Born with a serious heart condition called dilated cardiomyopathy, Chloe Narbonne had five major operations – and four hearts – by the age of 12. She defied the odds to become the youngest person in Europe to receive an artificial heart thanks to groundbreaking surgery involving 30 NHS staff. Now Chloe, her mother and medical personnel tell her amazing story for the first time
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Chloe Narbonne’s heart failed when she was 11, starting a near-hopeless fight for survival. A year on from groundbreaking surgery, she is alive and this is her story
“By the time I met Chloe she was dead,” André Simon says matter-of-factly. “I told her parents clearly that she didn’t really have a chance to survive. What I was proposing gave her a theoretical chance.” He pauses. “But I also said that the operation might just prolong her agony and suffering – I didn’t even know if she would survive it – and that it was OK just to let her go.”
Simon, one of the world’s leading heart and lung specialists, is recalling the conversation he had at the beginning of May last year with Fabienne and Todd Narbonne that led to him implanting an artificial heart inside their 12-year-old daughter Chloe. “It was an emotional meeting, it was tense, it was horrible. They were trying to be calm but they were extremely anxious and were holding on to each other for support. They put their last hopes in me and they prayed for a miracle.”
We owe the donors and their families eternal thanks
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A high carbohydrate diet of rice, plantain, manioc and corn, with a small amount of wild game and fish – plus around six hours’ exercise every day – has given the Tsimané people of the Bolivian Amazon the healthiest hearts in the world.
It may not be a life that everyone would choose. The Tsimané live in thatched huts with no electricity or modern conveniences. Their lives are spent on hunts that can last for over eight hours covering 18km for wild deer, monkeys or tapir and clearing large areas of primal forest with an axe, as well as the gentler pastime of gathering berries.
But as a result of this pre-industrial lifestyle, the Tsimané have hardly any hardening of the arteries. Heart attacks and strokes, the biggest killers in the US and Europe, are almost unknown.
The study published in the Lancet medical journal and being presented at the American College of Cardiology conference shows that an 80-year-old Tsimané man has the vascular age of an American in his mid-50s.
Researchers, who investigated the lifestyles of the Tsimané and checked out their arteries with CT scanners, say that there are lessons for those of us who live sedentary lives in urban areas and eat packaged foods.
“This study suggests that coronary atherosclerosis [hardening of the arteries] could be avoided if people adopted some elements of the Tsimané lifestyle, such as keeping their LDL cholesterol, blood pressure and blood sugar very low, not smoking and being physically active,” said senior cardiology author Dr Gregory S Thomas from Long Beach Memorial Medical Centre in the US.
“Most of the Tsimané are able to live their entire life without developing any coronary atherosclerosis. This has never been seen in any prior research. While difficult to achieve in the industrialized world, we can adopt some aspects of their lifestyle to potentially forestall a condition we thought would eventually effect almost all of us.”
Coronary atherosclerosis is the build-up of plaque in the arteries leading to the heart, which slows the blood flow and can cause blood clots – which may in turn lead to a heart attack. The researchers found that almost nine out of 10 of the 705 Tsimané adults who took part in the study had no risk at all of heart disease; 13% had a low risk and only 3% – 20 individuals – had moderate or high risk.
Even in old age, 65% of those aged over 75 had almost no risk and only 8% (four out of 48) had a moderate to high risk. By contrast, in the US, a study of more than 6,800 people found that half had moderate to high risk – five times as many as among the Tsimané people – and only 14% had no risk of heart disease at all.
In the Tsimané population, heart rate, blood pressure, cholesterol, and blood glucose were also low. The study suggests that genetic risk is less important than lifestyle. “Over the last five years, new roads and the introduction of motorised canoes have dramatically increased access to the nearby market town to buy sugar and cooking oil,” said Dr Ben Trumble, of Arizona State University, US. “This is ushering in major economic and nutritional changes for the Tsimané people.” Those whose lifestyle is changing have higher cholesterol levels than others who stick to hunting and fishing.
Senior anthropology author Prof Hillard Kaplan, from the University of New Mexico, said the loss of subsistence diets and lifestyles could be classed as a new risk factor for vascular ageing. “We believe that components of this way of life could benefit contemporary sedentary populations,” he said.
Tsimané people are more likely to get infections than those in the US, but even so, he said, “they have a very high likelihood of living into old age.”
The researchers cannot yet say whether diet or the active lifestyle is the more important component, said Kaplan, but they want to go on to investigate that by following those of the community whose lifestyles change with exposure to the town. “My best guess is that they act and they interact,” he said.
And it could be as much the foods that the Tsimané do not eat that gives them healthy hearts as the food that they do. Their diet is high in unrefined carbohydrates (72%) with about 14% protein and it is very low in sugar and in fat – also 14%, which amounts to about 38g of fat a day including 11g of saturated fat. “In the evolutionary past, fat and dense energy in the form of sugar were in short supply,” Kaplan said.
Ireland’s abortion regime has been responsible for a litany of tragedies in recent years. The death of Savita Hallapanavar, denied a life-saving abortion during her miscarriage; the state-sponsored abuse of Miss Y, a suicidal teenage asylum seeker and rape victim, forced to carry her pregnancy to viability and deliver by C-section; a brain-dead woman kept alive, effectively as an incubator, against her family’s wishes. And there are plenty more mundane, yet nonetheless heartbreaking, stories of approximately 12 women a day who travel to the UK to access abortion services.
In the last year, something fundamental has shifted. The Irish pro-choice movement is getting loud. Actors and writers including Tara Flynn, Helen Linehan and Susan Cahill have publicly shared their abortion stories, bravely breaking taboos. An “abortion bus” flouted the law to tour Ireland distributing medication. Comedian Gráinne Maguire had us all tweeting details of our periods to the taoiseach, Enda Kenny. Activist Anna Cosgrave designed distinctive Repeal jumpers, so that on any given day in Dublin you will see supporters with their commitment to repealing the 1983 eighth amendment to the constitution emblazoned across their chests. That’s just the tip of the iceberg.
The last two weeks have seen some of the most extraordinary activism yet in the campaign to repeal the eighth amendment. Under the Twitter handle @twowomentravel, two friends live-tweeted their journey to England so that one of them could access an abortion, turning a personal crisis into a powerful political action. Answering my questions, on the condition that her anonymity was preserved, the companion explained that while planning the journey her friend decided she wanted something good to come from it for Irish women.
“What’s the alternative?” she asks, “Silence? Silence is breaking 12 Irish hearts a day. Silence is trapping migrant women in desperate situations, silence has the blood of Savita on its hands, silence is the shape of Miss Y’s devastation. Silence has devastated the women and girls of Ireland, but now it’s time to talk, and get real.”
They certainly got real. The pictures they shared were striking in their ordinariness: boarding an airplane in the cold grey of dawn; views from taxi windows; waiting rooms with magazines; a basic hotel. They tagged Kenny in each. The most controversial image is a lightly bloodstained sheet, which they felt was important to show: they were certainly not the first women to face a long trek home, bleeding and sore.
“The anti-choice brigade have been all over that photo,” the friend tells me. “The realities of women’s bodies have been glossed over for too long. We bleed, and we birth, and it’s not pretty, but that’s life, and that reality needs to be brought to the fore. There’s no realism in the philosophical focus of the anti-choice side. They can speculate until the cows come home about when life begins. In fact, they have speculated so loudly and for so long that real lives of women and girls have ended unnecessarily.”
When #twowomentravel returned, 48 hours later, they had tens of thousands of Twitter followers and were making international headlines. “We could never have expected the response we received. It was surreal. Where do you even begin thanking people for standing with you in that situation?”
They believe that Kenny saw their tweets: “He stopped posting updates on the Olympics, which he had been doing regularly,” she says. In her view, Kenny going offline speaks volumes. In any case, they are not surprised by his silence.
“He has no compassion, no interest in the lives of women. There are more than 100,000 women who went before us. He could have listened to any number of them, and he didn’t. He owes over 3,000 women a year a whole lot of money and remorse.”
The #twowomentravel hashtag was brimming with gratitude and solidarity. But there were also, inevitably, anti-choice pundits aggressively shaming the women. “We were showing photos of waiting rooms, taxis, flights. In response, we got bombarded by violent rhetoric accusing both of us of murder, bombarded with pictures of mutilated foetuses.”
Perhaps the strangest criticism came from detractors who refused to believe that the anonymous women existed. Seemingly, even though a dozen women a day make this journey, the notion that one of them would refuse to be shamed into silence defies all logic.
The friend I interview is scathing of such critiques: “Nobody has to believe us. Our dignity does not rely on that. But I will say this: if you are sceptical of an eloquent, salient, honest and cutting telling of the travesty that faces so many Irish women, you are a sexist. If you doubt the ability of women to tell their stories with ferocity and confidence, even in crisis, you are a sexist. If you doubt us because we have succeeded in defying you, you are a sexist. We are not meek, and we owe no explanations.”
Right now, the friends are processing everything that has happened – one healing and taking time out following her abortion, the other dealing with media. They intend to keep fighting. “We have to break the hold of silence. We can no longer whisper. We have been failed for too long. Now is the time to be loud.”
An Australian cardiologist has accomplished what could demonstrate a key breakthrough in treating heart disease, following operating with US scientists to use human stem cells to regenerate the broken hearts of monkeys.
A evidence-of-principle examine, published in Nature, showed that human embryonic stem cells boosted heart regeneration when transplanted into injured macaque hearts.
The findings represent the very first time that scientists have been ready to develop stem cell-derived heart muscle at a scale to treat huge animals. The study was also profitable in displaying that the transplanted cells worked in tandem, rather than towards, host tissue.
Preceding work has shown that the human cardiac stem cells, known as cardiomyocytes, could be utilised on rodents. But the breakthrough with the macaque monkeys exhibits it could be possible to use the same remedy in people, albeit following many much more years of research. A lot more than twenty,000 Australians die from heart failure every single 12 months.
Dr James Chong, a cardiologist at the Westmead Hospital and Sydney University lecturer, authored the study paper in collaboration with a University of Washington group, led by Charles Murry.
The researchers induced a heart attack in eight macaque monkeys by impeding the blood flow into the organ. Two weeks later on, the stem cells had been injected into the heart.
In excess of a time period of 3 months, the hearts had been proven to have regenerated dead tissue by up to forty% and accomplished electromechanical coupling with the unique host heart. Even so, it is unclear from the examine whether a full recovery would be achievable by way of stem cell remedy.
Chong explained the investigation was a “very important advance” in the work to locate much better ways to treating heart failure.
“I feel it is practical to presume that this could be used in humans sooner or later on,” he informed Guardian Australia. “A whole lot of function needs to be accomplished but I don’t believe we’re also far away.
“Heart failure is a increasing issue. We’ve acquired much better at treating heart attacks but it means that a whole lot of people are living longer with damaged heart muscle. This harm gradually spirals out of handle and the drugs we have only slow down the approach.
“The only remedy truly is a heart transplant, which is certainly problematic. The human heart and brain are the least regenerative parts of the physique.”
The researchers are now looking for even more funding to advance the studies so that human clinical trials can eventually be undertaken.
Cardiac cells derived from human stem cells (green) and monkey heart cells (red) in a photo issued by the University of Washington. Photograph: Murry Lab/University of Washington/PA
Scientists have efficiently repaired damaged monkey hearts by injecting new heart cells created from human stem cells, paving the way for a trial in people just before the finish of the decade.
Researchers now hope that the remedy could give individuals a new lease of lifestyle following huge heart attacks that trigger scarring and in the long run heart failure.
“When human embryonic stem cells had been 1st discovered, this is just the type of treatment individuals hoped they would lead to. We are optimistic, but we are also cautious,” stated Charles Murry, who led the crew at the University of Washington in Seattle.
The heart is 1 of the poorest organs in the body at repairing itself when it sustains injury. Right after a heart attack, muscle tissue in the heart dies off, and is replaced a month or so later on with scar tissue. This does not contract like regular heart tissue, so the heart is weakened and struggles to pump blood around the body.
Much more than 100,000 people have heart attacks in Britain every single year, and one particular in three dies prior to reaching hospital. Significant heart attacks are accountable for 750,000 individuals residing with heart failure in the United kingdom. But the productive trial heralds the chance of a new approach: “We believe we can do our first patient in around 4 years in a phase-1 trial,” Murry mentioned. The study is reported in the journal Nature.
Studies in mice and rats have previously proven that injections of stem cells can help to repair damaged heart muscle, but those animals have considerably various physiology and heart rates to people.
Sian Harding, director of the British Heart Basis cardiovascular regenerative medication centre at Imperial School London, called the operate a big phase forward.
“This is as close as you can get to placing these cells into humans. It truly is actually essential, simply because this is searching at a big volume of muscle, and that has not been accomplished prior to. It truly is what you are going to need in humans,” Harding stated. “It shows us you can make the muscle, hold it there, get the blood vessels in, and have it perform even at higher heart rates.”
Murry’s crew examined the process in four pig-tailed macaques and located that the cells assisted to restore heart tissue injury. The researchers induced small heart attacks in the monkeys by blocking a heart blood vessel for 90 minutes.
For the duration of the subsequent two weeks – ahead of scar tissue had time to kind – they injected one billion younger heart cells developed from human embryonic stem cells into and around the damaged heart muscle. The animals have been offered drugs to stop their immune techniques rejecting the cells.
Most of the injected cells – all around 90% – died off. But the remainder grew into fresh heart muscle that commenced to perform with the animals’ remaining healthful heart tissue. The cells formed connections with neighbours for passing electrical signals across, and blood vessels grew into the new tissue to provide it with oxygen and nutrients.
But the procedure did not go fully smoothly. All of the monkeys that acquired human heart cells developed irregular heartbeats, or arrhythmias, which lasted for two to 3 weeks. Though none of the animals died from the arrhythmias, the dilemma will make researchers wary of transplanting the cells into humans.
The cells most likely caused irregular heartbeats simply because they were immature when they had been injected. As the cells matured in the animals, the arrhythmias subsided, Murry advised the Guardian.
“If we did this in individuals there would be a vulnerable period of a handful of weeks and they would stabilise following that, but we would favor to solve the problem prior to we treated individuals,” Murry mentioned.
Murry explained that close to a quarter of the heart muscle groups was damaged in the monkeys his group treated. Had they triggered significantly much more harm the monkeys might have died prior to the scientists had had a chance to inject them with fresh heart cells.
Harding added that rather of injecting the heart cells, one more choice might be to make grafts of heart cells in the lab and transplant them as a sheet of tissue. These could sit in excess of scarred heart tissue, and aid the heart to pump more strongly.
John Martin, professor of cardiovascular medicine at UCL, was cautious about the examine since it failed to present no matter whether the transplanted cells improved the perform of the monkeys’ hearts. The occurrence of arrhythmias was worrying as well, he extra.
Anthony Mathur, director of cardiology at Barts Well being NHS trust, is working with Martin on a trial that will see three,000 heart attack individuals across Europe infused with stem cells taken from their own bone marrow. Whilst the cells do not gather in the heart and make fresh muscle tissue, they do release chemical compounds that lessen damage and possibly assist the heart to recover. A single benefit of the procedure is that individuals do not need to have to get anti-rejection medication, simply because the cells are their own.
Peter Weissberg, health care director at the British Heart Basis, explained: “This analysis brings us 1 step closer to repairing a damaged human heart, but we nevertheless have some way to go until finally we reach our aim.”
If the torrent of studies suggesting that sugar is bad for our health wasn’t quite enough, new research again suggests that added dietary sugar increases the risk of death from heart disease. Among the health concerns of eating or drinking too much sugar have been a higher risk of obesity, high blood pressure, dementia, type 2 diabetes, dyslipidemia (a bad assortment of blood fats), cirrhosis of the liver, and, of course, cardiovascular disease. And from the new study, which looked at sugar intake and the health of men and women over about 15 years, a clear trend emerged: The more added sugar a person consumed, the greater his or her risk of dying from heart disease.
Researchers from the CDC looked at data from 31,000 people who’d taken part in the National Health and Nutrition Examination Survey, comparing a multitude of different lifestyle and physical variables to health outcomes.
Heart Cake (Photo credit: FantasyClay)
The good news is that sugar consumption has decreased a bit over the years. The percentage of calories we get from added sugar decreased from 16.8% in 1999-2004 to 14.9% in the years 2005-2010.
The slightly discouraging news is that 70% of adults consumed 10% or more of their daily calories from added sugar – and about 10% of adults consumed more than 25% of their calories from added sugar. (To give some perspective, drinking a 20-ounce soda would be about the equivalent of taking 15% of your daily calories from added sugar, assuming a 2,000/day diet.)
The bad news is that added sugar appears to significantly increase our risk of death from heart disease. People who consumed about 15% of their daily calories from added sugar had a 18% higher risk of dying from heart disease, compared to people who only took in very little added sugar. For people whose added sugar intake made up over 21% of their daily calories, their risk of death doubled.
And the phenomenon appears to be completely independent of other factors – like weight, calories consumed, smoking, blood pressure, sex, cholesterol level, and physical activity – which indicates that there’s something specific about the relationship between sugar and the heart.
What could sugar be doing to increase the risk of heart disease? There are a lot of possibilities. One is that sugar has been shown to increase blood pressure, independent of other health problems it can trigger. Another idea is that it increases unhealthy blood fats like triglycerides and “bad” LDL cholesterol levels, while decreasing “good” HDL cholesterol. Other studies have suggested that excess sugar can trigger inflammation in the body, by boosting levels of certain inflammatory biomarkers. Finally, some studies have suggested that sugar may enhance the genetic effects of obesity, boosting the heart risks that obesity genes were already threatening to begin with.
“Our findings indicate that most US adults consume more added sugar than is recommended for a healthy diet,” the authors write. “A higher percentage of calories from added sugar is associated with significantly increased risk of CVD mortality.”
The bottom line is that added sugar appears to confer risks far beyond weight gain. In her editorial, Laura Schmidt, a UCSF researcher, says that we’re beginning a paradigm shift in the current thinking on sugar. Unlike trans fats and salt, she points out, there’s no upper limit to how much food companies can add: Sugar is on the FDA’s “generally recognized as safe” list. This, she suggests, should change.
The WHO recommends having added sugar make up no more than 10% of our daily calories, while the Institute of Medicine (IOM), a U.S. organization, is more lenient, saying upper limit should be 25%. But the American Heart Association is much more conservative, recommending that added sugars should be limited to 100 calories per day for women and 150 per day for men.
And the new study supports that this lower estimate is probably pretty smart. Whether the government steps in with more “sin taxes,” or we continue to eat and drink less sugar on their own, is anybody’s guess. As Schmidt says, one thing’s for sure: “Too much sugar does not just make us fat; it can also make us sick.”
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