the hands of other doctors. Mrs. Victoria Graboys and Dr. Thomas B. Graboys recently participated in Harvard Medical Schools Palliative Care Symposium. The focus of the symposium centered on the role of caretaker. Mrs. Graboys presented her perspective on the critical roles of caretaker and spouse. The program examined the difficulties for patients suffering several neurological disorders including: Parkinsons disease, Alzheimers, and Lewy Body Dementia. Dr. Craig Vinch joined former Lown patient Bill Nawn on New England Cable News (NECN) Chet Curtis Report on April 27, 2007. They recapped the 2007 Boston Marathon fundraising ultra-marathon and discussed the importance of heart health awareness and the benefits of regular exercise. (Story p. 5 ) Using ICTS to Prevent Cardiovascular Disease in Developing Countries: The ProCOR Programme, by Dr. Brian Bilchik, ProCOR director, and Catherine Coleman, editor in chief, ProCOR has been published in the International Hospital Federation Reference Book 2006/2007.

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Two research papers by Dr. Craig Vinch and colleagues at the University of Massachusetts have been accepted for publication in the journal Echocardiography. The first article describes new 3-dimensional echocardiography that non-invasively assesses heart size and function in patients with heart disease. In their findings, 3-D echocardiography compares well to older, standard methods to assess cardiac size and function. The second article focuses on novel ultrasound STRAIN methods to study ventricular function. STRAIN imaging allows cardiologists to measure ventricular twisting, which is not easily seen or measured with standard echocardiography. Dr. Brian Bilchik was elected co-chair of the Brigham & Womens Hospital Physician Council in March of 2007. Catherine Coleman has been appointed to the Editorial Board of Prevention and Control, a peer-reviewed journal providing a forum for dialogue and education on the prevention and control of cardiovascular diseases, with a special focus on countries with middle and lower economies. She has also been named a member of the steering group for Healthy Information for All by 2015, a global campaign promoting access to health information with the goal that by 2015, every person worldwide will have access to an informed healthcare provider. Dr. Brian Bilchik discussed the importance of heart healthy behaviors, such as reducing sodium intake and exercising daily, as the guest speaker at the Brookline Rotary Club in early spring 2007. Lown Foundation Board member, Dr. Barbara Roberts presented Grand Round lectures on Gender-Specific Aspects of Cardiovascular Disease at Jordan Hospital in Plymouth, MA, at St. Vincents Hospital in Worcester, MA and at UMass Medical Center in Worcester, MA. Lown researcher Dr. Yinong Young-Xu read his poignant essay A Potential for Brutality on the NPR program All Things Considered in March 2007. ProCORs email discussion forum was instrumental in the launch of Nepals first cardiovascular disease study, according to that countrys largest newspaper, and its online edition, eKantipur.com. The article credits support from around the world generated through ProCORs forum for the landmark project. Medical studies of this scope have rarely been conducted in Asia, let alone Nepal. This will be an inspiration for developing countries and also Nepals contribution to knowledge, the article states.

Catherine Coleman recently spoke about ProCOR at the National Institutes of Health in Bethesda, MD. The meeting was hosted by Ovations, a subsidiary of the UnitedHealth Group, which launched an international effort to prevent chronic disease at the 2006 meeting of the Clinton Global Initiative. Lown Foundation Board member, Robert T. Hale, Sr. and son, Robert T. Hale, Jr. were profiled in the Boston Business Journal (BBJ). A cover story, Startups Starting All Over Again, examined the Hales successful second business venture. The father-son team first joined forces in 1990 entering the then competitive and growing telecommunications industry. Twelve years later, an economic downturn and market shift in the technology sector forced the company to close its doors. In 2002, having learned hard but valuable lessons, and with the guidance and support of Bob Sr., Rob launched a new company, Granite Telecommunications. Rob credits his father as being the inspirational force behind his resiliency to begin anew. Rob appeared on the cover of the BBJs special April 19, 2007 Pacesetters issue. Ranked third among the regions fastest growing private companies, the article, Granite Builds Rock-solid Firm Without High-tech Magic, celebrates Granites success with both revenue growth and customer service. Considered the sixthlargest telecommunications carrier in the nation, Granites customers include more than a quarter of the U.S. Fortune 100 companies. Bob Hale, Sr. serves as Granites Chairman of the Board, and Rob is the companys President and CEO. Dr. Craig Vinch recently presented, Evidence for Treating to Lower LDL Levels in Established CAD to physicians, residents, and nurses from Boston University Medical Center. Dr. Vinch presented evidence from the most recent clinical research on ideal noninvasive care of cholesterol and coronary heart disease. Former Fellow, Dr. Bernard Nkum, has been named Assistant Secretary General of the West African College of Physicians. He has also been appointed by the Ghana Ministry of Health to the national Regenerative Health and Nutrition Programme, which aims at creating change agents at the district level to support the adoption of healthier lifestyles at the local level. On May 22, 2007, The Boston Globe ranked Aspect Medical Systems number 11 in its list of 100 Top Performing Public Companies. Aspects CEO is Nassib Chamoun, who also serves as the Lown Foundations Chairman of the Board.

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BOARD OF DIRECTORS LOWN CARDIOVASCULAR RESEARCH FOUNDATION

Join Our 2008 Team!

2008 will mark the 5th Anniversary of the Heart2Heart Run and the Lown Foundation is inviting runners of all levels to join our team.
Ways to participate include:
Writing support and design by Im-aj Communications & Design, Inc

Nassib Chamoun Chairman of the Board Vikas Saini, M.D. President Bernard Lown, M.D. Chairman Emeritus Thomas B. Graboys, M.D. President Emeritus Patricia Aslanis Charles M. Blatt, M.D. Janet Johnson Bullard Martha Crowninshield Renee Gelman, M.D. Barbara Greenberg Robert T. Hale Carole Anne McLeod C. Bruce Metzler John R. Monsky Barbara H. Roberts, M.D. Ronald Shaich Robert F. Weis David L. Weltman
ADVISORY BOARD

Short support runs along the Boston to Hopkinton leg The marathon run back from Hopkinton to Boston The complete ultra-run from Boston to Hopkinton and back to Boston Ways to support us include: Media coverage Individual and/or corporate team sponsorship Organized support along the route Bill Nawn has offered to help with training schedules and coaching for individuals or groups needing assistance. If you are interested in helping us raise awareness for better heart health and the prevention of cardiovascular diseases, please contact Carole Nathan via email at cnathan1@partners.org, or by calling 617-732-1318 ext. 3350. We look forward to welcoming you to the Lown team!

Herbert Engelhardt Edward Finkelstein William E. Ford Milton Lown Jeffrey I. Sussman Carole A. Nathan Executive Director

Lown Cardiovascular Research Foundation

21 Longwood Avenue Brookline, MA 02446-5239 (617) 732-1318

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