Black patients have been shown to receive coronary artery calcium scoring (CAC) tests eight times less frequently than white patients. The test reveals whether people at moderate risk for developing heart disease have calcium deposits in their heart arteries and physicians should recommend preventative medications for them, such as statins.

This summer, second-year medical students Brown and Ballenger created a video and questionnaire to help physicians understand and overcome potential barriers Black patients have experienced in obtaining the CAC test. With the help of Dinesh Kalra, chief of cardiology, and other physicians in the , the video and survey were sent to physicians in the UofL Department of Medicine and other UofL providers.

“It reminds physicians about when this preventive test should be ordered, much like screening for blood glucose, cholesterol or cancers. Hopefully after that, we will be able to show that the gap we were seeing in African Americans getting tested less often will be eliminated,” Kalra said.

The survey revealed that the study increased physicians’ confidence in CAC testing and understanding of its role in predicting the risk of future heart attacks. After providers watched the educational video and reviewed guidelines for the test, they reported a greater willingness to order the test and understanding of implicit bias in medicine, which may drive such disparities in health care between Blacks and whites. Kalra’s team hopes to apply these findings in other diseases affected by such disparities, such as heart failure or blood pressure control.

Brown and Ballinger worked on the study as part of the UofL cohort of the national . Winn CIPP offers a six-week summer service-learning experience for medical students who are underrepresented in medicine and committed to a career path that addresses diversity, equity, and inclusion in clinical trial studies.

Brown and Ballinger both have a personal or family history of heart disease, so they understand the need for preventative care delivered through the calcium scoring test. They see this summer’s project as a chance to improve their research skills to benefit their future patients.

“As medical students, we don’t get a lot of instruction on research in our classes,” Brown said. “This program has provided a great opportunity for me to learn as much as I can about research and how to ask questions and how to think and how to analyze data.”

Ballinger believes her experience in Winn CIPP will help her increase trust in research among Black and other underrepresented patients.

“The community aspect of reaching back and providing education and offering education to the community and creating trust in clinical research in general is really important to us moving forward in our career,” Ballinger said.

Seven medical students participated in four mentored projects with , five of whom are UofL students. UofL first hosted the Winn CIPP program in 2023 and is one of nine sites for 2024.

The grants contribute to UofL’s strategic imperative to address health equity and serve as part of The Humana Foundation’s strategy to eliminate unjust and unnecessary barriers in health care.

“UofL continues to appreciate the support of The Humana Foundation in addressing health equity,” President Kim Schatzel said. “Their generous support will enable us to conduct the important work of engaging with communities of color to research the role of nutrition, food quality and diagnostic screening as they relate to heart health.”

“Every day, people face a multitude of choices that can affect their health and quality of life,” said Tiffany Benjamin, CEO of the Humana Foundation. “In too many communities, these choices are limited by factors beyond their control. That is why we are expanding healthy choices for communities and eliminating social and structural barriers, so that more people can reach their full health potential.”

Each of the three-year grants will fund regional nutrition programs. The larger of the two grants is $1,037,000 and will support the DISPARITY Trial (Dietary Intervention for primary and Secondary Prevention And Plaque Regression Investigated with Computed TomographY). The grant will support cardiac disease screening and nutrition-based interventions to address cardiac health disparities among older Black adults in Louisville.

The second grant of $154,000 is earmarked for the H.E.A.R.T. of Louisville Project: Helping Everyone Address Risk Today. The funding will support the identification of members of the Black community in Louisville at-risk for coronary disease and enrollment into long-term nutrition and lifestyle interventions.

“Food insecurity is a major problem that correlates with health care disparities,” said cardiologist Kim Allan Williams Sr., chair of the UofL department of medicine. “Nutrition education and food quality issues plague our African-American community, keeping heart disease as the leading killer of Americans. Our trials will help detect disease in those who are at risk and manage those already diagnosed using lifestyle changes, medication, enhanced access to cardiac care and advanced diagnostic imaging.”

The programs funded by both grants will include efforts to create healthy emotional connections, as a vital part of a holistic approach to care and shaping a healthier approach to nutrition to support lifelong health and wellbeing.

“It is remarkable how our team of pediatric specialists came together with the device company to offer a resolution for such a small patient weighing less than three pounds at the time of implant,” said Soham Dasgupta, pediatric electrophysiologist, Norton Children’s Heart Institute, and UofL assistant professor of pediatric cardiology. “This case is unlike any other and we are so pleased to see this patient thriving as a result of the innovative approach.”

Approximately 1 in 22,000 infants are born with CCAVB. Untreated, the condition has a high incidence of prolonged illness or death. The usual treatment involves implantation of a pacemaker once the patient meets a minimum body size, typically 4.5 to 5.5 pounds, to accommodate the implantable device. Taking time for the baby to grow while being otherwise treated is strongly preferred for this situation. With this patient, however, the traditional plan was not working.

“In this instance, the patient was not of the optimal size and medical/conservative management was unsuccessful, so a specially modified pediatric-sized pacemaker also known as an implantable pulse generator (IPG) created by Medtronic was used,” Dasgupta said.

Dasgupta and his colleague, Christopher L. Johnsrude, director of pediatric and adult congenital electrophysiology at Norton and UofL associate professor of pediatric cardiology, reviewed the relevant preclinical data from a procedure where a similar tiny pediatric IPG had been implanted in an adult Yucatan miniature pig, an animal with a heart that resembles a child’s heart.

Once it was determined the pediatric IPG was potentially compatible with the patient at Norton Children’s, Dasgupta worked with Norton Children’s Research Institute, affiliated with the UofL School of Medicine, and the manufacturer, to obtain local Institutional Review Board approval and emergency authorization from the U.S. Food and Drug Administration. 

The procedure to place the implant was completed over the course of a two-hour open-heart surgery. The tiny device measures 1.16 by 0.65 by 0.38 inches and weighs 0.18 ounces.

“While the operative steps might be comparable to the usual pacemaker implantation surgery, this surgery was especially delicate due to the very small size of the baby,” said Bahaaldin Alsoufi, chief of pediatric cardiothoracic surgery, co-director of Norton Children’s Heart Institute, and UofL professor of cardiothoracic surgery. “This tiny pacemaker generator was positioned in the abdominal wall on the right side and was connected to the usual leads that were attached to the heart.

“This novel device will provide the necessary support that the baby currently needs. At time of repair of the patient’s congenital heart defect in the future, we will be able to utilize these same leads and likely connect them then to a traditional larger pacemaker generator.”

To date, the patient is doing well and continues to be cared for by cardiac and neonatal specialists across Norton Children’s Heart Institute.

As chair, Williams will lead the scientific, clinical and educational programs of the UofL School of Medicine’s largest department, which includes more than 200 faculty and 150 staff in 10 divisions. He will build collaborations within the and with its partners. He also will be responsible for the planning and guidance of clinical efforts within the UofL Health system as well as developing and implementing a vision for the department that integrates clinical, educational and research missions, while fostering a culture of collaboration, equity and inclusion.

“We are excited for Dr. Williams to be joining our team,” said School of Medicine Dean Toni Ganzel. “He brings a wealth of expertise in cardiology and health equity. His academic background, clinical experience and leadership skills will be strong assets to the department, the institution and oudeptr community. His work will enhance and augment our work with strategic partners in health equity.”

A Chicago native, Williams has over 40 years of experience as an educator, researcher, and clinician focused on advocacy for nutrition, national and international health care disparities, health care delivery and advanced access to cardiac imaging. He currently is chief of the Division of Cardiology at Rush University and associate dean for faculty diversity, equity and inclusion. He specializes in cardiology, cardio-nutrition, cardio-rheumatology, cardio-nephrology, preventive cardiology and cardiovascular radiology. A past president of the American College of Cardiology and the American Society of Nuclear Cardiology, he is former chairman of the board of directors of the Association of Black Cardiologists.

He also is the founder of the Urban Cardiology Initiative in Detroit, a program that works to reduce ethnic heart care disparities. Williams continues community-based efforts in Chicago at Rush, including leading the H.E.A.R.T. program (Helping Everyone Assess Risk Today), screening for heart disease and intervening with education, nutrition and lifestyle changes.

Williams earned his medical degree from the University of Chicago Pritzker School of Medicine. He completed his internship and residency at Emory University Department of Medicine and a fellowship in cardiology at the University of Chicago.

“Building and leading Rush cardiology has been challenging and fulfilling, yet I was drawn to the UofL Department of Medicine by the leaders, the faculty and the fundamentals already in place, as well as the potential that I see for growth and impact in the areas of prevention and health equity,” Williams said. “We have leadership with vision, and we have some existing programs that will be enhanced – and some robust opportunities to develop – aiming to expand health care access in Louisville, maintain our high level of clinical quality and patient experience, deliver cost efficient care and keep provider wellness at the forefront.”

“This is a very important advance in the field of cell therapy and in the management of heart failure. It suggests that a treatment, given only once, can produce long-term beneficial effects on the quality of life and prognosis of these patients,” said Roberto Bolli, director of the UofL Institute of Molecular Cardiology, who led the study at UofL. “The results pave the way for a larger, Phase 3 trial of cell therapy in heart failure.”

UofL led enrollment among seven institutions participating in CONCERT-HF, a Phase 2 clinical trial testing the safety, feasibility and efficacy of two types of adult cells, used alone and in combination, in patients with heart failure.

CONCERT-HF evaluated the use of two types of cells – autologous mesenchymal stromal cells (MSCs) and c-kit positive cardiac cells (CPCs) – alone or in combination, in patients with heart failure caused by chronic ischemic cardiomyopathy, a decrease in heart pumping effectiveness due to heart attacks and a lack of blood getting to the heart. Autologous MSCs are derived from the patient’s bone marrow and CPCs are from the patient’s heart tissue. Both are known as “autologous” cells because they come from the same patient in whom they are returned for the treatment.

In the study, patients treated with CPC cells alone had a significant reduction in major adverse cardiac events, particularly hospitalization. Patients treated with MSC cells alone and with a combination of both types of cells experienced significantly improved quality of life compared with patients who received no treatment. Quality of life was assessed using patient responses to the Minnesota Living with Heart Failure Questionnaire, which gauges the degree to which physical, emotional and socioeconomic effects of heart failure adversely affect the patient’s life and the extent to which they prevented the patient from living as they wanted to live.

“The results of this trial show for the first time that cell therapy reduces hospitalization for heart failure and improves clinical outcome, providing a cogent rationale for undertaking a pivotal Phase 3 trial” that could be the next step on the pathway to FDA approval, Bolli said.

The results of the were published in the . The Phase 2, randomized, placebo-controlled trial, funded by NIH National Heart, Lung and Blood Institute, was conducted by the Cardiovascular Cell Therapy Research Network, a network of clinical trial researchers involved in cell therapy for heart disease that includes UofL. UofL led enrollment in the study, accounting for 25% of the 125 trial participants.

Bolli’s expertise and long career in successful cardiac research led to the establishment of the CCTRN center at UofL in 2011. This consortium of leading cardiovascular research organizations includes Stanford University, the University of Miami, Indiana University, the Texas Heart Institute, the University of Florida and the Minneapolis Heart Institute Foundation, in addition to UofL. The School of Public Health at the University of Texas Health Science Center at Houston serves as the data coordinating center.

Bolli is a pioneer in research using adult stem cells for cardiac disease. Over the past two decades, he has shown that CPCs are beneficial in many preclinical models of heart failure, thus paving the way for the CONCERT-HF trial. He also led the recent – the first study to show safety and potential efficacy of cell therapy in cancer survivors with heart failure caused by anticancer therapy.

The project, led by Tamer M.A. Mohamed, assistant professor of medicine in the UofL Division of Cardiovascular Medicine and the UofL Institute of Molecular Cardiology, has received a five-year, $3.8 million grant from the National Heart, Lung and Blood Institute.

“After a patient suffers a heart attack, the heart loses muscle cells, reducing the heart’s ability to pump blood to the rest of the body. Muscle cells in the heart do not regenerate on their own, leaving the heart permanently impaired,” Mohamed said. “We are developing a transient gene therapy approach to regenerate these muscle cells to heal the heart.”

The therapy involves transient overexpression of a combination of four cell-cycle regulating proteins to induce cell division in the heart muscle. The four cell-cycle regulators, cyclin-dependent kinase 1 (CDK1), CDK4, cyclin B1, and cyclin D1, are known collectively as 4F, or four factors. In , the process stimulated cell division in cardiomyocytes, or heart cells, leading to improved heart function.

The new study will determine further the effectiveness and safety of the therapy in animal models as well as in human heart segments using of a developed at UofL by Mohamed that keeps slices of human hearts alive for a longer period of time. The system mimics the environment of a living organ through continuous electrical stimulation and oxygenation, maintaining viability and functionality of the heart segments for six days, allowing more extensive testing. The for use by researchers outside UofL.

In addition to further testing the therapy’s effectiveness, Mohamed and other investigators will focus on approaches for the process that do not lead to tumor development in other cells.

“The challenge comes in avoiding development of cancer in other areas of the body, which appears to be a side effect of the process as seen in mice,” Mohamed said.

If it is successful, the work will lead to the start of in-human clinical trials.

The $500,000 gift to the Division of Cardiovascular Medicine at the UofL School of Medicine establishes the James Ryan Fund for Cardiovascular Biomarker Research. Ryan pledged the gift before he passed away at age 81 in 2018.

“Thanks to Jim, we can help physicians everywhere in diagnosing what is one of the most common causes of death in the world,” DeFilippis said. “He was always interested in others and what their dreams were, their goals in life, their happiness and how he could help.”

The fund will support annual operating expenses for the research led by DeFilippis, who is director of Cardiovascular Disease Prevention and an associate professor in cardiovascular medicine at UofL. DeFilippis is an expert in cardiovascular diseases and cardiac intensive care. His research focuses on cardiovascular risk prediction and the identification of biomarkers that will allow physicians to diagnose the cause of different types of heart attacks, also called myocardial infarction.

A heart attack is death of heart muscle. There are many causes, including the most well-recognized that occurs when one of the heart’s coronary arteries is suddenly blocked or has very slow blood flow secondary to the formation of a blood clot.

Atherosclerotic cardiovascular disease progresses over time, allowing time for screening and early detection. Advances in biomarker research and other developments have led to more sensitive screening methods and a greater emphasis on early detection and diagnosis.

“We’re working to develop biomarkers that will allow clinicians to differentiate among the many different types of heart attacks that can occur,” DeFilippis said. “Not all are the same, and even in the medical community that’s not always given much thought. But if we can differentiate, it will help us better treat patients, allowing us to limit or stop heart damage.”

A biomarker is a biological characteristic that can be measured and evaluated as an indicator of normal biological or pathological processes or a response to a therapeutic intervention. Examples include patterns of gene expression, levels of a particular protein in body fluids or changes in electrical activity in the heart.

Ryan, an active philanthropist and retired insurance executive, suffered from a heart condition himself. A native of Pittsburgh who graduated from UofL and lived most of his life in Louisville, he was on a quest to ensure his estate went to good use. He and DeFilippis forged a friendship through their activities with the American Heart Association. He visited DeFilippis’ lab within the Division of Cardiovascular Medicine several times, even bringing a group of friends.

“He was really involved – he was more than a donor,” DeFilippis said. “He gave advice and offered assistance in business, enabling us to partner with industry to bring our discoveries to market. We really enjoyed his company. The two of us went to lunch several times and talked about lots of things – the lab, his struggles with congestive heart failure and his bucket list. He had a great sense of humor.

“He was an extraordinarily happy man with a deep voice that was very distinctive,” DeFilippis said. “We will certainly miss his presence and his inspiring words about the work we were doing. We take it as a tremendous compliment that he chose to donate to us. Jim was looking for a quality program, great ideas and things that really make sense to improve the health of world.

DeFilippis and one of his colleagues, Patrick Trainor, PhD, recently were invited editorialists for a new study published in the Annals of Internal Medicine that indicates current risk calculators for heart attack and stroke can sometimes be wrong, significantly overestimating some people’s risk while underestimating others’ risk. As a result, many people may be unnecessarily taking medication to control risk factors such as high cholesterol and high blood pressure, and others may not be getting enough treatment. The researchers developed a new risk calculation method with a more sophisticated statistical model and newer population data, suggesting it could be more accurate.

The free clinics will be held in Smoketown starting Feb. 9 and last into the spring and early summer. Participants will learn how healthy their heart is and their risk of heart attack and stroke, and those who need treatment will be given a referral for care. Health insurance is not required.

Inspired by Smoketown’s Muhammad Ali, who trained for boxing in the neighborhood, “Heart of a Champion” is a partnership between the UofL schools of Medicine, Nursing, and Public Health and Information Sciences; the Have a Heart Clinic; UofL Physicians; the UofL Envirome Institute; Surgery on Sunday; the American Heart Association; UofL’s Get Healthy Now; IDEAS xLab; Dare to Care; YouthBuild; Smoketown Family Wellness Center; and several Smoketown-area churches.

“With February being American Heart Month, it’s the perfect time to kick off these screenings,” said Erica Sutton, MD, a general surgeon with UofL Physicians and associate professor at the UofL School of Medicine who will lead the UofL doctors staffing the clinics.

“This is a model for community-engaged care, where we work with partners in the community who are taking care of a population we want to reach. It’s important for us not just to open our office doors to people, but really provide a presence for health and access to care by going out into the community.

“In Smoketown, there’s an abundance of heart disease, and we have the ability to make an impact on risk factors, such as diabetes, obesity and smoking. And screenings are a well-known tool to identify heart disease before the heart is irreversibly damaged. The saying ‘an ounce of prevention is worth a pound of cure’ really rings true here. Not only is prevention or identifying the potential for heart disease easier and more cost effective, but it’s healthier than trying to cure it.”

American Heart Month is a program of the U.S. Department of Health & Human Services’ National Heart, Lung and Blood Institute. The month aims to encourage and motivate everyone to adopt heart healthy behaviors, including screening for risk factors.

Referrals will go to the Have a Heart Clinic and University of Louisville Physicians, and Surgery on Sunday also will be providing services. Sutton also volunteers with Surgery on Sunday.

The clinics will be held at churches and community centers in the Smoketown neighborhood. UofL doctors will staff the clinics, assisted by students and residents from school.

Other UofL faculty involved include cardiologist Andrew DeFilippis, MD, an expert in cardiovascular diseases whose research focuses on cardiovascular risk prediction, and cardiothoracic surgeon Kristen Sell-Dottin, MD.

Clinic dates

No advance registration is required. Dates and locations for the clinics are:

• Bates Memorial Church (620 Lampton St.)
  • Feb. 9 (Saturday) from 10:30 a.m.-1:30 p.m.
  • Feb. 10 (Sunday) from 9:30 a.m. to 2 p.m.
• Smoketown Family Wellness Center (760 S. Hancock St., Suite B100)
  • Feb. 23 (Saturday) from 12 to 2 p.m.
• Coke Memorial United Methodist Church (428 E. Breckinridge St.)
  • June 2 (Sunday) from 1:30 to 3:30 p.m.
• Grace Hope Presbyterian Church (702 E. Breckinridge St.)
  • (TBD)
• Little Flock Missionary Baptist Church (1030 S. Hancock St.)
  • (TBD)
• YouthBuild (800 S. Preston St.)
  • (TBD)

Clinic services

Participants will get screenings for factors that affect heart health, such as blood pressure and cholesterol, body mass, diet, exercise, use of tobacco products and sleep. Arterial ultrasounds also will be available.

A heart health profile will be provided, as well as information on actions to take to reduce the risk of heart attack or stroke.

Those who attend will also be able to participate in short informational sessions on diet (including how to cook healthy foods), exercise (including low-intensity options), better sleep and smoking cessation.

Heart disease prevention

In addition to screenings to learn risk, the likelihood of heart attack and stroke can be reduced by:

• Lowering cholesterol (consider what you eat)
• Burning calories every day (exercise or walk) and strength training (you can use your body to strength train)
• Decreasing stress (meditate or relax)
• Eating a healthy diet, including heart-healthy foods
• Stopping smoking
• Finding a physician

. For questions about the Heart of a Champion program, contact Lora Cornell, senior program coordinator at the UofL School of Medicine, at 502-852-2120.

In this study, the first of its kind, researchers from the University of Louisville investigated the impact of neighborhood greenspaces on individual-level markers of stress and cardiovascular disease risk.

Over five years, blood and urine samples were collected from 408 people of varying ages, ethnicities and socioeconomic levels, then assessed for biomarkers of blood vessel injury and the risk of having cardiovascular disease. The participants were recruited from the and were largely at elevated risk for developing cardiovascular diseases.

The density of the greenspaces near the participants’ residences were measured using the Normalized Difference Vegetation Index (NDVI), a tool that indicates levels of vegetation density created from satellite imagery collected by NASA and USGS. Air pollution levels also were assessed using particulate matter from the EPA and roadway exposure measurements.

Researchers found living in areas with more green vegetation was associated with:

• Lower urinary levels of epinephrine, indicating lower levels of stress;
• Lower urinary levels of F2-isoprostane, indicating better health (less oxidative stress);
• Higher capacity to repair blood vessels.

They also found that associations with epinephrine were stronger among women, study participants not taking beta-blockers – which reduce the heart’s workload and lower blood pressure – and people who had not previously had a heart attack.

“Our study shows that living in a neighborhood dense with trees, bushes and other green vegetation may be good for the health of your heart and blood vessels,” said Aruni Bhatnagar, PhD, lead study author and professor of medicine and director of the UofL and the . “Indeed, increasing the amount of vegetation in a neighborhood may be an unrecognized environmental influence on cardiovascular health and a potentially significant public health intervention.”

The findings were independent of age, sex, ethnicity, smoking status, neighborhood deprivation, use of statin medications and roadway exposure.

Previous studies also have suggested that neighborhood greenspaces are associated with positive effects on overall physical and psychosocial health and well-being, as well as reduced rates of death from cardiovascular and respiratory diseases and improved rates of stroke survival, according to Bhatnagar. However, these reports are largely limited by their reliance on self-reported questionnaires and area-level records and evaluations, Bhatnagar said.

Co-authors of this study are Ray Yeager, Ph.D.; Daniel W. Riggs, M.S.; Natasha DeJarnett, Ph.D.; David J. Tollerud, Ph.D.; Jeffrey Wilson, Ph.D.; Daniel J. Conklin, Ph.D.; Timothy E. O’Toole, Ph.D.; James McCracken, Ph.D.; Pawel Lorkiewicz, Ph.D.; Xie Zhengzhi, Ph.D.; Nagma Zafar, M.D., Ph.D.; Sathya S. Krishnasamy, M.D.; Sanjay Srivastava, Ph.D.; Jordan Finch, M.S.; Rachel J. Keith, Ph.D.; Andrew DeFilippis, M.D.;  Shesh N. Rai, Ph.D. and Gilbert Liu, M.D. Author disclosures are on the manuscript.

The WellPoint Foundation and the National Institute of Environmental Health Sciences of the National Institutes of Health supported the study. View the manuscript .

Brian Holland, MD, has been serving as interim chief since 2017 and practices with . The UofL Board of Trustees approved his appointment in March.

“Dr. Holland relentlessly pursues quality improvement initiatives, research projects and growth opportunities to enhance and improve pediatric cardiovascular services, both in UofL pediatric clinics and at Norton Children’s Hospital,” said UofL Department of Pediatrics Chair Charles Woods, MD.

Holland is board-certified by the American Academy of Pediatrics, American College of Cardiology and American Society of Echocardiography. He joined UofL as a pediatric cardiologist in 2010. In 2015, he became the medical director for echocardiography, which is the use of ultrasound to obtain images of the structure and function of the heart. He also is chief of cardiology at .

Holland specializes in fetal, transthoracic and transesophageal echocardiography. Fetal echocardiography uses ultrasound to find details of heart defects before birth. Transthoracic echocardiography looks through the patient’s chest wall to see the heart, while transesophageal echocardiography uses a device that passes through the mouth into the esophagus to obtain images.

Holland attended the University of Pennsylvania where he graduated summa cum laude with a degree in bioengineering and then received his MD degree from the Medical College of Georgia in Augusta, where he was awarded membership in Alpha Omega Alpha Honor Medical Society.

Following his graduation from medical school, Holland served seven years with the U.S. Army Medical Corps. While in the Medical Corps, he completed an internship and residency in pediatrics at Tripler Army Medical Center in Honolulu and served as a pediatrician in Germany. He also earned the Bronze Star for exceptional service while deployed as a U.S. Army physician during Operation Enduring Freedom in Afghanistan.

After finishing his military service, Holland completed a three-year fellowship in pediatric cardiology at New York-Presbyterian, the training hospitals of Columbia University and Cornell University, before coming to UofL.