Medical Students’ Discoveries
Feinberg students contribute to research in a variety of fields — and publish and present their discoveries on a national level.
Childhood Trauma’s Effect on Cardiovascular Risk
Entering medical school, Jacob Pierce, a third-year student in Northwestern’s MD/MPH Combined Degree Program, was interested in “investigating the intersection between social determinants of health and clinical medicine, and how I could impact both of those arenas as a physician.”
As the first author of a study that helps provide new insights into the connection between Adverse Childhood Experiences (ACEs) and cardiovascular disease, he is well on his way.
Using a prospective cohort of more than 3,000 participants, Pierce found that people exposed to the highest levels of childhood family environment adversity were more than 50 percent more likely to have a cardiovascular disease event over a 30-year follow-up, even after controlling for other risk factors.
Pierce, who conducted the research under mentor Joseph Feinglass, PhD, research professor of Medicine in the Division of General Internal Medicine and Geriatrics and of Preventive Medicine, recently presented his findings at the annual American Heart Association Scientific Sessions in Chicago.
One of the big questions Pierce’s research project has prompted is, “Okay, so now what?” he said. “We know that childhood trauma is associated with increased risk for cardiovascular disease — so now what can we do to prevent heart attacks and strokes from occurring? Cardiovascular disease is still the number one cause of mortality in the United States. As a physician, I hope to work on both the clinical and research aspects of cardiovascular disease prevention to try to move the needle on that statistic.”
Jacob Pierce, a third-year medical student who is also pursuing a master’s in public health, studies the connection between adverse childhood experiences and cardiovascular disease.
Local Food Environment and Heart Disease Risk
As an undergraduate student at Northwestern, third-year medical student Julie Kelman spent time in France learning about public health as part of her minor in global health. Studying the determinants of health abroad morphed into an interest in public health at home.
I wanted to combine my desire to engage in public health alongside my fascination with the pathophysiology of the heart,” she said.
She became curious about the interplay between the food environment of neighborhoods and its effect on the development of atherosclerosis.
Could a preponderance of fast food outlets and conveniences stores increase risk of cardiovascular disease for area residents?
Using data from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, Kelman investigated whether increases in the neighborhood density of fast food chain restaurants and convenience stores were related to the development of coronary artery calcification (CAC, a measure of atherosclerosis, or, the narrowing of arteries due to plaque buildup) over time. She found that middle-aged people with a 10 percent increase in the number of convenience stores in their neighborhoods were more than 30 percent more likely to develop CAC over a 10-year follow-up — even after controlling for a variety of health behaviors, including smoking, alcohol use and fast food consumption, as well as personal health characteristics such as blood pressure and diabetes.
“While a number of studies have linked neighborhood characteristics to the development of subclinical atherosclerosis, we are one of the first to investigate longitudinal associations of fast food chain restaurants and convenience stores with the development of CAC,” said Kelman, adding, “This research is significant because it supports the notion that cardiovascular health depends not only on the behavioral and biological characteristics of individuals, but also on the environments where people live.”
Kelman conducted the research, which was published in the Journal of the American Heart Association, under mentor Kiarri Kershaw, PhD, MPH, ’12 GME, associate professor of Preventive Medicine in the Division of Epidemiology.
Julie Kelman, a third-year medical student, investigated the link between neighborhood food environment and the development of coronary artery calcification.
Role of Microbiome in Arterial Injury Response
The gut microbiome plays a role in a variety of processes, including inflammation and wound healing.
Now, another of its roles has been uncovered by a team including Kelly Wun, a fourth-year medical student (who, at press time, found out he will complete his residency in orthopaedic surgery at Northwestern). He was the first author of a study (published in the journal PLOS ONE) demonstrating the role the microbiome plays in the development of restenosis, in which arteries re-close after a previous intervention to clear blockage. The discovery was made in the lab of Karen Ho, MD, assistant professor of Surgery in the Division of Vascular Surgery.
The team used germ-free mice, raised in completely sterile conditions, and thus lacking all microbiota. The scientists then compared the arterial injury response in the germ-free mice with a group of conventional mice. They discovered that the germ-free mice developed significantly less neointimal hyperplasia (a form of scarring which is a major cause of restenosis) than the conventionally raised mice — illustrating the influence of microbiota on the arterial injury response. The findings suggest that modulating microbiota may offer a novel approach to preventing restenosis in patients, and Ho’s laboratory is continuing to investigate other ways microbiota can impact inflammatory pathways after arterial injury.
“The microbiome is still a fairly unexplored field and lends itself to a lot more questions,” Wun explained. “An understanding of how the microbiome affects inflammation and these inflammatory pathways can represent potentially new therapeutic targets.”
Kelly Wun, a fourth-year medical student, dedicated a research year to completing the project under the mentorship of Karen Ho, MD, assistant professor of Surgery in the Division of Vascular Surgery.
Largest Study of Medical Students’ Views on ACA
Medical students have strong opinions about the Patient Protection and Affordable Care Act (ACA), yet their views on the subject have not been charted since the 2016 presidential election and the elimination of key ACA provisions. Fourth-year medical student Jourdan Rook, along with fellow medical students, Jacob Pierce and Antoinette Oot, and a team of students and faculty at six other medical schools, set out to get those voices heard, and the results of the study were published in Academic Medicine.
According to Rook, the study shows that medical students want an active and vocal role in the formation of health policy. “Nearly nine in 10 students indicated that addressing health policy is a professional responsibility,” he said. “This is a 30-percentage point increase from only three years prior.”
Conducted under the mentorship of Bruce Henschen, ’12 MD, MPH, ’15 GME, assistant professor of Medicine in the Division of General Internal Medicine and Geriatrics, this was the largest study of medical student opinions regarding the ACA since the 2016 election. In total, 1,660 medical students from seven medical schools across the country responded to the survey. Results indicated that nine in 10 support the ACA and eight in 10 support the individual mandate.
“While the goal of research is to improve the world in which we live, it is a pleasant side effect that it improves us as investigators and physicians,” said Rook.
Jordan Rook, a fourth-year student, conducted a large survey on medical students’ views on healthcare reform and political engagement, receiving more than 1,600 responses and publishing the findings in the journal Academic Medicine.