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that the lack of sleep redces the bodys ability to healwonds. Getting enogh sleep is critical after srgery. Yetit is in the hospital that patients often sffer the mostfrom sleep deprivation. From the glare of lights throghthe night, to the sometimes noisy nightshift workers, tothe biqitos midnight and 4 am wake-p to check vitalsigns we health care people disrpt sleep rotinely.Instead we shold be offering a systematic approach toimproving the sleep of or patients, both in the hospitaland at home.

Sleep and agingSleep has a particlarly strong effect on body chemistry.The anabolic (body-bilding) hormones, growth hormone(GH), and inslin are secreted preferentially dring sleepand redced by poor sleep. Since aging affects sleepqantity and qality, and also redces these hormones,many of the effects of aging can be aggravated by poorsleep in a vicios circle.

Insulin

Sleep dration has decreased in Western societies inrecent years, and the increased rates of diabetes over the

same period may not be a coincidence. Redctions insleep dration over mltiple nights can reslt inprediabetic chemistry, and recent research has fond thateven a single disrpted night of sleep can have profondeffects on inslin response and blood sgar even inyong, healthy people.

Growth hormone

In yong men, p to 70% of daily GH is secreted dring thedeepest part of sleep. With aging, deep sleep decreasesby p to 80% from or teenage years, and a big decreasein GH secretion occrs at the same time. Meanwhile, thestress hormone cortisol, which increases with daytime

stresses, rises with aging and even more so at night with

Lown Forum 2 0 1 1 N U M B E R 2THE

LOWN CARDIOVASCULAR RESEARCH FOUNDATION

IN

SID

E 6 Meet the nrse & medical assistant teamProCor: Global heart health sccesses

7 NewsBeat

Contact s8 Snlight and yor health

Carrie Snow said, No day is so badit can't be fixed with a nap.

Sleep has always been a mysterios,somewhat magical state that keeps swondering abot its prpose. We spendan enormos amont of or lives in thisnconscios condition, yet we know

little abot its natre and role. After 50 years of research,William Dement reportedly said, "As far as I know, the

only reason we need to sleep that is really, really solid isbecase we get sleepy."

Sleep and memoryWhy do we need sleep? There is no good answer to thisqestion, bt there are a lot of hints. While the folkloreabot dreaming tells s that sleep may be important forcomplex mental fnction, it does seem to be a veryancient biological process: even flies deprived of sleephave disrptions of their memory!

Researchers divide sleep into stages based on thecharacteristic electrical waves that can be recorded

throgh the skll. The most well-known is the Rapid EyeMovement (REM) stage, and is associated with dreaming.Yet this occpies only 25% of sleep time. Delta-wave, orslow-wave sleep, is the deepest non-REM stage, whichoccrs early in the night, and is very important for health.

Getting enogh sleep is critical to maintaining memory aswe age. REM and slow-wave sleep each have distinctiveeffects on different types of memory and decision making.Disrptions of sleep can case memory to weaken.

Sleep and healingSleep is also known to be a general healer. Not only doesit promote the rejvenation of the immne, skeletal,

msclar, and nervos systems, bt it is literally a healer in

1-2 Sleeping yor way to health3 Florida friends welcome Fondation4 Q & A: Harvard Medical stdents

5 Patient profile: Trsting heart healthCan statins affect my memory?

continued on page 2

The Lown Fondation is gratefl to the Rodgers Family Foundation for their steadfastspport of or work for nearly a decade. Their contribtions have enabled s to advance or

patient-centered model of health care here in Brookline, across the contry, and arond the world.

Sleeping yor way to health

Vikas Saini, MD

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(contined from page 1)

Sleeping yor way to health

Vikas Saini, MD

poor sleep. It makes sense that these changes of sleep,GH, cortisol, stress, and health are interrelated as we age.Importantly, yong men given drgs that increase deepsleep have increases in nighttime secretion of GH. Perhapsif we cold increase deep sleep in the elderly, we mightenhance GH secretion in them as well, restoring a yongerhormonal pattern (Hint: exercise increases deep sleep).

Am I getting enogh sleep?One key test of adeqacy of sleep is daytime sleepiness. Ifyo are not tired or sleepy dring the day, it is nlikelythat there is anything seriosly wrong. Bt what is thebest amont? Research involving thosands of people hasshown that the amont of sleep one gets correlates withlongevity and it seems that seven hors or so is thesweet spot. A lack of sleep (five hors or less) can morethan doble the risk of cardiovasclar death while toomch sleep (eight hors or more) is associated withincreased non-cardiovasclar death. Too little sleep seemsto be a particlar risk factor for weight gain, hypertension,and type 2 diabetes.

Factors that inflence sleepFood

Althogh tryptophan, the amino acid in Thanksgivingtrkey dinner, has become a legendary sleep indcer,there doesnt seem to be mch hard evidence to spportits claims. On the other hand, a very fll stomach by itselfwill enhance sleepiness.

Caffeine

Caffeine is one of the major clprits in the sleep disrptionof modern life even more so in recent years when thepace of mltitasking and over-schedling has beenaccelerating.

Tea has far less caffeine instead it has theophylline,which doesnt stimlate the brain as mch. Switchingfrom coffee to tea may help redce sleep disrption. Forsome people even one cp of coffee in the morning isenogh to case a middle-of-the-night awakening

followed by insomnia. This can be deceptive since oftenthey have no troble falling asleep at bedtime.

Exercise

Common sense tells s that plenty of exercise shold helpyo get to sleep and stay asleep most people whoexercise report improved sleep. However, it may take pto three weeks for the fll effects to be noticeable, so anexercise program needs to be taken on faith for the firstmonth. The most beneficial effect on sleep comes fromaerobic endrance training and exercise that lasts formore than an hor.

Alcohol

Some of the important healing benefits of sleep areredced by alcohol consmption. While it cases peopleto fall asleep faster, alcohol increases the amont oflighter REM sleep throgh a rebond effect when itwears off in the middle of the night. This shortens slow-

wave sleep earlier in the night and redces overall sleeptime. As a reslt, it can case more sleepiness dring thenext day.

Melatonin

The body creates a chemical called melatonin, which maybe a helpfl sleeping aid in certain sitations like jet lag,shift work, and general insomnia. I sometimesrecommend melatonin for my patients particlarly postsrgical patients when they are recovering from ahospitalization as a way to restore a more normal cycle.

Althogh there are some who take melatonin nightly,and some on the internet who tot it as an anti-aging

cre-all, I generally advise my patients to se it sparinglyin specific settings since we dont really know the longterm effects of daily se. For jet lag the optimal doseappears to be 5 mg, bt for insomnia, a dose of less thanone tenth of that (0.3 mg) appears adeqate.

Tips on sleep

If yo can, aim for seven hors of sleep a night. Sinceyo cant control when yo wake p go to bed earlyenogh to get seven hors.

Exercise: While aerobic exercise is better for sleep than

weight training, exhastive, high-intensity exercise forlong periods of time can disrpt sleep it decreasesREM sleep and increases wakeflness.

Jet Lag: Take melatonin close to the target bedtime atthe destination (10pm to midnight). The optimal doseseems to be 5 mg above that doesnt seem to addmch. Reglar melatonin seems to work better thanslow-release.

Caffeine: Before yo discont that morning cp ofcoffee as casing yor insomnia, abstain for severaldays (on a weekend if yo have a weekday job!) and

see what happens.

Alcohol: If yo enjoy that glass of wine, I sggesthaving yor drinks with lnch or in the afternoon tooptimize yor night time sleep cycle.

Or common sense and folk traditions are good gidesto nderstanding sleep. Now science is filling in manydetails. Paying attention to sleep is an important, thoghmch-neglected part of achieving optimal health andfnction especially as we age. Like so many areas oflife, the secret of getting proper sleep is to trainorselves into healthy, habital rotines. Sweet dreams!

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DEVELOPMENT

Traveling to Florida to promote theFondations heart health messageThe week of March 7th was a snny one for the LownFondation. Florida friends of the Fondation welcomedDr. Vikas Saini, Dr. Charles Blatt, and Andi Brown intotheir commnities for pdates on heart health and thework of the Fondation.

The Naples home of Jdy Hale, a longtime LownFondation friend, was the setting for a talk by Dr. Saini,who noted that foods and activities that preventcardiovasclar disease are also anti-aging. He remindedgests that the Fondation is contining to advance Dr.Lowns work in advocating for a more patient-centeredway of delivering health care.

Two days later, Ira and Jdy Rosenberg also dear

friends of the Fondation welcomed gests to theirhome in Boca Raton. Dr. Blatt spoke on avoidingnnecessary care sch as srgeries, while Andi Brownreminded attendees of the vale of their contribtionsby spporting activities that inclde a nationalconference on overtreatment in health care; theexpansion of or Second Opinion Program; spreadingthe word abot the Lown model and heart health bestpractices throgh social media; redcing the globalbrden of cardiovasclar disease throgh ProCor; andgiving the Loise Lown Heart Hero Award.

Yo can help advance better health care with a generos

donation to the Lown Fondation. Yo can mail a checkto Lown Fondation, 21 Longwood Avene, Brookline,MA 02446, or give online by clicking the Donate Nowbtton on or homepage at www.lownfondation.org.For more information abot how yo can help, pleasecontact Andi Brown, arbrown1@partners.org, 617-732-1318, ext. 3350.

L O W N F O R U M 3

Naples host Judy Hale with Dr. Saini

Boca Raton hosts, Judy and Ira Rosenberg, with Dr. Blatt

Boca Raton guests Melvin and Beverly Shapiro

Boca Raton guests Paula and Allan LandauBoca Raton guests Dr. Norton Klotz, and Joan and Richard Carroll

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QuESTION & ANSWER

Harvard Medical stdentsThe Lown Center provides two different trainingopportnities to Harvard Medical School stdentsthroghot the year: a year-long Primary Care Clerkshipand a month-long Clinical Cardiology in the Otpatient

Setting corse, which is directed by Dr. Blatt. We recentlycaght p with three Harvard Medical School stdentswho are crrently training at the Lown Center.

Jeffrey Wessler, a 3rd year stdent with Dr. Bilchik, grewp in Massachsetts, and after stdying Chemistry atWilliams College, he fond himself prsing an MPH at theuniversity of Cambridge in England. Dring college,Jeffrey also spent six months in Soth Africa working onthe prevention of child-to-mother transmission of HIV.

Andrew Chao, originally from Florida, is a 4th year medicalstdent with Dr. Blatt. Andrew is hoping his interest in

global health will take him otside of the uS once he isdone with medical school. If he has anytime left over fromschool and work, Andrew enjoys cooking.

Edmund Anstey, a 3rd year stdent with Dr. Saini, isplanning on working in some of the more remote regionsof Gyana, where mch of his family is from. Edmndenjoys volnteering with peer mentorship programs andhe considers himself a cookie connoisser.

Why did you choose a careerin medicine?

JW: As a science nerd withan interest in epidemiology,

a career in medicine offereda means to se science toredce sffering andimprove poplation health.

AC: Im interested in medicine becase its a field where Ican interact with people and help gide them throghsome difficlt decisions and times in their lives.

EA: What most appealed to me abot practicing medicineis that at its core, I believe it to be a service profession.Physicians are asked to se their knowledge andexperience to help patients physically and emotionally, a

calling that I believe to still be noble in its ends.

Why did you choose to come to the Lown Center?

AC: Dring my inpatient rotation at a hospital I didnt getto see what happens to patients before or after theirvisits. So mch care has shifted to the otpatient setting,bt so mch of or training is inpatient. I heard goodreviews abot the Lown corse from my classmatesdring my hospital rotation.

What is unique about working at the Lown Center?

EA: There is an emphasis on trst when treating a patient.In hospital settings the doctors are very hands-on, bt at

the Lown Center, the doctors work with the patient todevelop a treatment plan and trst that the patient willfollow throgh on their own.

AC: The philosophy is different. The focs is on non-interventional procedres. If I didnt do this training, I

wold have left medicalschool with a mch more

invasive model of care. Whentheres no clear clinicalgideline to follow, thephilosophy takes over. Also,people talk abot patientsmore here.

JW: The atmosphere and attitde of patient care isfndamentally different from other clinical experiences.The patient/physician relationship is based on mtalrespect patients are viewed as more than jst a seriesof laboratory data or exam findings. There is athoghtfl approach to management plans that

incorporates many aspects of a patient's story and past,and as a reslt each plan is different and individallytailored.

What have you learned here that you didnt learn in theclassroom or at other offices?

EA: A good relationship with a patient can dictate theircorse of care. We get to see how the doctor talks totheir patient and how they respond to the patient todevelop good rapport. This program stands ot becaseof the doctors willingnessto wait, and to give thepatient a shot.

JW: I learned jst howimportant it is to get toknow yor patient.Bilding relationships iscritical to the Lown Center philosophy, and something Ihope to always take with me in a ftre career.

Would you recommend this training course?

EA: Yes, my experience here has proven to me this styleof management works. Yo can see how individalphysicians practice and how patients respond to that.Yo see how the decisions were made; yo read notes inthe hospital, bt yo get to make the notes here.

AC: Yes, especially becase of the way the Lown Centerapproaches the patient/physician relationship. Becasethe emphasis is on behavior change, the patientsbecome more involved in their own care.

What are your interests/future plans?

JW: I plan to apply to a medicine residency followed bya cardiology fellowship. The Lown Center has helpedsecre my belief that cardiology offers a satisfyingclinical career with rich patient relationships and theability to add vale to the health of or commnity.

Edmund and Dr. Saini

Andrew and Dr. Blatt

Jeffrey and Dr. Bilchik

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PATIENT PROFILE

Trsting in yor heart healthWhen he was only 28, Brian Bishop sffered a heartattack. His doctor inserted a stent and sent him off with acardiac cocktail of 11 pills to take for the rest of his life.

Bt Brian wanted answers. Whythe heart attack? Why the stent?And why so many pills? His doctorseemed to lack the time or interestto answer of any his qestions.

Brian (who was 511 and 288ponds) had seen his mch olderroommates in the intensive carenit and told himself, Im 28, I

dont belong here. He vowed to change his life and,retrning home, emptied his pantry. He started walking jst a block at first, bt soon he was walking as mch as a

mile. And he fond Dr. Bilchik and the Lown Center.Ill never forget Dr. Bilchiks opening statement: Orjob is based on trst. Yo have to trst that what Imtelling yo will make yo better, and I have to trst thatyoll do what I say. Together, well make yo healthier

than yove ever been. I trstedhim implicitly.

Dr. Bilchik explained exactly whathappened to Brians heart. Healso told Brian he didnt need allthose medications. He began toeliminate some and redce the

dosages of others.

Brians walking trned into a five-mile jog. He started tobike, and then took p swimming. A friend sggested hetry a triathlon. This was jst a year after his heart attackand by then he had already lost 112 ponds. Initially Brianwas afraid he might die dring the triathlon, bt Dr. Bilchikencoraged him on, Try it. I dont want to hold yoback.

Its been six years since Brian came to the Lown Center,and seven years since his heart attack. He nowparticipates in the Iron Man Triathlon 146 miles ofswimming, biking, and rnning a fll marathon. And hesdown to two pills a day a low dose statin and an aspirin.

If it wasnt for Dr. Bilchik and how he approached me asan individal, I woldnt be doing Iron Man events today.He gave me the confidence to try anything.

Brian finishing a triathlon

Brian before training

QuESTION FROM A PATIENT

Can statins affect my memory?

Fred Mamya, MD, PhD

In Febrary of 2008, a headline from theWall Street Journal read: Can a drgthat helps hearts be harmfl to thebrain? Since then, we have contined torespond to nmeros qestions frompatients regarding this headline. I wantto begin by emphasizing that in properly

selected patients across all ages, statins have beenshown to redce overall mortality, heart attacks, andminor strokes by a significant margin. Statins have manybiological effects other than lowering total and LDLcholesterol. These inclde lowering inflammation,improving the fnction of cells that line blood vessels,and lowering the risk of blood clots.

Unfortunately, we do not yet have a clearunderstanding of the interaction betweenstatins and memory.

Over 25 million patients se statins worldwide. Majorpatient concerns inclde mscle inflammation andmemory loss. As of 2008, there were over 5000 reportedcases of memory problems in the literatre. The biggest

confonder is that memory problems afflict an estimated10% of the poplation older than 65 years. Patients in thisage grop are also more likely to be taking other drgsthat alone or in combination may affect memory.

A literatre review in 2003 fond 60 cases of statin-associated patient reported memory loss. The changessally occrred within the first two months after theinitiation of therapy, and abot half the patients noted animprovement when the statin was discontined.However, a recent large randomized trial of over 20,000patients condcted over five years showed a similar rateof cognitive impairment in patients taking simvastatin(23.7%) and a placebo (24.2%). The major criticisms of thisstdy were that it did not set ot to test the hypothesis ofwhether statins affect memory, and that the rigor of thememory tests was qestionable.

No causal link between statins and memory losshas been conclusively demonstrated.

However, if yo feel that yor memory has changed afterthe initiation of a statin, please discss the isse with yordoctor. Statins that are water-solble, sch as pravastatinand to a lesser extent rosvastatin, are less likely to crossthe blood-brain barrier and may be an option worthtrying. It is reasonable to discss trying to lower the doseof yor crrent medication, or consider other alternativeapproaches to lowering yor LDL.

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MEET THE LOWN CENTER STAFF

Nrse and Medical Assistant TeamWhen visiting the Lown Center, the first part of yorappointment will likely be condcted by a member of orNrse and Medical Assistant team. This team is anessential part of the Lown Center and or commitment to

patient care. Their range of dties incldes: preparingcharts, bringing patients to exam rooms, reviewingmedications, checking vital signs, performing blooddraws, checking pacemakers, helping with prescriptions,and answering rgent patient calls. Meet the team:

Helene Glaser, RN is a cardiac nrse and oversees theMedical Assistants at the Lown Center. She earned herdegree in nrsing from Boston City Hospital School ofNrsing in 1966. In 1976 Dr. Tom Graboys persadedHelene to join the Lown Grop to work in the arrhythmiaclinic. Now in her 36th year with the Grop, she lovesworking at the Lown Center becase of the high level of

care provided to patients. She greatly appreciates that theLown physicians are foremost interested in patient careand treating their patients as people and not jst a heartproblem. Helenes favorite activity is taking day tripswith her hsband on their Harley motorcycles.

Sharon Cullinane is a Medical Assistant who has beenwith the Lown Center for ten years. She earned a BS inEnvironmental Sciences and a degree in MedicalAssisting from Framingham State College. Originallyfrom Brookline, she is now raising her two boys (ages 13and 17) here as well. In her spare time, Sharon enjoysjogging, walking, riding her bike, and reading.

Christina Fowler is a Medical Assistant who joined theLown Center in 2008. Born in Massachsetts, Christinawas raised in Jamaica ntil age five and then moved toMalden, MA with her family. She received her associatesdegree from Labore College, and is crrently enrolled intheir nrsing program. Christina enjoys the family-oriented environment created by the Lown Center staff.Otside of work and school Christina enjoys Zmbaclasses and spending time with family and friends.

Elena Popkova is a Medical Assistant who has been withthe Lown Center for five years. She enjoys the friendlyand spportive work environment created by the staff

and physicians. Originally from Siberia, she moved to theunited States 14 years ago, bt retrns home everysmmer to visit her family. Elena enjoys spending timewith friends and taking hot yoga classes. Her favoritewinter activity incldes a visit to the sana immediatelyfollowed by a jmp in the snow!

PROCOR

Recognizing heart health sccess in

the developing worldBrian Bilchik, MD

Heart disease is the leading case ofdeath worldwide it is responsible forone in three deaths globally each year.Nearly 82% of CVD-related deaths occr indeveloping contries. Recognizing thisbrden, the Loise Lown Heart HeroAward was created in 2007 to honor

innovative, preventive approaches to cardiovasclarhealth in developing contries and other low-resorce

settings.

The Award is given annually in recognition of therole that Louise Lown, Dr. Lowns wife, had on hiscareer in health promotion.

The Loise Lown Heart Hero Award aims to identifyinnovators who have an impact, are able to mobilizepeople, and edcate their commnities to make a change.Previos winners inclde: the Childrens Program of theHeart and Stroke Fondation of Soth Africa, which helpsyong children develop heart healthy habits by teaching

them how to grow vegetables for their daily meals; BeAlive with Yor Heart, a grassroots effort in uganda thatpromotes heart health from childhood throgh old age;and Olavarra: Tobacco Free City, a city-rn, commnity-focsed tobacco advocacy, edcation, and spportprogram in Argentina.

The 2008 award recipient, Dr. Toakase Fakakovikaeta,the sole pediatrician in the Soth Pacific island nation ofTonga, was recognized for initiating a program to screenprimary school children for rhematic heart disease(RHD) and provide early, effective treatment. As a resltof the Award pblicity, The Lancet, a leadinginternational medical jornal, pblished a featre articleabot her work. The article was discovered by the WorldHeart Federation, leading to new partnerships andplacing RHD on the global health agenda.

Every year we receive many applications from all overthe world that deserve the global visibility andopportnities for development that the Award brings.The Lown Cardiovasclar Fondation Board of Directorsand ProCor leadership engage in a dynamic process ofnarrowing the field of many deserving programs downto one Award winner. We are crrently reviewingapplications for the 2011 Loise Lown Heart Hero Award,which will be awarded in early smmer.

For more information, or to help spport the Award,please visit the ProCor website at: www.procor.org.

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Thank yo for yor spportThe Lown Cardiovasclar Research Fondation promotes carcare that advocates prevention over costly, invasive treatmeand restores the relationship between doctor and patient.

Yor financial spport allows s to contine or work and caor heart health message to local, national, and global adieWe greatly appreciate any donation yo are able to make.

Yo can donate online at or website (www.lownfondationor mail yor donation to 21 Longwood Avene, Brookline, MA02446. Please make checks payable to the Lown CardiovascResearch Fondation. For more information abot spportinFondation, please contact Andi Brown, Director of Developmat arbrown1@partners.org or 617-732-1318 (x3350).

Edcational opportnitiesInterested in hosting a lectre on a heart health topic by oneor physicians at yor worksite or commnity organization? Pcontact Jessica Gottsegen at jgottsegen@partners.org or 6171318 (x3805).

Receiving the FormIf yo wold prefer to receive the Lown Form by email, sendfll name and email address to info@lownfondation.org.

LOWN CARDIOVASCuLAR CENTER

N e w s B e a tOn March 1, 2011 Dr. Tom Graboysparticipated in Brigham and WomensHospital Center for FacltyDevelopment & Diversity LetsPrepare Form for Caregivers of OlderAdlts. Dr. Graboys discssed hismemoirLife in the Balance on April 6,

2011 at the Atrim at Drm Hill, an assisted living facility inNorth Chelmsford, MA.

ProCor and Lown Foundation staff attended theconference: The long tail of global health eqity: Tacklingthe endemic NCDs of the bottom billion at HarvardMedical School on March 2-3, 2011. The conference washosted by the Harvard School of Pblic Health, Partners inHealth, the NCD Alliance, and the Department of GlobalHealth and Social Medicine at Harvard Medical School.Please visit www.procor.org to learn more.

Dr. Fred Mamuya was a gest speaker at Linden PondsRetirement Living in Hingham, MA on March 7, 2011. More

than 50 people attended this lectre where he discssedthe topic of Second Opinions.

Dr. Brian Bilchik has been nominated to serve anothertwo years on the Brigham and Womens HospitalPhysician Concil.

Mychal Voorhees, a gradate commnications consltantworking with the Lown Fondation, gave a presentationon the otreach and marketing campaign she developedfor ProCor at Emerson College on April 26, 2011. Thecampaign seeks to engage African medical schoolstdents and professors in ProCors global network.

Board of DirectorsNassib Chamon

Chairman of the Board

Vikas Saini, MD

PresidentBernard Lown, MD

Chairman Emeritus

Thomas B. Graboys, MDPresident Emeritus

Patricia AslanisCharles M. Blatt, MD

Joseph Brain, SD

Janet Johnson BllardJ. Breckenridge Eagle

Carole Anne McLeod

C. Brce MetzlerBarbara H. Roberts, MD

Ronald Shaich

Robert F. WeisAdvisory BoardMartha CrowninshieldHerbert Engelhardt

Edward Finkelstein

William E. FordRenee Gelman, MD

Barbara Greenberg

Milton Lown

John R. MonskyJeffrey I. Sssman

David L. Weltman

CONTACT US

Lown Cardiovascular ResearcFoundation21 Longwood Avene

Brookline, MA 02446 uSA(617) 732-1318info@lownfondation.org

www.lownfondation.org

www.lowncenter.orgwww.procor.org

Lown Cardiovascular GroupBrian Z. Bilchik, MD

Charles M. Blatt, MD

Wilfred Mamya, MD, PhD

Shmel Ravid, MD, MPHVikas Saini, MD

Lown Forum Editorial StaffAndi Brown

Jessica Gottsegen

Benn GroverCladia Kenney

2011 Lown FondationPrinted on recycled paper with soy

based ink.

Meet the Staff (left to right): Helene, Sharon, Elena, and Christina

New patient appointments availableNew patient appointments are crrently available. Ifyo wold like to make an appointment with one ofthe Lown Grop cardiologists, please call 617-732-1318and select option 1.

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Lown Cardiovasclar Research Fondation21 Longwood AveneBrookline, Massachsetts 02446-5239

Snlight and yor health

Shmel Ravid, MD, MPH

For centries the sn has beenworshipped, yearned after, and sng to. Ithas inspired everything from poetry toritals to spray-on tanning. Yo are mysnshine, my only snshine wroteLoisiana governor Jimmie Davis in 1939,coining the state's official tne (and

hmmed by contless toddlers and smitten lovers since).There's no qestion abot it: The sn is one importantstar. It is or primary sorce of energy, it spports life onthis planet, and it drives the Earth's climate and weather.It is only natral that as the crocses begin to poke ot ofthe stern winter grond, we anticipate a snny smmerahead. And so we shold review the potential healthimplications of sn exposre.

While moderate snlight exposre is beneficial, excessiveand nprotected exposre may reslt in serios long-termhealth implications. ultraviolet (uV) light, a component of

snlight, is invisible electromagnetic radiation that hasboth beneficial and damaging effects on health. Dringsnlight exposre, uV light penetrates the skin andgenerates pre-vitamin D, which is then metabolized by theliver and kidneys into active vitamin D. Adeqate levels ofvitamin D are needed to maintain bone health. The hmanbody cannot prodce vitamin D and so we depend onotside sorces. Vitamin D is nicknamed the snshinevitamin becase we receive most of or vitamin D fromthe sn. Moderate sn exposre (e.g. 10 mintes in thesn with exposed hands, arms, and face, several days aweek) will get yo plenty of vitamin D. Yo can also get

vitamin D from foods sch as fortified milk, grains, andocean fish. However, experts disagree on whatconstittes adeqate vitamin D blood levels and whethevitamin D spplements shold be prescribed rotinely.

Bright, fll-spectrm light exposre is also shown toimprove mood and alleviate symptoms of depression another benefit of moderate exposre to snlight.

Prolonged sn exposre can reslt in snbrns,prematre skin aging, and higher risk for skin cancers.Cmlative sn exposre can case skin cancers sch asbasal cell and sqamos cell cancer in areas of the bodytypically exposed to the sn. Intense, intermittent snexposre can case melanoma, the most serios skincancer, in areas of the body less freqently exposed tothe sn. Childhood exposre is particlarly hazardos.

Staying healthy in the sn

Althogh getting some sn is important to yor health,yo want to make sre yo dont get too mch.

1) Avoid excessive sn exposre is the key, especially in

children and people with fair skin.

2) Minimize exposre when the sn is at its strongest,stay in shaded areas, and se protective clothing (schas large brimmed hats, long sleeved shirts, and pants).

3) Snscreen is mandatory, with SPF of at least 30.Generosly apply snscreen to all exposed skin andreapply after swimming, sweating, or drying off.

4) Tanning beds are not recommended.

Have fn bt remember to be safe in the sn.

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