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Renown Health President and CEO Tony Slonim, MD, DrPH, discusses efforts nationwide to develop a more effective and efficient way to deliver care. explains the benefits of Renown Health’s population health study with the Desert Research Institute and 23andMe.

Read More About CEO Blog: Improving Health Through Genetics and Big Data

As the Healthy Nevada Project expands to 50,000 study participants, researchers are sharing the health insights gleaned from the pilot phase of the project.   Air pollution is a major health factor affecting northern Nevadans, according to data gathered by researchers in the pilot phase of the Healthy Nevada Project, one of the largest population health studies in the country. Today, the project — which began 18 months ago as a partnership between Renown Health and the Desert Research Institute — is expanding to add 40,000 additional participants bringing total enrollment to 50,000 Nevadans. “We are thrilled to share the first insights from our 10,000-person pilot phase and discuss how we will begin using those results to improve patient care,” says Anthony Slonim, M.D., Dr.PH., FACHE, president and CEO of Renown Health and president of Renown Institute for Health Innovation, a collaboration between Renown and DRI. Healthy Nevada Project Pilot Phase — and What Happens Next The pilot phase of the Healthy Nevada Project proved Nevadans are excited to know more about themselves and want to contribute to research that could improve health outcomes for the entire state. The pilot phase enrolled 10,000 participants in less than 48 hours and DNA sample collection from each participant was completed in just 69 working days. Based on pilot phase data, researchers have seen increased use of regional healthcare services correlated with fluctuations in air quality and so-called “bad air events” such as wildfires and atmospheric inversions. In phase two, Renown IHI will evaluate possible links between genetics and increased susceptibility to respiratory ailments. Study researchers also announced care providers and scientists will begin working on a number of clinical programs and scientific studies focused specifically on Washoe County’s high age-adjusted death rates for heart disease, cancer and chronic lower respiratory disease. Collectively, these conditions among local residents stand at 33 percent above the national rate. In the coming months, Renown IHI will begin providing advanced calcium score screenings to pilot phase participants at higher risk for cardiovascular disease. This will allow researchers to examine the link between genetics and calcium buildup in the heart. Researchers are also evaluating future studies focused on age-related macular degeneration and breast cancer risks in northern Nevada.   Pilot Phase Insights Fifty percent of pilot study participants responded to a comprehensive, socioeconomic survey, which revealed: High rates of lower respiratory disease in northern Nevada and co-morbidities such as diabetes and hypertension suggest air pollution in northern Nevada is a confounding and significant factor in health. Study participants had parents who died from cancer and heart disease at a higher rate than the age-adjusted national average. Study participants exercised less than recommended by the American Heart Association and expressed interest in receiving help with behavior modification using diet/nutrition and weight loss tools. In phase two, if study participants choose to complete a follow-up survey, they will have the chance to pick an additional health and wellness app specific to their individual genetic results. Learn More To see if you are eligible to participate in the study, to sign up for study updates and for full details on the Healthy Nevada Project, please visit HealthyNV.org.

Read More About Healthy Nevada Project: What We've Learned

Read about Jordan Stiteler, a local mom who says the Healthy Nevada Project provided insights into her family’s genetic makeup — and the likely cause of her dad and great grandfather’s deaths. Now she is changing her life due to her new diagnosis of familial hypercholesterolemia, which will allow her to take steps toward preventing the same fate. Jordan Stiteler’s dad died suddenly of a stroke nearly ten years ago — at only 45 years old. His grandfather died at age 40. Now through the Healthy Nevada Project’s no-cost genetic testing, she is closer to understanding why that may have happened. And she can take proactive steps to prevent the unhealthy symptoms that often lead to a stroke and heart problems. After getting her Geno 2.0 by National Geographic ancestry report, Stiteler got a call from Renown Institute for Heart & Vascular Health Cardiologist and Renown IHI Director of Research, Dr. Christopher Rowan. “They told me that I have FH, which is familial hypercholesterolemia,” she said. “I have genetically very high cholesterol because I have a non-functioning gene that doesn’t get rid of my cholesterol like a normal body would.” Familial Hypercholesterolemia: Simple Life Changes Dr. Rowan told Stiteler it is curable with medication and a change in lifestyle. Stiteler has embraced healthy lifestyle changes by exercising more and eating healthier. “It is so important. Being a mom, I think you have so much more to live for. Having this information has changed my life.” Stiteler feels confident FH affected her Dad. “It is helping my family realize that we need to get tested,” she said. “There were big milestones that my Dad missed. He didn’t get to see either of us get married or have our children. That was huge.” She has become passionate about sharing the need to join the Healthy Nevada Project as her way of helping to prevent other families from possibly going through what she and her family did with the early loss of her Dad. In addition to FH results, the Healthy Nevada Project is returning clinical results on BRCA 1/2 (hereditary breast and ovarian cancer) and Lynch syndrome (colorectal and endometrial cancer) to consenting study participants. To sign up for the Healthy Nevada Project, go to HealthyNV.org. Join the Healthy Nevada Project Recruitment for phase two is still open. In addition to opting in to receive clinical results, participants receive National Geographic’s Geno 2.0 ancestry app at no cost. They also have the chance to pick an additional app for health and wellness after completing a follow-up survey. Learn More or Sign Up

Read More About The Healthy Nevada Project Changed My Life: A Local Mom's Story

The Healthy Nevada Project – a first-of-its-kind population health study combining genetic, clinical, social and environmental data – has reached another landmark milestone. The study is notifying study participants at risk for familial hypercholesterolemia, BRCA and Lynch syndrome. “I took part in the Healthy Nevada Project to find out my ancestry. I didn’t even realize the test could give me so much information,” says 29-year-old Jordan Stiteler, who was recently diagnosed with familial hypercholesterolemia (also known as FH) through the Healthy Nevada Project. “After my dad passed away suddenly at age 45, I learned I had high cholesterol but I didn’t know it was genetic and I didn’t get an FH diagnosis until last week,” Jordan explains. “I immediately changed my diet, started walking more and doing more cardio. I also set up an appointment with my primary care physician for the first time in a while. I’ve talked with my family and even strangers about testing since my diagnosis. I hope my story will inspire others to test and can save someone’s family from going through the same loss I did.” Healthy Nevada Project Notifying Patients of Familial Hypercholesterolemia Risks Jordan is among the first Healthy Nevada Project participants to receive clinical results from the genetic study led by Renown Institute for Health Innovation (Renown IHI) – a collaboration between Renown and the Desert Research Institute Foundation. This groundbreaking population health study is now reaching out to study participants like Jordan, who asked to be notified of health risks. If study volunteers choose, the project will also provide guidance on treatment and additional testing for family members who may also be at risk. The project is starting with the return of FH risks which is a genetic tie to high cholesterol. Just a few months ago, a paper in the Journal of the American College of Cardiology recommended genetic testing become the standard of care for patients with a definite or probable FH diagnosis. Jordan says she plans to have her young son tested as well. “This is the future of health; not just reacting to sick people, but a coordinated effort between innovative technologies, data-driven researchers, and responsive practitioners to deliver personalized interventions to identify, prevent and treat disease,” says Anthony Slonim, M.D., Dr.PH., FACHE, president and CEO of Renown Health and president of Renown IHI. “As care providers, we often don’t see patients until they’re already sick and that’s a difficult problem. By embracing personal genomics, we can accelerate the ability of researchers to access data and apply those learnings back to our health system sooner.” In the Months Ahead: Notification of BRCA1/2 & Lynch Syndrome Risks The Healthy Nevada Project will start notifying study volunteers at risk for other CDC Tier 1 conditions including hereditary breast and ovarian cancer syndrome (BRCA 1/2 genes) and Lynch syndrome in the months ahead. These conditions are the key focus for the Healthy Nevada Project. The reason: Because early detection and treatment will save lives, and these conditions are some of the most common. “This research allows us to look into cancer, cardiac, respiratory illness and beyond to identify underlying causes, assess real risks and eventually initiate appropriate preventive actions much earlier. Human subject research is often intangible to participants – we are treated as subjects. The Healthy Nevada Project is creating actionable information for our participants while engaging in leading-edge research on health determinants,” said Joseph Grzymski, Ph.D., associate research professor at DRI, principal investigator of the Healthy Nevada Project and chief scientific officer for Renown Health. Landmark Population Health Study Continues to Expand Since launching two years ago, the Healthy Nevada Project has quickly evolved and expanded. The pilot project enrolled 10,000 participants in just 48 hours in September 2016. In March 2018, phase two of project expanded to an additional 40,000 participants with genetic testing partner, Helix. Helix’s genomic sequencing provides participants and researchers greater depth and quality of DNA data. With this, they can gain further insights to improve health. During a recent media roundtable announcing the return of clinical results, the Healthy Nevada Project also announced plans to complete testing of 40,000 people by the end of 2018. This will bring the project’s total enrollment to 50,000 people – approximately 10 percent of northern Nevada’s population. The Healthy Nevada Project hopes to reach more than 250,000 people in its next phase. The ultimate goal is to offer genetic testing to every Nevadan interested in learning more about their genetics and health. Join the Healthy Nevada Project Recruitment for phase two is still open. In addition to opting in to receive clinical results, participants receive National Geographic’s Geno 2.0 ancestry app at no cost. They also have the chance to pick an additional app for health and wellness after completing a follow-up survey. Learn More or Sign Up

Read More About Healthy Nevada Project Returning Clinical Results to Participants

National Healthcare Decision Day is forthcoming. Here’s an easy and free way to commemorate the occasion: openly discussing how we want to be cared for at the end of our lives. Join Renown Health’s experts at a workshop about making decisions about an advance directive. Among the random national holidays, this one has significance: April 16 is National Healthcare Decision Day. And experts agree that the best time to discuss your views about end-of-life care and to learn what choices are available is before a life-limiting illness or crisis occurs. By preparing in advance, you can help reduce the doubt and anxiety related to decision making for your family if you cannot speak for yourself. “Completing your advance directive is a gift you give your family,” says Mary-Ann Brown, RN, MSN, director of Palliative Care. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want the end of life.” What Are Advance Directives? An advance directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care. Find more information about advance directives and the form online. The Conversation The first step in completing an Advance Directive is to think about what’s important to you and talk to your loved ones. The Conversation Project provides helpful tools to guide you and your family through this challenging topic. Getting this information together will help you fill out and complete your advance directives. Some things to consider and discuss with your family include: When you think about the last phase of your life, what’s most important to you? Who do you want involved in your care? Who should make decisions on your behalf if you’re not able to? Where do you want or not want to receive care? Are there specific treatments you would or would not want? Complete Your Advance Directive Planning In order to complete an advance directive, you will need either two witnesses or a notary to sign the form. Be sure to note restrictions on the witness process. When an advance directive is complete, you should keep the original. Copies should be given to your agent named in the form, your family, your doctor(s) and the location that you receive care. Renown Health offers four advance directive workshops every month to cover the details of filling out this document. A healthcare team is available to answer questions and work through the process with you. A notary is also present to finalize the process, which means you can complete your advanced directives during this workshop. Find the workshop by calling 775-982-RSVP for more information. Advance Care Planning Workshop April 17, 1-2:30 p.m. | Free Join Renown Health’s experts for a workshop about making decisions regarding end-of-life care. You will learn how to fill out an advance directive, receive one-on-one assistance and have your documents signed by a notary. Workshops are typically held several times each month. To RSVP, call 775-982-7787

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Your mother had breast cancer. Your uncle had colon cancer. A cousin has stomach cancer. Could yours be the next name to make the family cancer list? “Possibly,” says Dr. Robert Nathan Slotnick, MD, PhD, Medical Geneticist at Renown Medical Group. In this article, the doctor discusses the genetics behind Lynch syndrome — and how you and your family can fight it. What is Lynch Syndrome? Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is one of the most common genetic conditions known to increase cancer risk in individuals and families. It enables colon and other cancers to develop by causing mutations in mismatch repair (MMR) genes. “The genes MLH1, MSH2, MSH6, PMS2 and EPCAM normally help to repair damaged DNA,” explains Dr. Slotnick. “But when they don’t work properly, naturally occurring DNA replication errors are not repaired efficiently. These errors accumulate and cancer can be the result.” Colon cancer is just one of many possibilities. People with Lynch syndrome also have a higher risk of developing endometrial cancer (cancer of the inside lining of the uterus) as well as cancer of the ovaries, stomach, pancreas, kidney, brain, and bile duct, among others. These syndrome-enabled cancers often appear in patients before the age of 50. Family Cancer Clues The family connection to cancer is a strong one notes the doctor. “Cancer is best considered a genetic disease because it is always tied to changes (or mutations) in our inherited material: our DNA,” says Dr. Slotnick. “These DNA changes cause cells to lose control of their normal constraints on growth and metabolism and can allow abnormalities to develop.” “Although all cancers are genetic,” he adds, “not all cancers are hereditary or passed down through generations.” But because Lynch syndrome IS a hereditary condition, personal and family cancer histories provide invaluable information toward diagnostic confirmation and to a path of surveillance, prevention and treatment. Once a strong family history of cancer is confirmed, doctors and geneticists can move forward with targeted genetic testing to identify specific gene mutations. If Lynch syndrome is diagnosed, testing can also reveal your risk for associated cancers. And your results could be a wake-up call to family members. According to the Centers for Disease Control and Prevention (CDC), close relatives of people with Lynch syndrome have a 50% chance of having similar gene mutations and a higher risk of cancer. The good news is detection and prevention progress is being made. “Lynch is just one of many cancer syndromes where risk is tied to heredity,” explains Dr. Slotnick. “In the last few years, our ability to identify those at risk for this type of cancer predisposition has improved markedly, both in diagnostic accuracy and cost. This allows us to provide aggressive surveillance and prevention choices to individuals and families at risk. Healthier families and lower cost: it’s a win-win.”

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Clinical research provides agency for our patients navigating a scary diagnosis, and the field has never been stronger in northern Nevada. This strength is thanks in part to the Affiliate Clinical Research Office (ACRO) formed by the 2021 affiliation between Renown Health and the University of Nevada, Reno School of Medicine. Since its creation, the ACRO team has been busy ensuring that community members have access to the latest care options and exceptional experiences as participants in both research and their healthcare. Here are just a few things that set this office apart from the rest. 1. A focus on engagement In 2022, the ARCO team focused on promoting a research culture with patients, clinicians, residents and students by intentionally engaging with healthcare providers, department administrators, internal research team members and leadership. They educated the community with learning materials that emphasized the importance of doing research. This team also worked with front-line staff to raise awareness and excitement about the clinical research options available for Renown Health patients. 2. Meaningful partnerships The most impactful partnership to date is between Renown Health and UNR Med. By identifying opportunities and leveraging resources across institutions, we have maximized our impact and built a solid and sustainable foundation. This gives the people of northern Nevada greater access to new interventions or novel treatments. This team is also investing in the community and national partnerships to provide training opportunities for our research staff and learning opportunities for our medical students. 3. Novel treatments across many disease areas Our research study offerings must reflect the healthcare needs of our community and the expertise of practicing clinicians. The department has over 80 active studies in neurology, pulmonology, oncology, cardiology, pediatrics and disease prevention. The ARCRO team strives to expand care opportunities to allow our community members to stay close to home when seeking care. This year, they will continue exploring our community's unmet healthcare needs by bringing new treatment options to the greater Reno area.

Read More About Keeping Research Close to Northern Nevada

In February, we think about hearts not just in honor of Valentine’s Day but because it is American Heart Association Month. This is a great reminder to focus on our personal cardiovascular health. Renown Health helps patients think about their heart health with our world-class providers and cutting-edge treatments through our Cardiovascular Clinical Trials. “Research serves a vital role in the future care of cardiovascular diseases. Being involved in research will help our medical community to further discover new treatment plans in our quest for life preservation and extension,” Dr. Thomas To, Cardiologist and Researcher at Renown Health. For example, let’s talk about atherosclerosis. When our hearts are healthy, they are a strong muscle that pumps our oxygen-rich blood through our coronary arteries. Over time, cholesterol and fats can build up in our arteries. This is a condition known as atherosclerosis. This type of plaque buildup in the arteries can lead to a heart attack or stroke if not properly managed. If you are experiencing chest pain or discomfort, shortness of breath or pain in areas of the upper body, these can be the warning signs of a heart attack, and you should call 911. One contributing factor to atherosclerosis is elevated lipoprotein(a) levels and the accumulation of cholesterol in the arteries, which increases the likelihood of a heart attack or stroke. Lipoprotein(a) is tested separately from the standard panel that is completed for cholesterol management, and while your total cholesterol levels may be in a healthy range, lipoprotein(a) levels can still be elevated. "Increasingly we are realizing that lipoprotein(a) levels can be used as an important assessment in more carefully delineating an individual's risk of future cardiovascular events and treatment targets" said Dr. Michael Bloch, Lipid Specialist and Researcher at Renown Institute for Heart and Vascular Health. While it is clear that elevated lipoprotein(a) contributes to atherosclerosis, there are currently no approved medications for reducing cardiovascular disease risk through reducing lipoprotein(a) levels. This is why Renown Health’s Research Office is proud to offer a phase III clinical trial, called the OCEAN(a) study, to our patients with elevated lipoprotein(a) levels as a care option for management of their heart disease risk. Our teams of expert providers and researchers are here to support you on your healthcare journey. “I am thrilled to be able to be part of this study and bring opportunities like this to our patients. The highlight of my day is getting to hear life stories from my patients during our study visits,” Lisa Preciado, Primary Clinical Research Coordinator for the OCEAN(a) study said. Join us in raising awareness around American Heart Month by talking to your provider about lipoprotein(a) at your next appointment. At Renown Health, our goal is to make it easy for patients to access clinical research as a care opportunity where patients can access a variety of standard care treatment options for their health condition or choose to participate in a clinical trial. For more information about clinical trial opportunities available to you or to ask any questions, contact the Renown Research Office at Renown-CRD@renown.org or 775-982-3646.

Read More About Getting to the HEART of Research