{"id":5913,"date":"2020-12-21T11:09:00","date_gmt":"2020-12-21T11:09:00","guid":{"rendered":"https:\/\/aspree.org\/aus\/?p=5913"},"modified":"2021-08-02T06:56:57","modified_gmt":"2021-08-02T06:56:57","slug":"meet-the-team-prof-mike-ernst","status":"publish","type":"post","link":"https:\/\/aspree.org\/aus\/meet-the-team-prof-mike-ernst\/","title":{"rendered":"Meet the team: Introducing a US ASPREE investigator"},"content":{"rendered":"\r\n<p>&nbsp;<\/p>\r\n\r\n\r\n\r\n<figure class=\"wp-block-image size-large is-resized\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-5916\" src=\"https:\/\/aspree.org\/wp-content\/uploads\/sites\/2\/2020\/12\/112918portraiternst_3-jg_4.jpg\" alt=\"\" width=\"825\" height=\"549\" srcset=\"https:\/\/aspree.org\/wp-content\/uploads\/sites\/2\/2020\/12\/112918portraiternst_3-jg_4.jpg 825w, https:\/\/aspree.org\/wp-content\/uploads\/sites\/2\/2020\/12\/112918portraiternst_3-jg_4-480x320.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 825px, 100vw\" \/>\r\n<figcaption><em>Above: Prof Mike Ernst is a US based investigator to the ASPREE project.<br \/><br \/><br \/><\/em><\/figcaption>\r\n<\/figure>\r\n\r\n\r\n\r\n<div id=\"toc_container\" class=\"no_bullets\"><ul class=\"toc_list\"><li><a href=\"#Meet_Professor_Mike_Ernst\">Meet Professor Mike Ernst<\/a><\/li><li><a href=\"#How_did_you_decide_to_start_or_be_a_part_of_this_research_topic\">How did you decide to start or be a part of this research topic?<\/a><\/li><li><a href=\"#Do_you_expect_official_guidelines_for_health_care_providers_to_change_based_on_the_research\">Do you expect \u201cofficial\u201d guidelines for health care providers to change based on the research?<\/a><\/li><li><a href=\"#How_did_researchers_measure_healthy_independent_lifespan\">How did researchers measure \u201chealthy independent lifespan\u201d?<\/a><\/li><li><a href=\"#What_is_the_background_of_the_other_authors_listed_on_the_3_recent_ASPREE_papers\">What is the background of the other authors listed on the 3 recent ASPREE papers?<\/a><\/li><li><a href=\"#Is_ASPREE_ongoing\">Is ASPREE ongoing?<\/a><\/li><li><a href=\"#How_have_you_worked_inter-professionally_during_the_ASPREE_trial\">How have you worked inter-professionally during the ASPREE trial?<\/a><\/li><li><a href=\"#Aside_from_the_recent_aspirin_study_what_other_research_have_you_been_part_of_that_changed_healthcare_in_some_way\">Aside from the recent aspirin study, what other research have you been part of that changed healthcare in some way?<\/a><\/li><\/ul><\/div>\n<h2><span id=\"Meet_Professor_Mike_Ernst\">Meet Professor Mike Ernst\r\n\r\n<\/span><\/h2>\r\n<p>Michael E. Ernst is a clinical professor at the University of Iowa (UI) College of Pharmacy Department of Pharmacy Practice and Science. He is a pharmacist and a senior investigator to the ASPREE trial.<\/p>\r\n<p>Following announcement of the main ASPREE results, Mike shared his experience of working on the major project.<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"How_did_you_decide_to_start_or_be_a_part_of_this_research_topic\"><strong>How did you decide to start or be a part of this research topic?<\/strong><\/span><\/h3>\r\n\r\n\r\n\r\n<p>I had always been interested in being part of a major clinical trial but was not interested in working on drug-company funded trials. I had previously worked on some hypertension-related projects with Richard Grimm, a well-known cardiovascular clinical trialist from the University of Minnesota, and when ASPREE was funded in the US (with him as the main US Principal Investigator [&#8220;PI&#8221;], he asked me if I would be part of the study. For me, it was being in the right place, at the right time, and knowing the right people.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>I\u2019ve benefited greatly over the years from interdisciplinary collaborations. ASPREE has perfectly blended my interest in research along with geriatrics.<\/p>\r\n\r\n\r\n\r\n<p>I originally began in ASPREE as just the site PI here at Iowa, but \u2026\u00a0 my role gradually increased and I was asked to join the International Steering Committee and International Executive Committee and now am one of the three main U.S. lead investigators for the extension. It\u2019s a great example of what can happen if you raise your hand, work hard and follow through.<\/p>\r\n\r\n\r\n<hr class=\"wp-block-separator\" \/>\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"Do_you_expect_official_guidelines_for_health_care_providers_to_change_based_on_the_research\"><strong>Do you expect \u201cofficial\u201d guidelines for health care providers to change based on the research?<\/strong><\/span><\/h3>\r\n\r\n\r\n\r\n<p>Yes. Aspirin is a widely used preventative agent for heart attacks and strokes, especially in people who already have existing cardiovascular disease or have had a stroke. However, less is known about its role as a preventative in otherwise healthy older adults, despite the fact that many healthy older adults assume they should take it.\u00a0Current guidelines from the United States Preventive Services Task Force (2016) acknowledge there is insufficient evidence to make a recommendation for or against aspirin use for primary prevention in adults 70 and older.<\/p>\r\n\r\n\r\n\r\n<blockquote class=\"wp-block-quote\">\r\n<p>\u201c\u2026 It makes no sense to take a medication if you are otherwise healthy, if that medication does not help you live longer and remain healthy and independent.\u201d<\/p>\r\n<\/blockquote>\r\n\r\n\r\n\r\n<p>ASPREE was a randomized, placebo-controlled trial conducted in 19,114 generally healthy older adults in Australia and the United States designed to see if initiating a daily aspirin could prolong a healthy independent life in adults 70 and older (65 for US minorities) who did not have a current medical indication for aspirin.<\/p>\r\n\r\n\r\n\r\n<p>Rather than focus specifically on cardiovascular events as the main outcome like other aspirin primary prevention trials, we were interested in \u2026 (whether) aspirin prolonged healthy independent lifespan. \u2026 We found [that it did not]. It caused more harm than benefit because it increased the risk of serious bleeding.<\/p>\r\n\r\n\r\n\r\n<p>Around the same time, ASPREE was published, there were two other studies of aspirin primary prevention in other populations (diabetics, and those considered at \u201cmoderate-risk\u201d) which also found increased harm with minimal or no benefit.\u00a0 Collectively, findings from ASPREE and these other trials will likely be incorporated into updated guidelines and I would expect to see much less aspirin use for primary prevention. \u00a0<\/p>\r\n\r\n\r\n<hr class=\"wp-block-separator\" \/>\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"How_did_researchers_measure_healthy_independent_lifespan\"><strong>How did researchers measure \u201chealthy independent lifespan\u201d?<\/strong><\/span><\/h3>\r\n\r\n\r\n\r\n<p>Information on healthy independent life was assessed throughout the trial via a number of different measures because we were interested in a unique, geriatrically-relevant endpoint: disability-free survival. That was ultimately defined by comparing the rates of death, dementia, and persistent physical disability in those randomized to aspirin compared to placebo over the course of the study.<\/p>\r\n\r\n\r\n\r\n<p>After all, it makes no sense to take a medication if you are otherwise healthy, if that medication does not help you live longer and remain healthy and independent.<\/p>\r\n\r\n\r\n<hr class=\"wp-block-separator\" \/>\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"What_is_the_background_of_the_other_authors_listed_on_the_3_recent_ASPREE_papers\"><strong>What is the background of the other authors listed on the 3 recent ASPREE papers?<\/strong><\/span><\/h3>\r\n\r\n\r\n\r\n<p>ASPREE is very much an interdisciplinary collaboration of individuals with interest and expertise in geriatrics and includes epidemiologists, geriatricians, neurologists, cardiologists, biostatisticians, geneticists, among many in other areas of medicine and epidemiology.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>I am the only pharmacist involved with ASPREE.<strong>\u00a0<\/strong>I think that, along with my broad background in family medicine\/geriatrics and research, has enabled me to become involved at a high level in the ASPREE study and able to contribute to many of the different focus areas of the study.<\/p>\r\n\r\n\r\n\r\n<p>These various analyses are all led by different individuals, but I am fortunate to lead some of them myself in my own areas of interest as well as and collaborate with others. \u00a0The exciting thing for me is the discovery of new knowledge, and often generating new questions at the same time.<\/p>\r\n\r\n\r\n<hr class=\"wp-block-separator\" \/>\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"Is_ASPREE_ongoing\"><strong>Is ASPREE ongoing?<\/strong><\/span><\/h3>\r\n\r\n\r\n\r\n<p>The work of ASPREE is continuing via an extension (ASPREE-XT), which is planned for 5 more years of observational follow-up of the participants even though the aspirin intervention itself has ended.\u00a0\u00a0While the main findings of the intervention in ASPREE have now been reported, we still have many additional analyses to complete to fully understand some of the secondary outcomes of the study as well as other questions (some directly related to aspirin, and others not as much) that the data collected in ASPREE can help answer the health trajectory of older adults.<\/p>\r\n\r\n\r\n<hr class=\"wp-block-separator\" \/>\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"How_have_you_worked_inter-professionally_during_the_ASPREE_trial\"><strong>How have you worked inter-professionally during the ASPREE trial?<\/strong><\/span><\/h3>\r\n\r\n\r\n\r\n<p>We have a great inter-professional working relationship among the study leadership. There are no silos\u2014we are all linked by our common interest in understanding how we can prolong healthy independent life in older adults, and maximizing the value of the ASPREE study to the broader scientific community.\u00a0Both inter-professionally across disciplines, as well as\u00a0internationally, the collaborations within ASPREE have been highlights of my career and have helped me grow as a researcher and clinician.\u00a0 I hope we can continue this work for many more years to come.<\/p>\r\n\r\n\r\n\r\n<h3 class=\"wp-block-heading\"><span id=\"Aside_from_the_recent_aspirin_study_what_other_research_have_you_been_part_of_that_changed_healthcare_in_some_way\">Aside from the recent aspirin study, what other research have you been part of that changed healthcare in some way?<\/span><\/h3>\r\n\r\n\r\n\r\n<p>I\u2019ve also done a lot of work in hypertension over the years.<\/p>\r\n\r\n\r\n\r\n<p>About 10 years ago, we published a novel study comparing [two hypertension drugs] that received a great deal of attention by the scientific community, and probably single-handedly revived interest in the clinical use of chlorthalidone. Despite being an important drug \u2026 chlorthalidone had fallen out of favor. People used hydrochlorothiazide \u2026 mistakenly because they assumed it was an equally effective drug. Our study found that it wasn\u2019t as effective and that chlorthalidone was more potent and effective.<\/p>\r\n\r\n\r\n\r\n<p>I was also part of Dr.\u00a0<a href=\"https:\/\/pharmacy.uiowa.edu\/directory\/person\/barry-l-carter\" target=\"_blank\" rel=\"noreferrer noopener\">Barry Carter<\/a>\u2019s early ground-breaking studies looking at pharmacist-physician co-management of hypertension, which has paved the way for current hypertension guidelines which now emphasize the need for a team-based approach to caring for patients with hypertension.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>Back then, the idea of pharmacist as immunizer was pretty maverick. &#8230; It&#8217;s a great example of what you can accomplish, even as a student.<\/p>\r\n\r\n\r\n\r\n<p>Lastly, as a student project while on community pharmacy rotation in Anamosa, Iowa back in 1996<strong>,\u00a0<\/strong>I helped establish one of the first community pharmacy influenza vaccination programs. Back then, the idea of pharmacist as immunizer was pretty maverick, and no one had really done it before.<\/p>\r\n\r\n\r\n\r\n<p>We established the need for greater access in the community, developed a collaboration with one of the local physicians, and implemented the program asone of the first in the state, if not in the country<strong>.<\/strong><\/p>\r\n\r\n\r\n\r\n<p>We subsequently published our protocol and results in JAPhA [the\u00a0<em>Journal of the American Pharmacists Association<\/em>]. It was one of my first publications, and that process probably helped plant the seed for my future interests in being so engaged in scholarship. While I\u2019m no longer active in the area of immunizations, I like to think that this work helped pave the way for what is now a commonly accepted, and successful, role in our profession. It\u2019s a great example of what you can accomplish, even as a student.\u00a0<\/p>\r\n\r\n\r\n<hr class=\"wp-block-separator\" \/>\r\n\r\n\r\n<p>Major funding for the ASPREE study in the United States has come from the National Institutes of Health and its branches.<\/p>\r\n\r\n\r\n\r\n<p>ASPREE would like to thank the University of Iowa <a href=\"https:\/\/pharmacy.uiowa.edu\/article\/qa-michael-ernst-about-future-aspirin-prescribing\" target=\"_blank\" rel=\"noreferrer noopener\">College of Pharmacy<\/a> for permission to reproduce this article here.<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Senior investigator, Mike Ernst talks about his research and experience collaborating on the largest primary prevention aspirin trial in older adults. <\/p>\n","protected":false},"author":2,"featured_media":8257,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"1200","footnotes":""},"categories":[17,18,16],"tags":[53,86,49],"_links":{"self":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts\/5913"}],"collection":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/comments?post=5913"}],"version-history":[{"count":16,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts\/5913\/revisions"}],"predecessor-version":[{"id":8260,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/posts\/5913\/revisions\/8260"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/media\/8257"}],"wp:attachment":[{"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/media?parent=5913"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/categories?post=5913"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/aspree.org\/aus\/wp-json\/wp\/v2\/tags?post=5913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}