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February 2017 Vol.5, No. 2
Inside this issue:
Ask Dr. Grossman
2
1
Nutrition
6
Understanding and
addressing dementia
page 11
Research
8
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Ask Dr. Grossman
Dr. Grossman’s responses to patient questions
A PATIENT ASKS: Do acidic foods in general protect the
BOTTOM LINE: At this time, we don’t have hard evidence that
heart? Anecdotally or otherwise: aspirin (pH 3.0), grapefruit (pH 3.3),
the pH of food, acid or alkaline, affords cardioprotection. However,
apple cider vinegar (pH 2.9) are said to be healthy for you. Should
research is underway to clarify the role of intestinal bacteria in
we draw a broader conclusion, or are these specific cases?
cardiovascular health. This may have important implications for our
ANSWER: I am afraid that there is no convincing scientific
evidence that acidic foods protect the heart. It is likely that the low
diet, since what we eat can either help or harm the unsung heroes in
our gut microbiome. Stay tuned!
pH of aspirin and its cardioprotective properties are due to different
A PATIENT ASKS: After reading a recent article about alcohol
aspects of the acetylsalicylic acid molecule (this is the molecule that
and atrial fibrillation, I am confused. Some evidence suggests that
is the active ingredient in aspirin tablets). In other words, aspirin is
alcohol may be cardioprotective. What is your recommendation
an acidic substance, and it is cardioprotective, but these facts are
regarding alcohol consumption, atrial fibrillation, and heart health?
likely “true, true, and unrelated.”
ANSWER: A very good topic. For the person who
sent this question in, I hope you won’t mind my
However, your question touches
shortening it up and re-wording it a little.
on a very cutting-edge new
For many years, the body of evidence
field regarding cardioprotection:
suggested some heath benefit for
what is the role of the gut
moderate alcohol consumption
microbiome in cardiovascular
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health? Our intestines
(defined as not more than one drink
normally contain millions of
per day for women and two drinks
bacteria, including some 1,000 distinct species. These
per day for men), particularly with
intestinal bacteria, the “gut microbiome,” are now believed to play
regard
an important role in cardiovascular health, presumably by producing
However, new research has tempered this view, and most medical
to protection against heart attack.
certain chemicals and nutrients that we need for cardioprotection.
authorities are now much more cautious about recommending alcohol
to improve heart health. The Cleveland Clinic website says:
Experiments in mice have shown that if you eliminate these
bacteria, the mice become sickly, and often develop cardiovascular
“The effect of alcohol on your heart is complex. For some people, even
disease. Many of my patients take a “probiotic,” which is basically a
moderate alcohol use carries major risks. Research is ongoing to clarify
collection of normal intestinal bacteria, to replenish and strengthen
the relationship of alcohol and heart disease. You may have heard
their own gut microbiome. It may turn out that certain foods or
that moderate alcohol consumption (red wine or beer) may offer some
balance of foods in the diet are needed to maintain a healthy gut
people protection against heart disease. However, until more is known
microbiome. Also, this is another reason not to take antibiotics
about the pros and cons of alcohol consumption, the American Heart
unless absolutely necessary, so as not to kill off the “good bacteria”
Association cautions people NOT to start drinking alcohol for better
in your intestines. To read more about probiotics and the gut
heart health.”
microbiome, look at https://en.wikipedia.org/wiki/Probiotic.
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The Mayo Clinic website says:
“alcoholic cardiomyopathy.” This is a condition that develops in
heavy drinkers, usually after many years of alcohol excess (more
“It sounds like a mixed message: Drinking alcohol may offer some
than three drinks per day), and results from the toxic effects of
health benefits, especially for your heart. On the other hand, too
alcohol on heart muscle. The damaged heart muscle is weakened
much alcohol may increase your risk of health problems
and damage your heart. When it comes to alcohol,
the key is moderation. Certainly, you don’t have
to drink any alcohol, and if you currently don’t
and the heart’s pumping function is impaired, leading to
heart failure. In many cases, alcoholic cardiomyopathy
improves dramatically with abstinence from alcohol.
drink, don’t start drinking for the possible health
BOTTOM LINE: If you don’t drink alcohol,
benefits. In some cases, it’s safest to avoid
don’t start; there are many more effective ways to
alcohol entirely – the possible benefits don’t
outweigh the risks.”
improve your heart’s health. However, moderate alcohol
consumption (one drink per day for women and two for men)
is safe for most people. If you have a special situation (e.g., AF,
I find myself in agreement with both of these
cardiomyopathy or heart failure), check with your doctor as to how
quotes. My biggest specific concern is the
much (if any) alcohol is safe for you.
relation between alcohol consumption
and atrial fibrillation (AF). It is well known
A PATIENT ASKS: What is the difference between normal
that some individuals will be in good
and abnormal heartbeats, what brings on the abnormal
health until they go on vacation (or on a
heartbeats, and when should we be concerned?
business trip, or to a social event such
as the Bohemian Grove), drink alcohol
in excess of their usual consumption,
and develop AF. This abnormal heart rhythm
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ANSWER: Important questions, and ones that I am
asked frequently. First, the normal heartbeat is a mechanical
contraction of the heart, initiated by an electrical impulse
causes rapid irregular pounding or racing of the heart, and is often
generated within the heart itself. The heart has two upper
associated with shortness of breath, light-headedness, or even loss
chambers, the right and left atria, and two lower chambers, the
of consciousness. When occurring sporadically in this setting, it is
right and left ventricles. The ventricles are much more muscular
sometimes called “Holiday Heart”.
than the atria, and it is their job to pump blood around the body.
When you listen to the heart with a stethoscope, or simply by
I generally advise my patients with AF not to drink more than one
pressing your ear to someone’s chest, it is the beating of the
alcoholic beverage daily. The big danger of AF, of course, is that
ventricles that you are hearing.
it can lead to a stroke, by the mechanism of blood clots forming
in the fibrillating atria, and then breaking off and traveling in the
The normal heartbeat is initiated by an electrical impulse
bloodstream to the brain. There are also other types of heart
generated approximately once per second (60 times per minute) in
problems that can result from alcohol, especially something called
an area of the right atrium called the sinus node. For this reason,
continue to page 10
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a
As we begin the new year, perhaps even more so than ever, for many of us there is a deep sense of significant change and a profound
feeling of transition across many spheres of our civic and personal lives. Such marked change may, for some of us, raise questions of
where can we turn for reliable, verifiable sources of information that we can trust regarding matters that we care about deeply, such as
our own health and the health of our loved ones.
In this spirit it is unequivocally our goal with this publication to provide our readers with a consistent, reliable resource that is credible
and, we hope, enjoyable to read. This semi-annual newsletter always includes my responses to prevention questions from our readers
based on my decades of clinical experiences as well as my review and consideration of diverse medical perspectives from other
leading clinicians on a myriad of subjects ranging from exercise, to nutrition, to treatment therapies. My hope is that somewhere, in
each edition of YourHealthyHeart, you may find an idea, a tip, a publication reference or an opinion piece that inspires you to conduct
further research or formulate a question for your next visit with your physician as part of an ongoing open dialogue with him or her,
and with all of your medical providers.
For example, diet is always an important component of cardiovascular health. In this issue, the role fresh fruit can play in a balanced
diet is addressed in two features, first in an article by our Prevention Fellow, Philip Hall, MD (Page 6) and next, in one of our regular
sections, Research In The News (Page 8).
At our Prevention Center, while our core mission is to help people reduce their risks for cardiovascular disease, sometimes we also
spotlight other important health topics. In this issue, we are pleased to include a summary of a pair of excellent presentations on brain
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function, memory and dementia. These talks were given by two global leaders in neurology and neuro-science: Adam Gazzaley, MD
and Bruce Miller, MD, both faculty members of the UCSF Department of Neurology (Page 11). We hope you’ll enjoy our synopses and
that you’ll consider viewing the videos online of both talks at: http://healthyheart.ucsf.edu/resources-videolectures.shtml
Whether addressing cardiovascular disease prevention or exploring other important health issues, we strive
to present information based on validated research, years of clinical experience, or both. Our goal is always
to engage your interest and inspire you to sustain and expand your own pursuit of relevant healthcare
information to support yourself and those you love.
Please let us know how we’re doing by emailing us your feedback at: [email protected]. Also
please visit our program website at http://www.healthyheart.ucsf.edu for information about our
work.
Again, I’d like to express my most sincere thanks for your continued support of the Center for
Prevention, the UCSF Medical Center, the Department of Medicine and the Division of Cardiology.
Best wishes for good health,
H
William Grossman, MD
Charles and Helen Schwab Endowed Chair in Preventive Cardiology
Director, Center for Prevention of Heart & Vascular Disease
Professor of Medicine, University of California, San Francisco
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Join the
and make a difference
in heart disease
today!
1 in 3 adults have
heart disease.
We need your help.
University of California San Francisco (UCSF) is
5
pushing the boundaries of research with a new
study about cardiovascular health. The Health
eHeart Study uses online surveys, mobile technology, and social media as tools to help us
understand how real-life health patterns are
linked to our heart health.
You must be 18 years or older to join.
Health-eHeartStudy.org
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So what exactly is a Heart-Healthy Diet?
Cardiology Prevention Fellow reviews research, controversies and
considerations regarding dietary choices and heart health
By Philip Hall, MD
Some of the most common questions we hear from patients and their family
members at the Cardiovascular Care and Prevention Center are about diet
and nutrition. “What foods should I be eating?” And, just as frequently,
“What foods do I need to avoid?” These are deceptively challenging
questions for us, because the scientific evidence is often not as clear as
we would like it to be. Some commonly-held beliefs about healthy diets
have not been supported by rigorous scientific studies. A low fat diet, for
instance, we used to think was essential for heart health, based on the
premise that consuming less fat leads to lower levels of cholesterol, which
then should lead to a reduction in heart disease and stroke. Unfortunately,
several large randomized clinical trials of implementing a low fat diet including the Women’s Health Initiative study of 48,835 patients reported
by Barbara Howard and others in 2006 - have not shown a significant
benefit in reducing heart disease or stroke despite successfully lowering fat
consumption.
Ramon Estruch and others reported the results of the PREDIMED
Why wasn’t the low fat diet successful? One of the problems may be
that when we ask patients to reduce their fat intake, many replace the fat
6
in their daily diet with other unhealthy nutrients, such as refined sugars
and carbohydrates. The health benefits of cutting out the fat may be
outweighed by the problems resulting from the extra carbohydrates. That’s
one of the reasons why physicians have been moving towards placing just
as much emphasis
food groups to
on recommending specific
include in a healthy diet
as on recommending
foods to avoid. Scientific
studies of implementing
diet recommendations
like these have generally
been more successful than
the studies of low fat diets.
study in 2013, a randomized trial of the Mediterranean diet, which
includes higher consumption of olive oil, fish, fruits and vegetables,
nuts, and legumes, as well as a lower consumption of dairy products,
red meat, processed meats, and sweets. In their study of 7,447
people, the Mediterranean diet was associated with a significant 30%
reduction in heart disease or stroke.
Based upon the best available scientific evidence, the American Heart
Association (AHA) has developed dietary targets for food groups
to include in a healthy diet (fruits and vegetables, fish and shellfish,
whole grains, nuts, seeds, and legumes), and foods to limit (sodium,
sugar-sweetened beverages, processed meats, and saturated fat).
See the Table for details, and visit www.heart.org/nutrition for more
information. These recommendations represent a diet that is very
different from the average American diet, and the AHA estimates that
fewer than 5% of U.S. adults are currently meeting all of the targets.
Fortunately, our average diet has been improving over the past
decade, in large part due to an increase in our consumption of whole
grains and a decrease in sugar-sweetened beverages.
Unfortunately, there is still a lot we do not know. On the Table
you won’t find milk, butter, eggs, cheese, white meats, red meats,
coffee, dark chocolate, or red wine, all of which you may have heard
discussed in the news as being either healthy or harmful (or in some
cases both!). The AHA has concluded the evidence for any of those
foods is not yet definitive enough to make a recommendation one
Philip Hall, MD
YourHealthyHeart 20170124.indd 6
way or the other. Why not? Well in some cases there is conflicting
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evidence, and in other cases it is hard to confirm the true effect of
barriers to choosing healthy diet options is essential when trying
the food itself. If, in one study, it looks like people who consume
to make durable changes that will lead to long-term health gains.
dark chocolate have less heart disease than people who don’t, it
Finally, a heart-healthy diet is important, but it is only one of
may well be because dark chocolate truly prevents heart disease,
the seven factors the AHA identifies as components of ideal
but it may also be because people who consume dark chocolate
cardiovascular health. The other six factors include healthy
tend to exercise more than people who don’t, or they smoke
weight, physical activity, blood pressure, smoking avoidance
cigarettes less often, or they have different genetic backgrounds that
or cessation, cholesterol, and blood glucose. A healthy diet
make them less likely to develop heart disease, or are fundamentally
is intimately connected to the other six factors, and should be
different in some other way. Teasing out whether dark chocolate is
considered in that context. We are always eager to discuss these
actually protective in and of itself is challenging.
issues further in our clinic visits.
So how can we respond to our patients’ questions? The AHA targets
With that, I wish all of you a happy and healthy 2017!
are a good start to the discussion, but our answers frequently
References: (1-4)
need to be personalized and individualized. Some patients have
conditions requiring different dietary recommendations from others,
and please talk with your physician about what diet is best for you.
That said, nobody’s diet is perfect, and we can all try to identify
cardiovascular disease with a Mediterranean diet. The New England
journal of mediåcine 2013;368:1279-90.
2. Howard BV, Van Horn L, Hsia J et al. Low-fat dietary pattern and risk
ways to improve our own. Choosing lower sodium alternatives,
of cardiovascular disease: the Women’s Health Initiative Randomized
replacing processed carbohydrates with whole grains, cutting down
on sodas and sugary juices, and incorporating fruits and vegetables
are all generally good and healthy options. They’re not always easy
options, and doctors understand that less healthful diet choices
Controlled Dietary Modification Trial. Jama 2006;295:655-66.
3. Mozaffarian D. Dietary and Policy Priorities for Cardiovascular
7
Disease, Diabetes, and Obesity: A Comprehensive Review.
Circulation 2016;133:187-225.
4. Writing Group M, Mozaffarian D, Benjamin EJ et al. Heart Disease
are not evidence of moral failings – instead they’re usually driven
by taste, cost, and/or convenience. Identifying and recognizing the
Food groups
1. Estruch R, Ros E, Salas-Salvado J et al. Primary prevention of
and Stroke Statistics-2016 Update: A Report From the American
Heart Association. Circulation 2016;133:e38-360.
AHA Recommended Target
Primary recommendations (best evidence)
Fruits and vegetables
≥4.5 cups per day
Fish and shellfish
≥2 3.5-oz servings per week (≥200g per week)
Sodium
≤1500 mg per day
Sugar-sweetened beverages
≤36 fl oz per week
Whole grains
≥3 1-oz servings per day
Secondary recommendations (good evidence)
Nuts, seeds, and legumes
≥4 servings per week (nuts/seeds: 1 oz; legumes: ½ cup)
Processed meats
≤2 1.75-oz servings per week (≤100 g per week)
Saturated fat
≤7% of daily energy intake (calories)
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Research In The News
Commentary from Dr. Grossman on selected media coverage of medical research
DO YOU NEED TO BE FASTING BEFORE HAVING YOUR
CHOLESTEROL BLOOD TEST?
Some of you may have seen news reports in the last few months
on the new guidelines regarding the need to be fasting when
you go for your cholesterol blood tests. Dr. Samia Mora from the
Division of Preventive Cardiology at Harvard Medical School and
the Brigham and Women’s Hospital in Boston has summarized
these new guidelines in an article in JAMA Internal Medicine in
July 2016. For many years it has been believed that eating right
before having your cholesterol measured could falsely elevate
the blood cholesterol, and give a distorted picture of the risk of
heart attack or stroke. However, several studies in recent years
suggest that bloods drawn in either the fasting or non-fasting
state show remarkably little variability, particularly in the HDL and
LDL cholesterol values, which are the main ones of interest to me
and most cardiologists. Even the triglyceride level, which is most
8
likely to be affected by a recent meal, will rarely be pushed into the
abnormal range.
Most importantly, non-fasting measurement of cholesterol values
was at least as good, and in some cases better than fasting values
in predicting the risk of heart attack or stroke.
BOTTOM LINE: According to the new guidelines, It is not
necessary to be fasting prior to having a blood test for lipids
(cholesterol profile). Just make sure to tell your doctor whether you
were fasting or not, to help him or her interpret the tests. I agree
wholeheartedly with these guidelines, and I think it will make life
easier for all of us.
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FRESH FRUIT CONSUMPTION: In the April 7, 2016 issue of the
New England Journal of Medicine, a major study from China was
published on the effects of fresh fruit in the diet on cardiovascular
health. Between 2004 and 2008, the research team there recruited
512,891 adults who were 30-79 years of age, and followed them
through September 2014. By questionnaire, participants were
divided into five groups according to the frequency of fresh fruit
consumption: never or rarely, monthly, 1-3 days per week, 4-6 days
per week, and daily. Blood pressure and blood glucose (blood
sugar) were inversely related to fruit consumption, and were lowest
in the individuals with daily consumption of fresh fruit. As might
be expected, the hazard ratios (risk compared with those who
consumed no fruit) for heart attack, stroke and cardiovascular death
were progressively lower with increasing consumption of fresh fruit.
In those with daily fruit consumption, the risk of stroke was 25-35%
lower, and the risk of heart attack was nearly 40% lower.
BOTTOM LINE: I have fruit for breakfast every morning
9
(strawberries and bananas in my cereal), and my standard dessert
after supper is a bowl of grapes, sliced banana, blueberries, kiwi,
apple, pear, Asian pear, etc. I strongly recommend a high fruit intake
for all who want to avoid stroke or heart attack, and who have a
tendency to diabetes. Although this study was done in China, similar
data have been published from Europe and the United States.
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Ask Dr. Grossman
continued from page 3
Dr. Grossman’s responses to patient questions
normal heart rhythm is called “normal sinus rhythm.” This impulse
all of these conditions are reversible, at least to some extent. I
spreads through the atria, causing them to contract, and then
have had many patients who have been able to get off medication
spreads down to the ventricles, causing them to contract.
for hypertension and diabetes, and reduce or even eliminate their
cholesterol medications, if they had success with their weight loss
In most of us, there are other areas of the heart (in the atria, the
programs. Many programs work: for some, it is simply reducing or
ventricles, or the area between the atria and ventricles, called the
completely eliminating foods with sugar, as well as all breads, pasta
atrioventricular node) that are capable of generating an electrical
and potatoes. For others, a structured program such as Food Addicts
impulse and causing the whole sequence that leads to contraction of
Anonymous, Overeaters Anonymous, or even Weight Watchers or
the ventricles and a heartbeat. Simply put, if the heartbeat is initiated
Jenny Craig-type programs can be effective. If none of this works,
by the sinus node in the right atrium, it is called a normal heartbeat.
and if the overweight becomes significant obesity (Body Mass Index
If it is initiated from any place else, it is often called an “ectopic”
or BMI of over 35), I recommend considering bariatric surgery. This
or “extra” beat. Almost everyone has at least some ectopic beats,
can work miracles, and is the only therapy that I have seen which can
and when we do a Heart Monitor test (either the old Holter Monitor,
actually cure adult-onset (so-called type 2) diabetes.
or the newer 14-day Zio monitor), it is rare not to see at least a few
10
ectopic beats (“a few” might be defined as less than 1% of the total
BOTTOM LINE: As Sam sang to Humphrey Bogart and Ingrid
beats). Since everyone has them, it is hard to call them “abnormal.”
Bergman in Casablanca, “The fundamentals still apply, as time goes
Certainly for most people they are benign, and pose no danger.
by.” If you are overweight and have an enlarged heart or other heart
problem, diet, exercise and weight loss have not gone out of style!
Ectopic or extra beats are abnormal when they become more
frequent, and especially if they lead to an arrhythmia (medical term
for a heart rhythm disturbance), such as atrial fibrillation, prolonged
supraventricular tachycardia (SVT), or ventricular tachycardia (VT).
The definition of each of these arrhythmias is beyond the scope of
this column.
BOTTOM LINE: Suffice it to say, if you are having palpitations
and sense that your heart is jumping around, skipping a beat,
irregular, or racing without any explanation, see a cardiologist and
get an EKG, and if needed, a Heart Monitor test.
A PATIENT ASKS:
I have been told that I have
enlargement of the heart, likely related to being
overweight and inactive. My question: is this reversible
with losing weight, diet and exercise?
ANSWER: Being inactive and overweight can lead to
hypertension, arteriosclerosis and metabolic syndrome,
and eventually to diabetes. All of these medical conditions
can cause cardiac enlargement. The good news is that
with diet, exercise and ESPECIALLY WEIGHT LOSS,
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Cognition, Dementia and Video Games:
A Special feature on Brain Health and Aging
A recap of presentations by two renown UCSF neuroscientists on the effects of
aging on our brains and current research and treatment strategies
Cardiologists encourage patients to exercise, lose weight and engage
Improve sleep: During deep sleep, the brain clears away bad
their minds to prevent heart attack and stroke. It turns out these steps
proteins that cause dementia. Poor sleep or medications that induce
can also help prevent dementia, as UCSF neuroscientists Dr. Bruce
false states of sleep are associated with higher risk of developing
L. Miller and Dr. Adam Gazzaley discussed in a UCSF Center for
cognitive disorders. UCSF recently recruited Dr. Andrew D. Krystal, a
Prevention of Heart and Vascular Disease seminar entitled “Dementia in
world expert on sleep disorders, who is developing better treatments.
the Elderly: What’s New, and Is There Hope?”
Address depression: “Some people say, ‘I don’t want to take an
“It’s good to know that the advice I give my patients, ‘Use it or lose it,’
antidepressant, because it might do bad things to my brain,’” said Dr.
may help stave off cognitive decline as well as cardiovascular disease,”
Miller. “But untreated mood disorders are a very big risk for cognitive
said Dr. William Grossman, the Center’s director and Charles and Helen
decline, and it is far better to treat depression with medication.”
Schwab Endowed Chair in Preventive Cardiology.
Boosting Brain Function
There are many forms of dementia, of which
Alzheimer’s disease is the most common.
Dementia occurs when “bad” proteins – tau
or beta amyloid proteins – accumulate
in the brain, kill neurons, and spread
Besides preserving what we have, Dr. Gazzaley is
developing new ways to increase cognitive skills. The
brain is remarkably plastic, able to modify its own
structure, chemistry and function in response
to experience. Dr. Gazzaley’s laboratory has
to other neurons. These proteins likely
spent the last eight years developing video
begin accumulating years before
game technology to harness this plasticity to
patients exhibit symptoms, providing an
enhance cognition. For example, he partnered
opportunity for treatment or even prevention.
11
with game designers to create NeuroRacer, in
which players simultaneously drive and respond
“We don’t have any cures, but this is the most exciting
year I’ve seen in my field, and I believe we will have cures,”
to road signs. Young adults multitasked better
than older adults, but with 12 hours of practice, older
said behavioral neurologist Dr. Miller, director of the UCSF Memory
adults actually outperformed 20-year-olds who only played
and Aging Center and A.W. and Mary Margaret Clausen Distinguished
the game once. These older adults showed improvement in
Professor in Neurology. “Most critical to cures is early intervention, and
unrelated skills, such as the ability to remember faces and
that’s why we focus so much on healthy aging.”
complete tedious tasks.
Dr. Miller outlined ways to reduce the chances of developing dementia,
Dr. Gazzaley is excited about video games’ potential to
including:
Exercise: About one-third of dementias could likely be avoided through
calibrate the difficulty level to each player’s sweet spot, so the
game is challenging but not frustrating. “As you get better, the
game gets a little harder,” said Dr. Gazzaley. “It’s like a personal
lifestyle changes to prevent and treat diabetes, hypertension and
trainer. It’s the ideal way to induce change: intervene, record impact,
obesity. Dr. Miller recommends exercising 30 to 40 minutes, five days a
and use that data to rapidly reformulate your intervention. It’s a very
week. Exercise also stimulates production of brain-derived neurotrophic
targeted experience that can selectively activate brain networks in a
factor, which helps maintain memory.
way that no drug has ever achieved.”
Avoid head trauma: Although exercise is vital, sports such as football
To watch these presentations online, please visit:
or soccer carry increased risk of head trauma, which can contribute to
http://tiny.ucsf.edu/healthyheart.
dementia. Choose activities that carry a lower risk of concussion, such
as tennis, swimming or walking.
YourHealthyHeart 20170124.indd 11
This article reprinted with permission from Heartline, December 2016.
1/24/17 2:12 PM
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PAID
San Francisco, CA
Permit No. 8285
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Heart Healthy Strategies Education Series
These and other popular live lectures available online at:
http://healthyheart.ucsf.edu/resources-videolectures.shtml
Technology meets Neuroscience
Dementia in the Elderly:
Adam Gazzaley, MD, PhD
Professor of Neurology,
Physiology and Psychiatry, UCSF
Bruce Miller, MD
Director,
UCSF Memory and Aging Center
- A Vision of the Future of
Brain Health for Older Adults
What is New in
Diagnosis and Treatment?
Your Healthy Heart is published by the Center for Prevention of Heart and Vascular Disease at the University of California, San Francisco | www.healthyheart.ucsf.edu
For mailing list corrections, additions, or to be removed from the list please send an email to [email protected]
Contributors: William Grossman, MD; Philip Hall, MD Producer: Marc Vincent, MA Graphic Design: Niana Liu Photography: Niana Liu; iStock Photo (other photos)
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