During the COVID-19 pandemic, Johns Hopkins Medicine Media Relations is focused on disseminating current, accurate and useful information to the public via the media. As part of that effort, we are distributing our “COVID-19 Tip Sheet: Story Ideas from Johns Hopkins” every Tuesday throughout the duration of the outbreak.

We also want you to continue having access to the latest Johns Hopkins Medicine research achievements and clinical advances, so we are issuing a second tip sheet every Thursday, covering topics not related to COVID-19 or the SARS-CoV-2 virus.

Stories associated with journal publications provide a link to the paper. Interviews with the researchers featured may be arranged by contacting the media representatives listed.
 

PERSONALIZING ASPIRIN TREATMENT FOR PATIENTS AT RISK OF CARDIOVASCULAR DISEASE

Media Contact: Vanessa McMains, Ph.D.

When it comes to prescribing low-dose aspirin (“baby aspirin”), physicians must balance whether the benefit of preventing a heart attack or stroke in people without cardiovascular disease outweighs the potential harm from aspirin use, such as bleeding in the brain, stomach or other areas.

Now, after studying more than 3,500 participants from the Multi-Ethnic Study of Atherosclerosis, Johns Hopkins Medicine researchers have found that imaging the plaque buildup in the heart’s coronary arteries can help determine whether a patient would benefit from preventive aspirin or not.

“The coronary artery calcium score allows for more personalized allocation of therapy to give the right patient the right treatment,” says study lead author Miguel Cainzos-Achirica, M.D., Ph.D., M.P.H., a research associate at the Ciccarone Center for the Prevention of Cardiovascular Disease. “Those people with greater signs of plaque buildup are more likely to benefit from aspirin treatment, whereas people with little or no plaque buildup are more likely to be harmed.”

Their findings were published online on April 1, 2020, in the journal Circulation.

The new study analyzed data from patients under 70 years old with no history of bleeding risk and who hadn’t yet had a heart attack or stroke, but had risk factors for cardiovascular disease, such as elevated cholesterol or high blood pressure. In this group of patients, the researchers observed that using traditional cardiovascular risk estimators does not make it possible to distinguish good candidates for preventive aspirin therapy from people unlikely to benefit.

The researchers tested to see if data from coronary artery calcium CT scans could aid in decision making. The scale of measurement ranged from a score of zero for people with no buildup of arterial plaque and at low risk of having cardiovascular disease events, to those with scores greater than 400 who are at increased risk of having a heart attack or stroke.

For those people with no plaque buildup, the researchers calculated treating 1,190 patients for five years would prevent one cardiovascular disease event compared with treating 567 patients to yield one occurrence of bleeding. This would indicate that aspirin treatment wouldn’t be recommended for this group. For people with a coronary calcium score of 100 or higher, only 140 patients would need to be treated to prevent a cardiovascular disease event compared with treating 518 people to see a bleeding event — meaning that the benefit would outweigh the harm.

“The future will likely bring an expanded use of coronary artery calcium CT scans to inform treatment decisions not only for statins and aspirin, but also for other cardiovascular disease interventions and treatments,” says Michael Blaha, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine and senior author of the study.

Blaha consults for Bayer, who is a maker of aspirin.

STUDY CALLS FOR PRIORITIZING PREGNANCY CARE DURING AND AFTER INCARCERATION

Media Contact: Waun’Shae Blount

The number of women in U.S. jails — many in their childbearing years — continues to rise. Some of them will be incarcerated while pregnant, requiring specific medical attention while in custody. However, the availability of pregnancy care varies significantly from jail to jail. Some women will give birth in jail, and some will still be pregnant when they return to the community. The pregnancy care that the women receive — or do not receive — during their incarceration contributes greatly to their health outcomes and those of their babies.

Johns Hopkins Medicine assistant professor of gynecology and obstetrics Carolyn Sufrin, M.D., Ph.D., and her team recently examined various pregnancy outcomes for pregnant women facing jail time in the United States. A report on their findings was published online in the April 9, 2020, issue of Obstetrics and Gynecology.

“Our study shows that there is a surprisingly large number of pregnant people who go in and out of our nation’s jails each year. The fact that this is the first time anyone has collected and analyzed data on the outcomes of jail pregnancies shows just how much these people are overlooked. We hope our data can inform efforts to ensure they get the pregnancy care they need,” Sufrin says.

The team collected pregnancy data from six U.S. jails, including the five largest, each month for a year. Data included the number of pregnant people who were admitted, live births, miscarriages, induced abortions, ectopic pregnancies, stillbirths, cesarean births, preterm births, and maternal and newborn deaths. 

Each month, administrators at each of the jails reported the number of pregnant people admitted and total number in custody on the last day of the month, along with anyone who became pregnant while in custody. The researchers were unable to gather demographic characteristics about individuals, such as race and age, due to the aggregate nature of reporting.

Based on the analysis of the data, Sufrin and her colleagues recommend that jails, prisons and detention centers provide comprehensive pregnancy care. They also support a national system of standardizing pregnancy care behind bars, as well as its oversight. Because no such standards currently exist, the amount and quality of pregnancy care varies greatly across jails.

The researchers say that future studies should focus on collecting pregnancy data from a larger number of jails, and on the longer term impact of jail time on health and family outcomes for people who face incarceration while pregnant.

COMMUNICATION IS KEY TO HELPING PATIENTS WITH CYSTIC FIBROSIS FOLLOW THEIR TREATMENT REGIMENS

Media Contact: Michael E. Newman

Success working as a team almost always depends on the members being able to communicate well with each other. According to a recent multi-institutional study led by researchers at the Johns Hopkins University School of Medicine, nowhere is the need for clear, accurate and easily understood dialogue truer than in the partnership between a health care provider and a person living with a chronic illness such as cystic fibrosis (CF). CF is a genetic disease that causes persistent lung infections and limits the ability to breathe over time.

The findings from the study reported in the Feb. 25, 2020, issue of the journal Patient Education and Counseling, show that differences in perspective between health care providers and people with CF can often lead to the failure to identify “adherence barriers,” issues that get in the way of a person doing the recommended drug and physical therapy necessary to treat the disease.

For most people with CF, adherence to treatment takes approximately two hours a day. Sticking to this demanding regimen can reduce the number of pulmonary complications experienced. However, previous studies found that adherence rates for people with CF are surprisingly low, ranging from 48% to 63%.

“One of the reasons why people with CF find it challenging to follow their treatment plans is that it’s hard to balance doing hours of treatments with maintaining an as-normal-as-possible lifestyle,” says Kristin Riekert, Ph.D., director of The Johns Hopkins Adherence Research Center and senior researcher of the adherence barrier study.

“If people with CF talk and think about their barriers in a very different way than their providers, it could result in miscommunication about what’s really getting in the way of keeping up with the regimen,” adds Cyd Eaton, Ph.D., first author on the study and a postdoctoral fellow at The Johns Hopkins Adherence Research Center.

Riekert says that an example of such miscommunication is how health care providers and patients use and interpret the word “tired.”

“If a person with CF says, ‘I was tired,’ it usually means that he or she is physically exhausted and doesn’t have the energy to do one more thing, including treatments,” Riekert says. “However, the doctor or nurse may assume that ‘being tired’ is psychological — that the person is burnt out from doing therapy day in and day out. If that happens, it’s a missed opportunity to assess and treat debilitating fatigue.”

Daily life also can get in the way of treatments, Eaton says. Providers, she explains,

often assume that their patients need to get on a schedule and stick to it, whereas people with CF see themselves as having a schedule but needing flexibility to enjoy life.

“Imagine it’s Friday night and you’re a teenager with CF who has to do an hour of therapy, but your friends want you to meet them at the movies,” Eaton says. “Do you go out and socialize or stay home to do your treatments?”

The answer to communicating more effectively, the researchers say, is using patient-centered strategies to better understand a patient’s priorities and challenges.

“As one person with CF told me, ‘Am I doing my treatment to live or living to do my treatment?’” Riekert recalls. “Making sure that patients and health care providers are aligned is key to reducing adherence barriers.”

MOLECULAR MARKERS MAY HELP PREDICT RECURRENCE RISK FOR TRIPLE-NEGATIVE BREAST CANCERS

Media Contact: Valerie Mehl

Researchers at the Johns Hopkins Kimmel Cancer Center and six other medical centers have identified a set of molecular markers linked to a chemical process called methylation that may help predict the risk of cancer recurrence within five years for patients with triple-negative breast cancers.

The study confirmed the researchers’ hunch that higher levels of methylation — the addition of a methyl group (three hydrogen atoms bound to a carbon atom) to a DNA molecule — would be associated with earlier recurrence and worse outcomes for patients.

However, the findings did not distinguish specific levels of methylation or specific methylation markers that could be used to personalize patient treatment, says study author Christopher B. Umbricht, M.D., Ph.D., associate professor of surgery, oncology and pathology at the Johns Hopkins University School of Medicine and a member of the Johns Hopkins Kimmel Cancer Center.

In a report of the findings, published in the Jan. 31, 2020, issue of the journal npg Breast Cancer, he noted that the results may support physicians’ decisions to manage patients with less aggressive disease more conservatively and trigger earlier treatment for those with more aggressive disease.

Umbricht and colleagues examined breast cancer tissue from 110 triple-negative breast cancer (TNBC) patients from archival tissue repositories to look for the biological footprints of DNA methylation, an epigenetic process (where chemical compounds are added to genes to regulate their activity) that can chemically silence genes that suppress tumors, and has been well-documented across many types of cancer. They identified a set of such molecular markers in which higher levels of methylation were associated with a greater risk of five-year recurrence of TNBC.

TNBCs represent 15% of all breast cancers, are more aggressive, and have poorer survival rates than other types of breast cancer. Overall, about one-quarter of these cancers recur within five years of localized treatment with surgery or radiation. Physicians currently lack accurate tools to identify which patients are at greatest risk of recurrence.