Vital Views

Joe Gaccione 0:02
You are listening to Vital Views, podcast for U N L V School of Nursing. I'm Joe Gaccione, communications director for the nursing school. February is American Heart Month, a very timely awareness campaign that ties in with our topic for today. One of the biggest health conversations to kick off 2023 has been heart health among young people. Just in the last month, on the national stage, we saw 24 year old Buffalo Bill Safety Damar Hamlin suffer cardiac arrest during a football game and had to be revived right then and there. Here in Las Vegas, we've seen two high school students suddenly die from separate heart-related conditions. Talking to us more about heart health, particularly in youth, we are joined by UNLV Nursing tenured associate professor and nurse scientist, Dr. Dieu-My Tran. She specializes in cardiovascular risk factors among young adults and college students and creating risk reduction plans to prevent or minimize heart disease mortality and morbidity. Moreover, she has experience in a wide array of other nursing areas, including anatomy and physiology, med-surg telemetry, and nutrition and development. Dr. Tran, thanks for coming in.

Dieu-My Tran 1:06
Yes, thank you for having me.

Joe Gaccione 1:07
We think of young people as almost being impervious to most injuries, that's the, like, the stereotype. But what are, what are some common myths about heart health, particularly when it comes to young people?

Dieu-My Tran 1:18
I think you basically stated what the main issue is in this population, is they don't think they're at risk, or most people don't think they're at risk or need to worry about heart condition. But in actuality, they are at risk and there's a lot of myths that still exist today that has been around forever. And there's a lot, it really depends who you talk to, but some of the commons ones are, for instance, heart disease are old people disease, but in actuality, it’s not. Young adults start to develop these risk factors at a young age, especially nowadays with the lifestyle and the way we are. And so, they are at risk, it's not like “old people disease,” it's just that it gets expressed later in life. We start to develop these risks and accumulate in our arteries, start to form young. And just by the time we're middle age and older adults where arteries have occluded a certain percent, that's when we see heart disease and that's when it's expressed later in life. And so, we associate that with older people’s disease, but really it's just, it starts to develop and accumulate. We just need to be careful about that. Another one would be if I have family history of heart disease, so there's nothing I can do about it. And I think this is a dangerous belief to have because when you have this belief, you have this passive notion to your heart health and don't do much for yourself because, “I have it, there's nothing I can do.” If they change their attitude and perspective and make it so that way, “I have these risks, I need to do everything I could to avoid or delay these risk factors,” now that's the better attitude. But unfortunately, I see more of the other spectrum where they have an excuse to cling on and not do anything about it, and that's the unfortunate thing about that myth. Another one would be heart diseases are a men disease when in actuality it's both. Cardiovascular disease is the leading cause of both men and women, and it's just their timeline is different. Young adults, male, show more prevalence to heart disease because women have a protective factor. But once that protective factor goes away, women catch up to that. So it's both in men and women, not just what is portrayed in the media. And the other one I think it's important to talk about is that how we look outside doesn't dictate our health inside. And so, some of the cases you mentioned, you wouldn't assume these individuals would have heart risk or heart condition because they look very healthy, they're not overweight by any means, so you don't assume that they have heart condition. But, we need to do blood work and assess them to know if they're at risk or not and sometimes that's missed just because of how one looked from the outside.

Joe Gaccione 4:08
In the intro, we talked about your development of risk prevention programs. Can you talk a little bit about that?

Dieu-My Tran 4:12
Yes. So I start my interest in the research that I do now because it's, at the time, my family, I have three brothers and they look very healthy, they're young adults, they're not overweight by any means, but they have a lot of blood work that were abnormal. And so, that got me into the study areas that I, I do now. So, my research area is in cardiovascular risk factor in young adults / college students. And so, before I do that, I basically conduct studies to determine, “Are these populations at risk for cardiovascular disease?” And unfortunately, they are at risk for cardiovascular disease. My study shows that they're at risk and as well as other studies, like the big study, the Framingham study that has been conducted for years and years. And my study shows that young adults are at risk of cardiovascular disease and the two prevalence, the most prevalent risk factors are hypertension and obesity. And so, my research mainly focused on the hypertension aspect because we have been focusing on weight and diet for a while. So, I took the direction of, of taking on blood pressure, so I developed an intervention called MOBILE intervention and it's basically abbreviated for mHealth to Optimize Blood Pressure Improvement. In this intervention, I basically focused on motivation because there's a lot of behavior intervention out there that have moderate successful rate. But my focus is on motivation because we all know we feel differently on a daily basis. There are days where we feel very motivated that we wanna do everything we could to improve ourself or for ourself, and there are days we just, that it just doesn't feel the same, where you have a bad news or you're exhausted from work, well, you don't wanna do much. And so, this intervention focused on that motivational level on a daily basis. So I assessed my participants that day, “What are their motivation levels?” Now, if their motivation levels are high, like a five, then I sent encouraging messages that correspond to that level versus if their motivation is low, then I sent something that doesn't require a lot of work, that's easy to do. And this, the idea is so that way, it increases their chances of completing the task and adopting that long, lifelong healthy behavior as a routine. This increases their success of completing it. And so, I did this for a month and my pilot study demonstrated that the intervention group, the group that we did this on a daily basis, have significant reduction in blood pressure compared to the group that we don't have this interaction with, the group where you will consider, you just give them the knowledge and they go home and, and pick up their lifestyle changes by themself. And so, that's a very positive thing to have even though it's a short timeframe, it demonstrated the initial efficacy, which is very good to have. So right now, I'm currently seeking external funding to help determine if this method, this intervention can be sustained and can have a long-term impact in this population.

Joe Gaccione 7:20
When we talk about motivation, it kind of ties into the first question about taking care of yourself and thinking, assuming that, “I don't need to seek help because I'm either one thing or the other, and I don't have to worry about my heart or my body,” the motivation to go get a screening, to go get some type of checkup. I know in at least one of these high school student stories locally, it was a rare condition. I don't know what that would have manifested itself as physically, maybe even internally, but how difficult is it for, for a nurse, a cardiologist, or other provider to identify potential risks, especially if someone doesn't come in motivated to get a screening?

Dieu-My Tran 8:01
Yes, I, I think that's, that's the challenge. So, it's easy and it's hard at the same time. The easy part is that we do have risk assessment available out there that we can do. We have blood work that we can do. We can check their cholesterol level, we can check their blood pressure, we can check their height and weight. We can check their lifestyle, smoking, alcohol intake, so forth to help us determine where their risk factors are and help monitor them. But the challenging part of this population is that it's hard to get them in the door. And without them or seeing them, we won't be able to do and use all the tools we've been studying and developing. Even my main research is in college students and we have a health center here. A majority of the college students don't even utilize that. It's mostly free for them and they don't even use that, not to mention out there where they have a healthcare provider and somebody that they should go and have a physical examination every year. So, I think the challenge really is catching this population first and foremost, is they don't think they're at risk, and second, it's just not commonly practiced among them to go and see a healthcare provider frequently on, or on a routine kind of basis. And so, we miss a lot of this opportunity. So, it's shocking to see some of the cases come out, but it makes sense, right, because they don't go see a healthcare provider. Therefore, how could you know if you are at risk or you have a disease or any, any health condition that you may have? And so, it's a missed opportunity, I would think, for this population.

Joe Gaccione 9:34
If you had a rare heart condition, are there ways to, to notice the signs of that? I mean, I'm sure there are different types, so it might vary, but are there general red flags? If it's something that's not obvious, would you be able to notice it right away?

Dieu-My Tran 9:48
I think that's hard, especially if it's a rare condition because on a daily basis we have things that come up where we question, “Is this normal? Should I think anything about this?” And so, a lot of the time we kind of brush things off. And so, rare conditions, or conditions that you're not aware of or to look for, I think it's really hard. Maybe yourself, if you see a pattern where, “This feels odd,” for example, sometime you have a headache and this one feels different than the previous ones that you have, then maybe that can alert you a little bit. But without that, that awareness of oneself, it's very hard to do so, unless if you were monitored when you're young, where a physician or MD or clinician detected that there's potentially some defect or something is wrong with your heart, then maybe they can continually monitor it, then there's that chance, but without knowing that early, it's hard for anybody to kind of link a lot of those stuff to a specific condition. I know we use Google a lot to say sign/symptom, but they're not specific enough to pinpoint to one thing. I think there's a balance between, “When do I go to the doctor and when I do not,” and so if once we know that, “It's just different, it feels different this time,” than that, I think that's probably the opportunity right there to catch something. But beyond that, it's, the unfortunate thing will happen when we're not aware enough.

Joe Gaccione 11:20
Let's say the patient does come in, they do get a screening, they do get a checkup, and as a nurse, you notice something's gonna have to be done, maybe not an immediate risk, but as far as the lifestyle changes. How do you approach those conversations, especially for younger patients with parents and you have to almost like, breaking the news to them, so to speak, that, without getting too personal, like you're not trying to insult them, but you're also trying to tell them, “This needs to be addressed.”?

Dieu-My Tran 11:47
Yes, well, for me, the good news is that the news I give them are not horrible news. It's, it's something that can be done, and so that's the good news. It's not as if I'm giving you a, you know, “This is your stage four cancer.” Mine is lifestyle, and so usually if I share what I do and what my research are, patients or family are very interested. Believe it or not, majority of them are very interested in lifestyle changes. It's just they don't have the tool set to make that happen. They don't have the time, the means, and the knowledge to do it, and that doesn't mean that they don't have, they don't know anything, it's just that the knowledge to make it happen, it's more complex than what we make it sound. For example, we always say, “Eat healthier,” or “Do more physical activity,” but what does that mean? It's, it's so complex that a 30 minute or one time visit is really not enough because diet is so complex now. It has to depend on what you eat currently and how much you eat of it and everybody's diet is so different that it's hard to just give a generalized one. But when we individualize diet and physical activities, you can't do that to a mass production, if that makes sense. And so, for this population at least, we start with sharing the basic knowledge because sometimes they don't have all the information they have to make those changes. And so, I think that's why my intervention that I developed has found some significances because we give them the basic stuff first. And I know knowledge doesn't change or doesn't translate to behavior changes, but it's the foundation because without it, you can't do the other pieces. And so, I share as much as I could and then I refer them if I need to.

Joe Gaccione 13:33
I think you hit the nail on the head as far as how complicated a diet can be, nutrition can be, but also big picture and going back to your intervention, the motivation to get this done. As adults, we could think, “Oh, now we have to do, I have to do this thing? Now I have to change how I'm living.” You talked about time, “Now I have to take time out of my day,” and on the surface, it feels like, “I don't have time to do this. Now I have to go to the grocery store and spend more time looking at the foods versus in a pinch, I need to, need to go to a drive-through or something,” like, there's, there's so, there are so many factors and not, not, not to mention nowadays, you talked about Google before, it made me think, now with social media and all these different platforms, you're almost getting health advice sometimes from other sources. And you think, “Oh, I'm gonna base my lifestyle on that because that person said that they're an expert and I saw this recipe and it looked good, and that's supposed to be good for my heart,” you know, hypothetically. It's just, there's so many things coming at you.

Dieu-My Tran 14:33
Exactly. Yeah, and it's, it will continue to be that way and I think we still, as researchers and as clinicians, we’re still trying to find the right balance of, “How do we help them?” as well as maintain a healthy lifestyle for the general public as well. For this population, the reason I, I go into this population of young adults is because if you think about children, you have to intervene with the parents. And if you look at older individuals, middle-aged and older adults, they kind of have a routine that's set already. Not to say that they can't make changes, it's just harder for them to make changes versus young adults / college students, they're in this discovery mode where they start to know what they like, what they do, and establish a lifestyle for themselves. And then once, if they adopt a healthier lifestyle, they carry that on once they develop and have established a family and carry on to their kids. So, I think this is such a critical population to look into that we oftentimes neglect because we think they're fairly healthy in general.

Joe Gaccione 15:38
Your work in heart health goes beyond academics. You're also president of the American Heart Association, the Las Vegas Chapter’s Board of Directors. Can you talk about what that role entails and how you build awareness in our community?

Dieu-My Tran 15:50
Yes, so I work in partnership with the board chair and the executive director to provide the overall direction for the division on advancing the health of the community. I'm also the champion of health equity and recognizing the needs of the diverse community that we have. My responsibilities include leadership where I serve as a volunteer mission impact leader of the division, and I'm also the official spokesperson for, on science, medical, and health and public policy matters. I'm also part of the management because I know the key volunteers and staff role in the divisions. I also motivate and engage former, current, and future volunteer leaders, and also I provide strategic leadership and accomplishment of health priorities and goals in their vision. Basically, I work directly with the American Heart Association staff and other members of the board to build awareness in the community. I work closely with Angela Baker, she's our community impact director. She provides community impact updates regularly and we collaborate on focus areas for the time being. Some of the focus areas we currently work on are equity, cardiovascular disease, reduce the risk in women, the COVID response and research, tobacco and vaping by eliminating nicotine use. Some of the other things that we work on long-term are chronic diseases, how to reduce those risks, such as heart attack and stroke, and basically living healthier and a mental resilience and wellbeing. So one of the examples are, for instance, we are, in the literature, we know that smoking is bad for us.
There's plenty of literature on it, the chemical that's in it. So, we have been good with how to reduce and, and stop smoking, but the new thing out there is vaping now. And before, if you think about smoking, there's the taste and the smell that not a lot of people can be on board to, but with the new vaping, it comes out with different flavors, it looks cool, so it targets the younger population now. And so, it's a problem we're currently facing now, and so that's one of the things we are currently working on. We go to different schools to talk to the youth and then we try to bring more awareness to this population. One of the things we did just recently is that we partner with the School of Public Health at UNLV to work on a smoke-free policy, and it just currently got implemented a few months ago and I thought that was, that was, that was great. It's a start, and that's what we do. We depend on the community needs and then we address it and work with the right partner to get it done.

Joe Gaccione 18:39
On the subject of community, one narrative that's come from these recent cases that we mentioned in the intro is an increased interest in CPR courses, basic life support courses. Where can people go to find more information out about this? I'm sure the American Heart Association has resources on their website.

Dieu-My Tran 18:58
Yes, the American Heart Association is the, is the leading on, on this. Even if you found individuals, businesses that, that teach CPR it directly, the information and the license, the certification, come from the American Heart Association. The American Heart Association has multiple resources, that would be my go-to as well, and it branch off from there. So that would be the go-to.

Joe Gaccione 19:23
And we will have links to the AHA website on this episode page when it drops. That is all the time we have. Dr. Tran, thank you for coming in.

Dieu-My Tran 19:29
Thank you for having me.

Joe Gaccione 19:30
Thanks for listening out there, hope you have a great day.