Cardiovascular diseases are the world's leading cause of disability and death, and are responsible for nearly a million deaths each year in the U.S., and new research suggests the risk of stroke and other life-changing health events are not solely influenced by our genetics and family history.

Dr. Sanjay Rajagopalan, director of the Cardiovascular Research Institute at the Case Western Reserve University Reserve School of Medicine, said other factors are involved.

"Things in your environment might also play a role in raising the likelihood of somebody having a stroke," Rajagopalan pointed out. "Those factors are things like air pollution, certain types of toxins in the environment, mostly chemicals, for instance."

May is Stroke Awareness Month, and health professionals are reminding Americans tobacco use, lack of physical activity, high blood pressure, high cholesterol and diabetes are major risk factors to be addressed.

Signs someone could be having a stroke and needs immediate emergency care include loss of speech, vision or the inability to move their arms or legs or maintain balance.

Scientists said turning the tide on pollution-related strokes and other cardiovascular disease will require large-scale reduction of air pollution by rapidly transitioning to clean energy sources such as wind and solar.

Rajagopalan added the good news is genetics are not a trap into which we are hard-wired.

"It's almost like genetics loads the gun, but the environment pulls the trigger," Rajagopalan stressed. "It's almost as if you are programmed or primed, but nothing will happen unless there are other factors that conspire with your loaded genetics."

Exposure to air pollution can be at least partially mitigated by installing hepa and other air filters in homes, and Rajagopalan advised getting more exercise, reducing fatty foods and adding more vegetables to your diet can also tilt the odds in your favor.

"If you're genetically programmed to have a condition but you work around it -- by exercising, eating right -- you can decrease the risk that genetics confers on you," Rajagopalan concluded.


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Open enrollment begins soon for employer-sponsored health insurance for coverage starting Jan 1.

Most people will have multiple options to choose from. Some are complex, so now is the time to do your research. According to the website USA Facts.org, about 7.5% of Indiana residents do not have health insurance. Experts say it is important to shop for plans, see exactly what they offer, and if a choice fits a family's needs and budget.

Dr. Rhonda Randall, chief medical officer of Employer and Individual for UnitedHealthcare, said understanding some of the basic insurance jargon is a good place to start.

"Things like deductibles, copays, coinsurance, premiums, etc.," Randall outlined. "Be familiar with what those terms are and what the costs associated with each one is for the plans that you're offered and the plans that you're considering."

Randall advised paying close attention to out-of-pocket costs and monitoring changes which can occur within a plan each year. She suggested the online health insurance glossary Just Plain Clear, which UnitedHealthcare has compiled. In 2021, more than one-third of Indiana's population was covered by public health insurance funded by governments at the federal, state or local level.

Nearly 17% of Indiana's population is 65 or older and eligible for Medicare. But it does not cover everything, so most people also buy a supplemental policy for added coverage, and a prescription drug plan. The Medicare annual enrollment period starts Oct. 15 and ends Dec. 7, when people can get new coverage or change what they've had.

Randall noted UnitedHealthcare has also compiled an online guide to help people navigate those plans.

"Medicare beneficiaries want to make sure they're understanding and learning the difference between original Medicare -- Medicare Parts 'A' and 'B' -- and Medicare Advantage, Medicare Part 'C' and 'D,' the prescription drugs," Randall explained.

Randall encouraged Hoosiers to consider insurance plans including coverage for telehealth -- virtual 24-hours-a day, 7-days-a-week mental and behavioral health services, or management of chronic conditions, such as migraines, plus physical therapy and wellness visits.

Health care advocates are urging Gov. Gavin Newsom to sign four bills aiming to lower medical bills, improve transparency, and make health care more accessible.

Assembly Bill 665 would allow minors over age 12 to use Medi-Cal benefits for treatment they consent to on their own, while still allowing providers to involve a parent or guardian when appropriate.

Angela M. Vázquez, policy director for The Children's Partnership, said teens may avoid getting help if they have to give intimate details to their parents.

"Surveys show that making parental opt-in mandatory reduces the likelihood that teens will seek timely treatment, especially among LGBTQ+, and youth of color," Vázquez reported.

The bill would also allow Medi-Cal to cover services even if the youth is not a danger to him or herself or the victim of child abuse or incest. Opponents say the bill interferes with parental rights.

A second bill would stop surprise bills from out-of-network ambulance companies, instead requiring patients to pay only the in-network cost-sharing amount.

Danielle Miele, a mom from Citrus Heights, said after her teenage son tried to take his own life, the hospital transferred him via ambulance to a treatment center several hours away, resulting in a huge bill.

"Within a month we received an ambulance bill of over $9,000," Miele recounted. "Adding insult to injury, literally. Why is this practice commonplace? Why is it even considered acceptable?"

Debt collectors have objected to a section of the bill dealing with wage garnishment.

A third bill would add physicians' groups of 50 or more to the list of organizations required to make public financial data they report to two state agencies.

Sonia Pellerin, a health care worker in Sacramento and a member of the Service Employees International Union-United Healthcare Workers, said it is a matter of transparency.

"With health care costs rising, we all deserve to know where our health care dollars are going and what's driving up the costs," Pellerin contended. "Many times our patients are struggling to afford their health care. Those patients have the right to know how these medical groups are spending their money."

Medical groups have called the bill an unnecessary layer of regulation. A fourth bill would extend Medi-Cal's Comprehensive Perinatal Services Program from 60 days to 12 months postpartum. The program helps arrange housing and food assistance, job training, and breastfeeding support. Opponents cite budget concerns.


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In the wake of the devastating overdose epidemic in North Carolina, the state's Department of Health and Human Services is stepping up to aid families and provide resources for youths battling substance abuse disorders.

State data show in 2021 alone, overdose deaths in North Carolina spiked by 22%, and nationwide, teen overdose deaths rose by 20%.

Kelly Crosby, director of developmental disability and substance use services for the North Carolina Division of Mental Health, said recognizing many adults with substance use disorders start using during their teenage and young adult years, it is crucial to educate and support young people in preventing substance abuse and overdoses.

"In North Carolina, among kids 12 to 17 years old, around 5% had a substance use disorder in the past year," Crosby reported. "That's more than 41,000 kids."

Crosby pointed out the COVID-19 pandemic exacerbated mental health challenges and substance use, with increased reports of anxiety, depression and substance misuse.

Sara Howe, CEO of Addiction Professionals of North Carolina, said to help address youth substance use challenges, a range of resources are available in the state. Some resources include education, harm reduction and treatment and mental health support.

Howe noted parents can get additional help at AlcoholDrugHelp.org.

"They can look, they have a list of what they provide, what insurance they take, do they take Medicaid, do they take commercial insurance, and do they have intensive outpatient, residential," Howe outlined. "This is a resource that we have right in our backyard that we can take advantage of today."

Research from the Centers for Disease Control and Prevention showed other protective factors to youth substance abuse disorder are family engagement, conversations around the disapproval of substance use, and mental health support.


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