- Lean vs. regular ground beef: clearing up cholesterol confusion
- 7 High-Cholesterol Foods That Are Super Healthy
- 1. Cheese
- 2. Eggs
- 3. Liver
- 4. Shellfish
- 5. Cod liver oil
- 6. Other organ meats
- 7. Sardines
- The bottom line
- Meat in your diet – Eat well
- Storing meat safely
- Red and white meats are equally bad for cholesterol, study finds
- Study: Red and white meat might have equal effects on blood cholesterol
Lean vs. regular ground beef: clearing up cholesterol confusion
QUESTION: Does extra-lean ground beef have less cholesterol than lean or regular ground beef? There was an animated discussion at a restaurant the other night where it was put forth that the cholesterol is in the muscle cells (meat), not the fat, and this would mean that the uncooked extra lean has the most cholesterol.
The discussion then proceeded to cover whether, after you cook the meat and let the fat drip out, similar servings of regular beef would end up just as healthy as the lean one, and that spending the money for the extra-lean was a waste.
– M.E., Detroit, Mich.
ANSWER: A few things come into play to arrive at our answer. First is that cholesterol is present predominantly in the muscle tissue, but it is also present in the fat. The higher percentage of fat in regular beef contributes cholesterol to the total. The next thing to consider is that the muscle in meat is not all protein; it is mostly water by weight. The final factor is shrinkage.
Let’s compare two types of meat before and after cooking. Regular ground beef is about 70 percent lean. I have gathered my data from the U.S. Department of Agriculture Web site (tinyurl.com/36uag), where we find that a quarter pound (113 grams) of 70 percent lean ground beef contains 34 grams of fat, 88 milligrams of cholesterol, 16 grams of protein and 61 grams of water.
Extra-lean ground beef comes in various types, but for our example, we will use 95 percent lean. A quarter pound of 95 percent lean ground beef contains 6 grams of fat, 70 milligrams of cholesterol, 24 grams of protein and 83 grams of water.
Comparing these two, we see that the uncooked extra-lean beef has more water and more protein but less fat and cholesterol than an equal weight of the regular ground beef. Both types of ground beef will lose weight during cooking from fat drippings and lost water. We will use broiling to prepare the meat.
After being cooked, the 70 percent lean beef now weighs 70 grams (a 38 percent weight reduction). The cooked beef now consists of 13 grams of fat, 57 milligrams of cholesterol, 18 grams of protein and 39 grams of water. Note that 21 grams of fat and 31 milligrams of cholesterol have been lost.
The cooked 95 percent lean ground beef drops in weight to 82 grams (a 27 percent weight reduction) and consists of 5.4 grams of fat, 62 milligrams of cholesterol, 22 grams of protein and 54 grams of water. Less than a gram of fat and only 8 milligrams of cholesterol were lost. Most of the weight loss in the extra-lean ground beef was water.
Looking at these numbers, it would appear as though regular ground beef gives us more fat but slightly less cholesterol. We want, however, to look at similar serving sizes. This means we need to correct for the fact that the same uncooked weight will give you 15 percent more to eat if you are using extra-lean ground beef.
If we adjust the numbers to a similar serving size, we find that in addition to getting more to serve per pound of uncooked meat, the cooked extra-lean ground beef provides more protein, significantly less fat and less cholesterol on a weight basis.
Ed Blonz, Ph.D., is a nutritional scientist based in Northern California. General-interest questions about nutrition can be mailed to: Ed Blonz, Focus on Nutrition, P.O. Box 120191, San Diego, CA 92112-0191, or sent via e-mail to [email protected]
TUESDAY, June 4, 2019 (HealthDay News) — Flying in the face of popular belief, new research suggests both red meat and white meat can drive up your cholesterol levels.
The study was conducted by researchers from the Children’s Hospital Oakland Research Institute (CHORI), part of the University of California, San Francisco. The analysis is reportedly the first to comprehensively compare the impact that red and white meat have on cholesterol.
Red meat, such as beef and lamb, has become unpopular in recent years because of its association with heart disease, and government nutrition guidelines have encouraged consumers to eat poultry as a healthier alternative, the researchers noted.
“When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case,” said study senior author Dr. Ronald Krauss. “Their effects on cholesterol are identical when saturated fat levels are equivalent.”
Krauss is senior scientist and director of atherosclerosis research at CHORI.
After tracking how red meat, white meat and plant protein all impacted cholesterol levels, Krauss and his team determined that both red and white meat prompted higher blood cholesterol levels than diets containing an equivalent amount of plant protein. (Grass-fed beef, fish and processed meat products such as bacon were not included in the analysis.)
The finding held up even after accounting for a high intake of saturated fats, investigators noted, and it suggests that the best way to keep cholesterol under control is to turn to non-meat proteins, such as vegetables, legumes and dairy products.
“Our results indicate that current advice to restrict red meat and not white meat should not be based only on their effects on blood cholesterol,” Krauss noted in a university news release. “Indeed, other effects of red meat consumption could contribute to heart disease, and these effects should be explored in more detail in an effort to improve health.”
The findings were published June 4 in the American Journal of Clinical Nutrition.
For more than a decade, the preference for poultry, especially chicken, has been increasing in the United States. Eating away from home more often has been cited as one reason. For others, the choice was made for health reasons. Poultry (without the skin) is often recommended as a substitute for red meat, since it is lower in saturated fat. Although leaner cuts of beef and pork are available.
There are many options when it comes to chicken. It’s sold whole or in parts as chicken breasts, thighs, or wings and is available skinless and boneless.
Price can be an influence when choosing a thigh over a breast, but taste and how the chicken is prepared rank high as well.
Tastier…But Is It Healthier?
Some people prefer the taste of dark meat over white meat and consider it to be more tender and flavorful.
Both chicken thighs and breasts are good sources of lean protein. However, they differ in the amount of calories, fat and saturated fat. For example, a 3-ounce skinless, chicken breast provides about 140 calories, 3 grams of total fat and just 1 gram of saturated fat.
The same amount of dark chicken meat without the skin would provide three times the amount of fat for a total of 9 grams of fat, 3 grams of saturated fat and 170 calories. This difference may not seem like much, but depending on the portion size it can really add up.
Another option is to choose dark turkey meat, which has fewer calories and fat compared to a chicken thigh. A 3-ounce portion has about 134 calories, 5 grams of total fat and 1.5 grams of saturated fat.
It’s also a good idea to look at the Nutrition Facts label. Some poultry products are injected with salt, which helps to keep it moist. Most Americans get too much salt from the foods they eat, so finding ways to reduce sodium by reviewing the nutrition facts can help.
Cooking Matters, Too!
Of course, how the poultry is prepared will also make a difference in the amount of calories and fat. Chicken and turkey can be baked, grilled, roasted or fried; seasoned, stuffed or coated with breading. Baking, grilling and roasting are considered healthier options, so look for these descriptions when eating out and limit all types of fried and deep fried foods, including poultry. At home, keeping the skin on while cooking will help keep chicken and turkey moist and removing the skin before eating will help reduce calories and fat.
Keep it Safe
No matter which type of poultry you choose to buy and prepare at home, remember to handle it properly. Raw chicken and turkey should not be rinsed before cooking, but be sure to wash your hands with soap and warm water for at least 20 seconds before and after handling raw poultry.
Chicken and turkey that is purchased frozen should be thawed on the bottom shelf of the refrigerator. Use separate utensils, containers, and cutting boards for the raw and cooked foods. All poultry, regardless of the cooking method, should be cooked to an internal temperature of 165 degrees Fahrenheit. A thermometer inserted into the thickest part will help determine if it’s reached the appropriate temperature.
Storing foods safely is also important and will help to reduce the risk of foodborne illness. Perishable foods, like poultry, should be refrigerated within two hours and within one hour if the temperature is above 90 degrees. The same is true for leftovers when eating out, and they should be reheated to 165° F and eaten within three to four days.
7 High-Cholesterol Foods That Are Super Healthy
For years, you’ve been told that high-cholesterol foods increase the risk of heart disease.
However, many recent studies have shown that this isn’t necessarily true (1).
Most of the cholesterol in your blood is produced by your liver. When you eat foods high in cholesterol, your liver produces less (2).
For this reason, cholesterol in the diet has only minor effects on blood cholesterol levels in most people (3).
Studies also suggest that eating dietary cholesterol has no link to heart attacks or strokes (3, 4).
What’s more, many foods high in cholesterol are among the healthiest and most nutritious foods.
Here are 7 high-cholesterol foods that are super healthy.
Cheese is a tasty, filling, nutrient-dense food.
One ounce or slice of cheddar provides 28 mg of cholesterol, which is a relatively high amount.
However, cheese is also loaded with other nutrients. For example, an ounce of cheddar has 7 grams of quality protein and provides 15% of the Daily Value (DV) for calcium (5).
Despite also being high in saturated fat, research suggests that it may improve heart health (6, 7).
High-protein, low-carb dairy foods like cheese may likewise help decrease body fat and increase muscle mass (8).
Summary Cheese is a tasty, filling food that may improve heart health and promote the loss of body fat.
Eggs are among the most nutritious foods.
They’re also extremely high in cholesterol, with 2 large eggs providing 372 mg (9).
Additionally, they provide 13 grams of protein, 56% of the DV for selenium, as well as good amounts of riboflavin, vitamin B12, and choline (9).
Unfortunately, some people throw out the cholesterol-rich yolk and eat only the egg white. This is generally due to a misguided fear of the cholesterol in the yolk.
However, the yolk is by far the most nutritious part of the egg. It provides almost all the nutrients, while the white is mostly protein.
In addition, egg yolks contain the antioxidants lutein and zeaxanthin, which reduce the risk of eye disorders like cataracts and macular degeneration (10, 11).
Eating whole eggs may even reduce risk factors for heart disease in some people (12, 13).
What’s more, eggs may lower blood sugar levels and make you feel full and satisfied (14, 15).
Summary Whole eggs are loaded with nutrients. Almost all of the nutrients are found in the yolks, which also happen to be high in cholesterol.
Liver is a nutritional powerhouse.
It’s also rich in cholesterol, regardless of the animal source.
For instance, a 100-gram (3.5-ounce) serving of beef liver contains 389 mg of cholesterol.
This serving also provides 27 grams of protein and is rich in many vitamins and minerals. In fact, it contains more than 600% of the DV for vitamin A and over 1,000% of the DV for vitamin B12 (16).
Furthermore, it provides 28% of the DV for iron. Plus, this is the heme form of iron that is most easily absorbed (17).
In addition, 3.5 ounces of beef liver contain 339 mg of choline, an important nutrient that helps protect the health of your brain, heart, liver, and muscles (18, 19, 20).
Along with whole eggs, liver is among the world’s best sources of choline. This is important because most people don’t get enough of this nutrient (19, 21).
Summary Liver is packed with vitamin A, vitamin B12, protein, and iron. It is also extremely high in choline, which most people don’t get enough of.
Shellfish are delicious and nourishing foods.
Some of the most popular types include shrimp, crab, lobster, mussels, oysters, clams, and scallops.
Interestingly, shellfish are low in fat yet high in cholesterol.
For example, a 100-gram (3.5-ounce) portion of shrimp contains 211 mg of cholesterol and only 2 grams of fat.
It’s also a great protein source and very high in vitamin B12 and choline (22 ).
One serving of most types of shellfish likewise provides around 90% of the DV for selenium, a mineral that reduces inflammation and may decrease the risk of prostate cancer (23, 24).
In addition, shellfish are some of the best sources of iodine, which is crucial for proper brain and thyroid function. Research has shown that many people are at risk of iodine deficiency, particularly women and children (25, 26).
Summary Shellfish are high in protein and rich in several nutrients, including selenium and iodine, that reduce disease risk.
5. Cod liver oil
Cod liver oil delivers amazing health benefits in a concentrated form.
Just one tablespoon contains 570 mg of cholesterol. It also contains 453% of the DV for vitamin A and 170% of the DV for vitamin D (27 ).
Cod liver oil is also rich in omega-3 fatty acids, which may reduce the risk of heart disease and offer various other benefits (28).
What’s more, some researchers have suggested that vitamin D and omega-3 fats may work together to protect against cancer (29).
Summary Cod liver oil is rich in omega-3 fatty acids and vitamins A and D. It may protect against heart disease.
6. Other organ meats
Although liver is the most popular organ meat, others are consumed as well.
Some other common types include kidneys, heart, and brain.
Like shellfish, most organ meat is high in cholesterol and low in fat.
For instance, a 100-gram (3.5-ounce) serving of lamb kidneys contains 565 mg of cholesterol and only 4 grams of fat (30).
Organ meat is also rich in several vitamins and minerals, including the B vitamins, selenium, and iron. In fact, 100 grams of lamb kidneys provide a whopping 3,288% of the DV for vitamin B12 and 398% of the DV for selenium (30).
In addition, heart meat is very high in CoQ10, which may reduce the symptoms of heart failure. CoQ10 may also reduce muscle pain related to cholesterol-lowering statin drugs (31, 32).
Summary Organ meat, such as kidney and heart meat, is rich in many vitamins and minerals. Heart meat is also high in beneficial CoQ10.
Sardines are a true superfood.
They’re also higher in cholesterol than many people realize. A 100-gram (3.5-ounce) serving of sardines contains 142 mg of cholesterol.
One serving of sardines provides 25 grams of protein, 24% of the DV for vitamin D, 29% of the DV for calcium, and 96% of the DV for selenium (33 ).
Additionally, it contains 982 mg of omega-3 fatty acids. These have several health benefits, including reducing the risk of heart disease and protecting brain health (34, 35, 36).
Omega-3 fats may also ease symptoms in people with depression. In one 12-week study, 69% of people who took the omega-3 fat eicosapentaenoic acid (EPA) daily reported a reduction in symptoms of depression (37).
Summary Sardines are rich in several nutrients. They are very high in omega-3s, which improve heart and brain health while fighting depression.
Dietary cholesterol has only minimal effects on blood cholesterol in most people. More importantly, it has no strong links to the risk of heart disease.
The truth is that most of the foods that are high in cholesterol are also healthy and nutritious.
Meat in your diet
Storing meat safely
It’s important to store and prepare meat safely to stop bacteria from spreading and to avoid food poisoning:
- store raw meat or raw poultry in clean sealed containers on the bottom shelf of the fridge, so the meat can’t touch or drip onto other food
- follow any storage instructions on the label and don’t eat meat after its “use by” date
- if you cook meat that you’re not going to eat straight away, cool it as quickly as possible and then put it in the fridge or freezer – remember to keep cooked meat separate from raw meat
- always thoroughly clean plates, utensils, surfaces and hands straight away after they have touched raw or thawing meat to stop bacteria from spreading
Freezing meat safely
It’s safe to freeze raw meat providing that you:
- freeze it before the “use by” date
- follow any freezing or thawing instructions on the label
- cook the meat straight away if you defrost it in a microwave. If you want to defrost meat and cook it later, thaw it in a fridge so that it doesn’t get too warm
- use the meat within two days of defrosting. It will go off in the same way as fresh meat
- cook food until it’s steaming hot all the way through
When meat thaws, liquid can come out of it. This liquid will spread bacteria to any food, plates or surfaces that it touches. Keep the meat in a sealed container at the bottom of the fridge so that it can’t touch or drip onto other foods.
If you defrost raw meat and then cook it thoroughly, you can freeze it again. But never reheat meat or any other food more than once as this could lead to food poisoning.
There is more information about how to freeze foods safely in Food safety.
Cooking meat safely
Some people wash meat before they cook it, but this actually increases your risk of food poisoning, because the water droplets splash onto surfaces and can contaminate them with bacteria. For this reason, it’s best not to wash meat.
It’s important to prepare and cook meat properly. Cooking meat properly ensures that harmful bacteria on the meat are killed. If meat isn’t cooked all the way through, these bacteria may cause food poisoning.
Bacteria and viruses can be found all the way through certain meat. This means you need to cook these sorts of meat all the way through. When meat is cooked all the way through, its juices run clear and there is no pink or red meat left inside.
Meats that you should cook all the way through are:
- poultry and game, such as chicken, turkey, duck and goose, including liver
- offal, including liver
- burgers and sausages
- rolled joints of meat
You can eat whole cuts of beef or lamb when they are pink inside – or “rare” – as long as they are cooked on the outside. This is because any bacteria are generally on the outside of the meat.
These meats include:
Those who eschew steak in favor of chicken because they think it’s healthier may be able to put lean beef back on the menu.
That’s because new research, published Tuesday in the American Journal of Clinical Nutrition, is raising questions about poultry and cholesterol.
The small study found that consuming high levels of red meat or white poultry resulted in higher blood cholesterol levels than consuming an equal amount of plant protein. The findings held even when diets contained high levels of saturated fat, which increased blood cholesterol to the same extent as all three protein sources.
Red and white meats are equally bad for cholesterol, study finds
June 4, 201901:37
The key takeaway from the study, nutritionists say, is to watch out for saturated fat, no matter the protein source. And when it comes to poultry versus red meat, “it’s easier to get higher amounts of saturated fat from some cuts of red meat,” said Elizabeth Kitchin, assistant professor of nutrition sciences at the University of Alabama at Birmingham who wasn’t involved with the research.
Still, it was unexpected that poultry had the effect on cholesterol levels that it did.
“I was surprised that the effect of white meat on cholesterol levels was identical to the effects of red meat,” said Dr. Ronald Krauss, study author and director of atherosclerosis research at Children’s Hospital Oakland Research Institute.
Let our news meet your inbox. The news and stories that matters, delivered weekday mornings.
In the study, 113 adults were randomly assigned to one of three diets for one month: rich in lean cuts of beef, lean cuts of chicken or turkey, or plant proteins. After each month, the participants’ diet was changed, so that each participant ended up trying all three diets. However, half of the participants’ diets, regardless of protein source, were high in saturated fat; the other half ate a low-saturated fat diet.
After each month, the researchers measured the participants’ levels of LDL cholesterol, the so-called bad cholesterol.
“Keeping all else constant — even the level of animal fat — the levels were higher on both sources of meat compared to the nonmeat diet,” Krauss told NBC News.
Researchers said that the findings may not affect most people who aren’t at high risk for heart disease. When participants’ diets were low in saturated fat, the rise in LDL was minimal regardless of whether they ate chicken or lean red meat. But for the person actively trying to bring down high levels of LDL cholesterol, researchers said, it may be worth cutting back on both red and white meats, and relying more on plant proteins.
Red meat is a source of high-quality protein, zinc, iron and vitamin B12, but most nutritionists agree that it is best to choose a lean cut in a modest portion for optimal health benefits. The positives of having red or white meat can be canceled out if too much saturated fat, from any source, is included in one’s diet.
Previous evidence shows that fatty red meat is a prime source of artery-clogging saturated fat, a factor associated with heart disease. And two studies published last year showed that people who eat red meat — but not vegetarians or people who eat only white meat such as chicken — have higher levels in the blood of a chemical called TMAO, which has been linked to higher heart disease risk.
The researchers cautioned against demonizing any food based on one study. “People often get the impression that if something raises cholesterol, it should be eliminated,” Krauss said. “I don’t want people to get too focused on an all or nothing approach.”
Indeed, the American Heart Association recommends a combination of poultry, fish, vegetable proteins and lean red meat for a heart-healthy diet.
“For many people a varied approach including any or all of these foods within the context of high fruit, vegetable and whole grain, nuts/seeds/legume intake along with polyunsaturated or monounsaturated oils can serve as a healthy eating pattern with plenty of variety,” Dr. Linda Van Horn, a volunteer nutrition expert with the AHA, told NBC News.
Other outside experts also pointed out that diet is just one factor when it comes to overall heart disease risk.
“This study focused on just saturated fat,” Kitchin told NBC News. “There are a lot of other risk factors for heart disease, like extra body weight and inactivity, that are big players in heart disease.”
FOLLOW NBC HEALTH ON TWITTER & FACEBOOK
Contrary to popular belief, consuming red meat and white meat, such as poultry, has equally negative effects on blood cholesterol levels, according to a study published today in the American Journal of Clinical Nutrition.
The study, led by scientists at Children’s Hospital Oakland Research Institute (CHORI) – the research arm of UCSF Benioff Children’s Hospital Oakland – surprised the researchers with the discovery that consuming high levels of red meat or white poultry resulted in higher blood cholesterol levels than consuming a comparable amount of plant proteins. Moreover, this effect was observed whether or not the diet contained high levels of saturated fat, which increased blood cholesterol to the same extent with all three protein sources.
“When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case – their effects on cholesterol are identical when saturated fat levels are equivalent,” said the study senior author Ronald Krauss, MD, senior scientist and director of Atherosclerosis Research at CHORI.
Krauss, who is also a UCSF professor of medicine, noted that the meats studied did not include grass-fed beef or processed products such as bacon or sausage; nor did it include fish.
But the results were notable, as they indicated that restricting meat altogether, whether red or white, is more advisable for lowering blood cholesterol levels than previously thought. The study found that plant proteins are the healthiest for blood cholesterol.
When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case – their effects on cholesterol are identical when saturated fat levels are equivalent.
This study, dubbed the APPROACH (Animal and Plant Protein and Cardiovascular Health) trial, also found that consuming high amounts of saturated fat increased concentrations of large cholesterol-enriched LDL particles, which have a weaker connection to cardiovascular disease than smaller LDL particles.
Similarly, red and white meat increased amounts of large LDL in comparison to nonmeat diets. Therefore, using standard LDL cholesterol levels as the measure of cardiovascular risk may lead to overestimating that risk for both higher meat and saturated fat intakes, as standard LDL cholesterol tests may primarily reflect levels of larger LDL particles.
Consumption of red meat has become unpopular during the last few decades over concerns about its association with increased heart disease. Government dietary guidelines have encouraged the consumption of poultry as a healthier alternative to red meat.
But there had been no comprehensive comparison of the effects of red meat, white meat and nonmeat proteins on blood cholesterol until now, Krauss said. Nonmeat proteins such as vegetables, dairy, and legumes, such as beans, show the best cholesterol benefit, he said.
“Our results indicate that current advice to restrict red meat and not white meat should not be based only on their effects on blood cholesterol,” Krauss said. “Indeed, other effects of red meat consumption could contribute to heart disease, and these effects should be explored in more detail in an effort to improve health.”
Co-Authors: Lead author Nathalie Bergeron, UCSF Children’s Hospital Oakland Research Institute, Oakland, California and Touro University; Sally Chiu, Children’s Hospital Oakland Research Institute and Touro University; Paul T. Williams and Sarah King, Children’s Hospital Oakland Research Institute.
Funding: National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH).
Disclosures: Krauss and Bergeron are recipients of a grant from Dairy Management Inc., but this grant is not for the submitted work; Krauss holds a licensed patent for ion mobility analysis of plasma lipoprotein particles.
UCSF Benioff Children’s Hospitals in Oakland and San Francisco are among the nation’s finest pediatric medical centers, according to U.S. News & World Report’s annual rankings. Their expertise covers virtually all pediatric conditions, including cancer, heart disease, neurological disorders, pulmonology, diabetes and endocrinology, as well as the care of critically ill newborns, in the Bay Area, California and beyond.
The UCSF Benioff Children’s Hospitals are known worldwide for basic and clinical research and are at the forefront of translating research into interventions for treating and preventing pediatric disease. The hospitals are affiliated with University of California, San Francisco, whose schools of Medicine, Pharmacy, Dentistry and Nursing are among the nation’s leaders in graduate-level health science education, as well as research grants from the National Institutes of Health.
Study: Red and white meat might have equal effects on blood cholesterol
In a study that could debunk years of conventional wisdom, researchers are reporting that red meat and white meat might have equal effects on blood cholesterol. The findings suggest that factors other than saturated fat may better explain the long-touted link between red meat consumption and heart disease. The study also showed that plant proteins are healthier for blood cholesterol levels than both red and white meat.
The study is one of the first detailed comparisons of the effects of different sources of dietary proteins on blood cholesterol. It evaluated changes in the participants’ blood cholesterol levels after eating diets containing high levels of proteins from either lean red meat, lean white meat, or non-meat sources (including vegetables). Participants included 113 healthy men and women between 21-65 years old. They consumed each of the three high-protein diets for four weeks in random order, and the researchers tested blood cholesterol levels after each dietary type.
The researchers found that consuming high levels of saturated fat was associated with an increase in blood cholesterol, regardless of meat type, and that both types of meat protein resulted in higher blood cholesterol than the non-meat diets. The study, called the APPROACH trial (Animal and Plant Protein and Cardiovascular Health), appeared in the American Journal of Clinical Nutrition. It was supported by the NHLBI and the NIH National Center for Advancing Translational Sciences.