The Number One Way to Reduce Heart Risk

Can You Mend a Broken Heart Through the Arts?

The Number One Way to Reduce Heart Risk | Johns Hopkins Medicine

Music, painting, writing and other arts enrich our lives in so many ways. But they’re not only good for the soul; they can also enhance physical well-being, including heart health, and may even lower our risk of developing certain types of heart disease.

These heart-healthy benefits start with a calming influence. Whether we create art or simply enjoy it, the experience can reduce stress, lower blood pressure and bring heart palpitations under control.

Reduction of stress is especially important since “acute or chronic stress can increase the risk for cardiovascular disease,” according to Harlan Krumholz, M.D., on the Bottom Line Inc website. Dr.

Krumholz is a professor at Yale University School of Medicine and member of the board of directors of the Foundation for Art & Healing, an organization that studies the connection between creative expression and healing. He suggests that creative activities may provide an antidote to stress.

“If stress is bad for you,” Dr. Krumholz says, “then creative pursuits are the opposite—creative pursuits allow people to find their ‘flow state,’ a mental state in which they are so fully involved in an activity that they become unaware of passing time.”

Music Does a Heart Good

Anyone who has had a massage at a health spa knows how the hypnotic tones of a New Age soundtrack can relax you. The right music can also provide therapeutic benefits for people who have had serious heart problems.

A review of eleven studies found that music therapy significantly reduces systolic blood pressure, diastolic blood pressure and heart rate in a number of clinical settings.

In one assessment of hospitalized patients who had recently suffered a heart attack, a group listening to relaxing music along with receiving standard care experienced significant reductions in heart rate, respiration rate and their hearts’ demand for oxygen compared to patients receiving standard care only. This difference was seen after just twenty minutes of listening and continued for one hour after the music was over.

Other research has isolated the benefits of music to the heart on a chemical level.

After critically ill patients listened to slow movements of Mozart sonatas in a hospital setting, blood tests revealed increases in growth hormone and decreases in interleukin-6 (a protein that cause inflammation).

These may indicate positive changes for cardiac health, since high levels of interleukin-6 are associated with congestive heart failure and growth hormone has been shown to normalize these levels.

Creative Expression Gets to the HeART of the Matter

Some investigations have explored how creative arts therapies affect levels of cortisol, a stress hormone that strains the heart when chronically elevated.

Investigators at Drexel University  instructed a group of healthy adults to make art using collage materials, modeling clay and/or markers.

Salivary cortisol levels were reduced significantly in 75% of the participants after 45 minutes of art making. Amount of art experience did not affect the results.

Art activities have also been shown to improve heart rate variability (HRV), an important measure of heart health. The HRV index is a marker for how well we can adapt to changes both in our brain activity and the environment around us, and a consistently low HRV increases the risk of developing future heart disease.

Some research indicates that artistic expression with certain forms of media may elevate HRV to a heart-healthier level. One study, for example, found that participants using oil-based pastels experienced a greater positive effect on HRV compared to those engaged in gouache painting and pencil drawing.

This may be due to the more tactile experience of using oil-based pastels, which allows a lot of freedom of expression as well as a sense of control.

Write Two Pages and Call Me in the Morning

Extensive research shows that writing about one’s emotions can reduce stress hormones and blood pressure.

In one study of 156 patients who had recently experienced a myocardial infarction, one group was instructed to write about their thoughts and feelings related to their cardiac event, while a control group was told to write in a neutral way about daily activities.

Five months after study completion, the experimental group reported significantly greater attendance at rehabilitation sessions, fewer cardiac-related symptoms and lower diastolic blood pressure. These findings demonstrate the importance of expressing one’s emotions, even on paper, when going through a life-threatening event.

Nature: Setting the Scene for Better Heart Health

Landmark research by environmental psychologist Roger Ulrich in the 1980s showed that looking at a garden may accelerate healing after surgery. In a later study of patients in the ICU of a Swedish hospital, Dr. Ulrich narrowed his subject group to those recovering from heart surgery.

Those who viewed large nature photographs of an open, tree-lined stream had less anxiety and needed less pain medicine than those looking at a darker forest photograph, abstract art or no pictures at all. The evidence on the value of nature to heart health overall has “grown” dramatically since.

We now know, for example, that viewing a garden for only three to five minutes results can reduce blood pressure and muscle tension in healthy viewers.

Closing the Gap between ART and HeART

Many healthcare institutions and other organizations nationwide have embraced art programs.

The University of Florida, for example, has a general arts in medicine program that addresses applications of music, painting, dance, theater, and other art forms in healing practice.

For the younger set, Hip Hop Public Health promotes cardiovascular fitness and better eating habits with interactive hip hop songs, videos and games.

Across the northern border, a new Canadian initiative will enable doctors to give patients free access to local museums so they can immerse themselves in serenity-fostering creative works.

Meanwhile, across the pond, a new program for doctors in Scotland’s Shetland Islands promotes the use of “Nature Prescriptions” that encompass everything from going outside to ponder a cloud to writing one’s worries on a stone and tossing it into the sea.

A primary goal of this initiative: reducing the risk of heart disease.

While the “vital signs” for creative arts therapies look good, we need more rigorous, controlled studies to determine more specific applications of the arts as preventive and complementary therapies for heart disease. The beat goes on as we explore the possibilities of arts-based interventions to improve mind, body and spirit.

Written and reported by IAM Lab Contributor Ed Decker.  Ed Decker is a freelance neuroscience writer and former Science/Health Editor at Rewire Me, a wellness website.

Art Art Therapy Medicine


I thought my heart attack risk was low. A coronary calcium scan told me otherwise

The Number One Way to Reduce Heart Risk | Johns Hopkins Medicine

“Thin on the outside, fat on the inside.” That’s what my cardiologist called me, and I sure didn’t it — or its abbreviation, TOFI, which sounds a cross between tofu and toffee.

But the moniker wasn’t the problem. A heart scan had revealed I had too much coronary calcium — plaque — in my blood vessels. With a score of 172, I was at “moderate to high” risk for a heart attack.

This was in 2007, just before I turned 50. As my 40s waned, my total cholesterol, measured in a blood test, had begun to inch up. My triglycerides also had increased.My primary care physician wasn’t concerned. “You really fall into the gray area,” she told me. “We could go either way when it comes to starting you on a [cholesterol-lowering] statin.”

And, too many heart attacks continue to occur in people considered low or intermediate risk because the traditional risk models aren’t great at predicting heart attacks. Coronary calcium scoring is proving to be a game-changer in determining an individual’s risk.

For me, learning my calcium score, by having a heart scan, proved fortuitous.

Using the traditional risk factors, I had about a 2 percent risk of having a heart attack when I was 50; when my calcium score was added into the mix, my risk jumped more than fourfold, to nearly 9 percent. That made me pay attention in a new way. (To determine your own risk, use the National Institutes of Health calculator: )

I had it at the urging of my cardiologist, Arthur Agatston, who created the “Agatston score,” a formula that measures a person’s amount of coronary artery calcification.

He developed the score in the 1980s after seeing the correlation in his patients between high amounts of plaque and the incidence of heart attack.

The score, reported in the Journal of the American College of Cardiology in 1990, is now widely accepted as one of the most significant preventive cardiology tools.

“This test is a better predictor than all the risk factors or calculations from various risk factors because it [shows] the actual disease,” Agatston explained when he urged me to have the test done.

I was curious, but not worried. My labs were decent and neither my parents nor my siblings had heart disease. Yes, my grandfather, Arthur Straus, dropped dead from a heart attack, but he was 82, and that was back in 1962. I considered him a distant relative.

I paid $99 for the test, which is not covered by most insurance plans, mine included. According to the Johns Hopkins Medicine website, “Because this test is relatively new, it’s not part of standard guidelines for heart screenings — and not all insurance plans cover it.”

But it’s apt to be used more in the future, especially since the American College of Cardiology and the American Heart Association added coronary calcium scores in its 2018 guidelines for cholesterol management. (But the U.S.

Preventive Services Task Force, an independent panel of medical experts that evaluates the effectiveness of clinical tests, has said the current evidence is “insufficient”to add it to traditional risk assessment tools for asymptomatic people.)

The Cleveland Clinic, among most other major U.S.

medical centers, recommends heart scans to patients with a family or personal history of coronary artery disease; men over 45, women over 55; past or present smokers; and those with a history of high cholesterol, diabetes or high blood pressure. I am generally wary of tests marketed direct to consumers, which is why it’s important to do your homework ahead of time.

The test itself is a noninvasive CT scan that took about 1o minutes. It was easy: no fasting or injection of contrast. The amount of radiation is about the same as a mammogram or a chest X-ray. It can certainly pay to price-shop around: some places near me in central North Carolina were charging almost $800.

A day after I had the scan, Agatston called me with the unsettling results. My score — that 172 — “is associated with a relatively high risk of heart attack or other heart disease over the next three to five years,” according to the Mayo Clinic site.

Thus began my crash course in cardiology. I am (and was) height and weight proportionate, had a little belly fat, and my total cholesterol numbers did not ring any alarm bells. But those high calcium deposits lit up my scan a Christmas tree. That’s why Agatston called me “Thin on the outside, fat on the inside.”

Over the years, I’ve come to know others — overweight with much bigger bellies — who scored zero. What about them? I asked the doctor. “Fat but fit,” he explained.

Then he dropped a public health bomb: “Your total cholesterol level is essentially worthless for predicting a future heart attack. Forget your cholesterol level, know your calcium score.” If I didn’t start treatment and change my diet and exercise patterns, Agatston made clear that I was at serious risk of having that “major adverse coronary event” in the next 10 years.

I was “persuaded” and started taking the statin Lipitor, plus a baby aspirin.

Agatston also put me on a ­moderate-protein, high-fat, ­low-carbohydrate eating plan — and challenged me to start high-intensity interval training, an exercise strategy of alternating short periods of intense activity with less intense recovery time until exhaustion. Studies show this can help reduce belly fat, or what is know as visceral fat, that can be particularly bad for one’s health.

Stephen Kopecky, a cardiologist at the Mayo Clinic who focuses on cardiovascular disease prevention, says, “If calcium is seen, especially if a higher calcium score [greater than 100], then the patient would benefit from lifestyle change, including the anti-inflammatory Mediterranean diet, regular physical activity . . . and possibly initiation of a statin.”

Kopecky says “a heart scan for coronary calcium can help motivate patients to change their lifestyle. Studies have shown that when a patient sees calcium in their own coronary arteries on the scan, they are more ly to comply with therapy and change habits.”

I know I upped my game — both in diet and fitness — after learning my score.

It’s been more than 10 years since that life-preserving heart scan.

Now, thanks to the statin and lifestyle changes, I have excellent blood chemistry, with low LDL (the bad cholesterol), low triglyceride levels and high HDL (the good one). I’ve lost some weight, which translates into less belly fat, although I’m still considered TOFI.

But here’s the real deal. Learning that I had significant coronary calcium all those years ago gave me “a long window of opportunity,” as Agatston put it, to understand my risk and to decide how aggressively to be treated. The devil is in the data: My 8.5 percent chance of having a heart attack was the wake-up call I needed not to become one of those fatal heart attack statistics.

An ageless question: When is someone ‘old’?

Is the hype about CBD real?

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Fish Oil Drug May Prevent Heart Attack and Strokes in High-Risk Patients

The Number One Way to Reduce Heart Risk | Johns Hopkins Medicine
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Cardiologists may one day have a new tool to help prevent heart attacks and strokes in some high-risk patients: a prescription drug that contains large doses of EPA, an omega-3 fatty acid contained in fish oil.

A large clinical trial found that the drug, called Vascepa, sharply reduced the rate of cardiovascular events in people with a history of heart disease or Type 2 diabetes, according to early results that were announced on Monday.

The findings were particularly relevant for people with high triglycerides, a type of fat in the blood that has been linked to an increased risk of heart disease.

The new trial, called Reduce-IT, focused on people whose cholesterol levels were well controlled with statins but whose triglyceride levels remained very high.

Many cardiovascular experts were doubtful that adding fish oil on top of statins would produce much if any benefit because a number of smaller and less rigorous studies over the years had failed.

But the new trial showed that statin-treated adults with elevated triglycerides who were prescribed high doses of the purified EPA had a 25 percent reduction in their relative risk of heart attacks, strokes and other cardiac events compared to a control group of patients who received placebo.

“I’m very surprised by the magnitude of the results, which quite frankly are large,” said Dr. Michael J. Blaha, the director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medical School, who was not involved in the study. “My expectations were very low. A lot of people are legitimately surprised by this.”

Fish oil has long been a popular supplement to protect against heart disease. It contains high levels of omega-3 fatty acids, primarily EPA and DHA, which reduce inflammation and lower triglyceride levels. Omega-3 fatty acids also have blood-thinning effects similar to those of aspirin.

But until now most of the clinical trials that have looked at fish oil in heart patients had not found convincing evidence that it helps.

Some argued that the trials were deeply flawed, saying they relied on doses that were too small or that they failed to recruit the patients who were most ly to benefit, those with high triglycerides.

Some of the studies were observational, which are less rigorous than clinical trials, in which different groups of patients receive different treatments. They also used various types of fish oil.

The new trial differed from previous ones in a number of ways. It focused specifically on two groups of high-risk patients: People with a history of cardiovascular events, such as heart attacks, strokes and angina; and those with Type 2 diabetes and other risk factors high blood pressure.

The patients also had to have high triglycerides. The median baseline level of triglycerides among the subjects was 216 milligrams per deciliter — well above the cutoff for what is considered a normal level, which is 150 milligrams per deciliter.

In addition, all of the patients were on statins, which lower cholesterol.

The intervention in this trial, which was sponsored by Amarin, was not the typical fish oil supplement that can be purchased at any supermarket or pharmacy. Vascepa is a prescription drug that contains highly purified EPA.

Fish oil supplements, on the other hand, often contain a mixture of both EPA and DHA and in some cases other oils as well. EPA and DHA are similar but have slightly different effects.

Both can lower triglycerides, for example, but DHA also tends to raise LDL cholesterol, the so-called bad kind associated with heart disease.

The trial enrolled 8,179 adults and followed them on average for about five years. In addition to lowering cardiovascular events, the trial found that Vascepa was safe and well tolerated. Amarin announced the findings on Monday and is expected to present the full results and data at an annual American Heart Association conference in November.

Dr. Ethan Weiss, a cardiologist and associate professor at the University of California, San Francisco, who was not involved in the study, said that the findings confirm the role that high triglycerides play in heart disease but that they nonetheless came as a shock because so many earlier trials of fish oil found little or no benefits.

He pointed to several caveats: He and others need to see all of the data, and the patient population that is ly to benefit from Vascepa is very specific.

Diet and exercise can also lower triglycerides — especially very low carbohydrate diets — and whether the outcome on heart risk might be similar to the effect produced by Vascepa should be studied, he said.

“Lots of questions remain,” he said. “But the takeaway is that this is really big and I was wrong. And I am happy I was wrong and am excited we have a new pathway and set of tools to explore for our patients.”

Some experts cautioned that Vascepa is not for everyone who has heart disease or risk factors for it. The drug is currently approved for certain patients with unusually high triglyceride levels.

“The worried well shouldn’t run out and take fish oil,” said Dr. Michael Shapiro, a site investigator for the Reduce-IT trial and the director of Oregon Health and Science University’s Atherosclerosis Imaging Program. But the group that is ly to benefit includes a large proportion of patients in heart clinics.

“The amount of people around the world who have atherosclerotic disease or diabetes who take a statin and still have elevated triglycerides is enormous,” he said. “This has huge implications.”

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Heart attack prevention lags for people with stroke, peripheral artery disease

The Number One Way to Reduce Heart Risk | Johns Hopkins Medicine

DALLAS, May 16, 2020 — Although several artery-clogging diseases increase the risk of heart attack, prevention efforts are unequal, according to research presented today at the American Heart Association's Quality of Care & Outcomes Research Scientific Sessions 2020. The virtual conference, May 15-16, is a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, health care professionals and policymakers.

Researchers found that patients with peripheral artery disease or stroke were less ly than those with coronary artery disease to receive recommended treatments to prevent heart attack. All three are types of atherosclerotic cardiovascular disease.

2016 AHA/ACC guidelines recommend aspirin for patients with symptomatic peripheral artery disease to prevent major adverse cardiovascular events, while 2018 guidelines from multiple organizations note that statin therapy reduces the risk of atherosclerotic events.

Worldwide, cardiovascular disease is the leading cause of death and a major contributor to cardiovascular disease is atherosclerosis, which occurs when cholesterol, fat and inflammatory cells build up and form plaque that blocks the arteries and impedes blood flow.

Depending on the location of the blockage, atherosclerosis increases the risk for three serious conditions: coronary artery disease, stroke and peripheral artery disease.

Coronary artery disease results from damaged heart arteries and can cause a heart attack. A common type of stroke occurs when clogged arteries block blood flow to brain.

Peripheral artery disease results from damaged arteries in the extremities, often the legs, and can lead to pain during walking and, in severe cases, amputation.

“Our study highlights the need for public health campaigns to direct equal attention to all three major forms of atherosclerotic cardiovascular disease,” said senior study author Erin Michos, M.D., M.H.S.

, associate professor of medicine at the Ciccarone Center for the Prevention of Cardiovascular Disease at The Johns Hopkins University School of Medicine in Baltimore.

“We need to generate awareness among both clinicians and patients that all of these diseases should be treated with aggressive secondary preventive medications, including aspirin and statins, regardless of whether people have heart disease or not.”

Since atherosclerosis can affect arteries in more than one part of the body, medical guidelines are to treat coronary artery disease, stroke and peripheral artery disease similarly with lifestyle changes and medication, including statins to lower cholesterol levels and aspirin to prevent blood clots.

Lifestyle changes include eating a healthy diet, being physically active, quitting smoking, controlling high cholesterol, controlling high blood pressure, treating high blood sugar and losing weight.

What was unclear was if people with stroke and peripheral artery disease received the same treatments prescribed for those with coronary artery disease.

This study compared more than 14,000 U.S. adults enrolled in the 2006-2015 Medical Expenditure Panel Survey, a national survey of patient-reported health outcomes and conditions, and health care use and expenses.

Slightly more than half of the patients were men, the average age was 65, and all had either coronary artery disease, stroke or peripheral artery disease. These individuals were representative of nearly 16 million U.S.

adults living with one of the three forms of atherosclerotic cardiovascular disease.

Compared to participants with coronary artery disease:

participants with peripheral artery disease were twice more ly to report no statin use and three times more ly to report no aspirin use;

additionally, people with peripheral artery disease had the highest, annual, total out-of-pocket expenditures among the three atherosclerotic conditions;

participants with stroke were more than twice as ly to report no statin or aspirin use; and

moreover, those with stroke were more ly to report poor patient-provider communication, poor health care satisfaction and more emergency room visits.

“Our study highlights a missed opportunity for implementing life-saving preventive medications among these high-risk individuals,” Michos said. “Peripheral artery disease and stroke should generally be treated with the same secondary prevention medications as coronary artery disease.”

Limitations of the study include that it relied on medical diagnosis codes in health records, which could have been incorrectly coded, and did not include health information about people who live in nursing homes or who are incarcerated. Also, the study did not include information about medication changes over time or why people were not taking the recommended medication.


JOHNS HOPKINS MEDICINE: Sex Hormone Levels Alter Heart Disease Risk in Older Women

The Number One Way to Reduce Heart Risk | Johns Hopkins Medicine

Source: Johns Hopkins Medicine

Johns Hopkins Medicine issued the following announcement on May 29.

In an analysis of data collected from more than 2,800 women after menopause, Johns Hopkins researchers report new evidence that a higher proportion of male to female sex hormones was associated with a significant increased relative cardiovascular disease risk.

The researchers caution that theirs was an observational study that wasn’t designed or able to show or prove cause and effect. But they say the study, described online May 28 in the Journal of the American College of Cardiology, suggests that having a more male- hormone profile seems to increase the risk of heart disease and strokes in postmenopausal women independent of other risk factors.

“A woman’s sex hormone levels and ratios of them isn’t something that physicians regularly check,” says Erin Michos, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine and member of the Ciccarone Center for the Prevention of Cardiovascular Disease.

“Because an imbalance in the proportion of testosterone (the main male sex hormone) to estrogen (the main female sex hormone) may affect heart disease risk, physicians may want to think about adding hormone tests to the toolbox of screenable risk factors, blood pressure or cholesterol, to identify women who may be at higher risk of heart or vascular disease. But this needs further study.”

Decades of research have shown that, prior to menopause, women have lower heart disease rates than men, and because estrogen levels drop sharply after menopause, physicians once thought that replacing estrogen would reduce cardiovascular disease risk. That idea was essentially upended when results of a landmark women’s health study reported in 2002 showed that replacement female hormones weren’t necessarily protective and could possibly raise the risk of strokes, blood clots and heart disease.

Some experts have suggested that those results may have been skewed or exaggerated by the use of older forms of hormone therapy and the fact that it was given many years after menopause in the trials.

Additionally, researchers had not focused on the body’s natural levels and ratios of sex hormones as an index of risk in their own right.

The estrogen used in the most common hormone therapy preparation is in a different chemical form than that of the body’s natural premenopausal estrogen, estradiol.

For the new study, the researchers looked at data from 2,834 postmenopausal women who had participated in the federally funded Multi-Ethnic Study of Atherosclerosis (MESA). Participants were an average age of 65 at the start of the study, and 38 percent white, 28 percent African-American, 22 percent Hispanic and 12 percent Chinese-American.

At an initial visit that took place between 2000 and 2002, researchers took blood samples and measured levels of testosterone and estradiol.

Over 12 years of follow up, the women had 283 instances of cardiovascular disease, including 171 instances of coronary heart disease and heart attacks, 88 strokes and 103 instances of heart failure as determined by medical records, hospitalizations, telephone interviews and death certificates.a

Among the postmenopausal women in this study who were all free of cardiovascular disease at the beginning, almost 5 percent developed new cardiovascular disease within 5 years.

When the researchers compared testosterone and estradiol levels to instances of heart and cardiovascular diseases, they found, in general, that higher testosterone was associated with increased risk and higher estradiol levels with lower risk.

After adjusting the results to account for multiple other heart disease risk factors including age, body mass index, education, diabetes and blood pressure, they looked at the ratio of testosterone to estradiol ¾ essentially dividing the testosterone level by the estradiol measurement.

For every standardized unit increase in the ratio of testosterone to estrogen, there was a 19 percent increase in cardiovascular disease risk, a 45 percent increase in coronary heart disease risk and a 31 percent increase in heart failure risk.

“Although our study adds to evidence that higher estradiol relative to testosterone may have a protective effect on the cardiovascular system in older women, it is premature to advise them to take hormone therapy to reduce their risk,” says Di Zhao, Ph.D., research associate at Johns Hopkins and the lead author of the published research results. “At this point, doctors may want to step up their advice to women to reduce other known risk factors after menopause,” Zhao says.

As to why these hormones may affect risk, Michos says there is ample evidence from other studies in women that testosterone can raise blood pressure and contribute to insulin resistance, which are harmful effects, whereas estrogen relaxes blood vessels and lowers bad cholesterol levels, which tend to be good things for the heart and vascular systems.

According to the U.S. Centers for Disease Control and Prevention, heart disease remains by far the No. 1 killer of women in the United States and accounts for one every four deaths.

Additional authors include Eliseo Guallar, Pamela Ouyang, Vinita Subramanya, Dhananjay Vaidya, Chiadi Ndumele, Joao Lima and Wendy Post of Johns Hopkins; Matthew Allison of University of California, San Diego; Sanjiv Shah of Northwestern University; Alain Bertoni of Wake Forest University and Matthew Budoff of University of California, Los Angeles.

The study was funded by grants from the American Heart Association Go Red for Women Strategic Focused Research Network (16SFRN27870000), American Heart Association (16SFRN28780016), Blumenthal Scholars Fund for Preventative Cardiology Research, National Heart, Lung, and Blood Institute (R01 HL107577, R01 HL127028, R01 HL074406, R01 HL074338) and the MESA study contracts through NHLBI (N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169).

COI: Michos has received an honorarium from Siemens Diagnostics. Ouyang has grant funding from Cordex Systems, Inc. Budoff has received research funds from GE Healthcare.

Original source can be found here.