Living with atrial fibrillation (AFib) means paying extra attention to your risk of stroke. AFib is an irregular heartbeat in which the heart's upper chambers quiver instead of beating effectively. When the heart doesn’t beat normally, blood can pool in the atria and form clots. If a clot travels to the brain, it can block blood flow and cause a stroke. This is why AFib is so closely linked to strokes – in fact, people with AFib are about five times more likely to have a stroke than people without AFib.

However, not everyone with AFib has the same stroke risk. It depends on your individual risk factors. Doctors have a tool to measure this risk: the CHA₂DS₂-VASc score. Knowing your CHA₂DS₂-VASc score is important for stroke prevention and overall heart health because it guides decisions about treatments (especially blood thinners) that can prevent strokes.

What Is the CHA₂DS₂-VASc Score?

The CHA₂DS₂-VASc score (pronounced “Chads-vasc”) is a clinical scoring system that helps predict stroke risk with AFib. Each letter in the name stands for a specific risk factor:

• C – Congestive heart failure
• H – Hypertension (high blood pressure)
• A₂ – Age 75 or older (this risk factor counts double)
• D – Diabetes (high blood sugar)
• S₂ – Stroke (prior stroke, TIA, or blood clot history – counts double)
• V – Vascular disease (like a previous heart attack or peripheral artery disease)
• A – Age 65 to 74
• Sc – Sex category (female gender)

This score is an expanded version of an older tool called the CHADS₂ score. The CHADS2 score included fewer factors, but experts found it missed some people who still had meaningful risk. Now, major heart guidelines recommend using CHA₂DS₂-VASc for all patients with atrial fibrillation to assess stroke risk. 

In practice, your doctor will calculate this score to decide if you need medication to prevent strokes. A high CHA₂DS₂-VASc score means a greater risk of stroke, while a low score means a lower risk.

Breaking Down the CHA₂DS₂-VASc Score: Your Risk Factors

How do you get your CHA₂DS₂-VASc score? It’s the sum of points for each risk factor you have. Let’s break down each component of “CHA₂DS₂-VASc” and what it means:

• C – Congestive Heart Failure (1 point): Add one point if you have congestive heart failure or reduced heart pumping function. Heart failure can cause blood to pool, contributing to clot formation.
• H – Hypertension (1 point): High blood pressure (hypertension) is a well-known stroke risk. If your blood pressure is persistently high or you’re on medication for high blood pressure, that’s one point.
• A₂ – Age 75 or Older (2 points): Age is among the most important risk factors. You score two points for age if you are 75 years or older. Getting older increases stroke risk significantly, so this factor is “weighted” double in the score.
• D – Diabetes (1 point): Diabetes means your blood sugar is too high. Having diabetes (Type 1 or Type 2) adds one point. Stroke risk is higher in people with diabetes, especially if it’s not well-controlled.
• S₂ – Prior Stroke or TIA (2 points): If you’ve had a stroke or a TIA (mini-stroke) in the past or any thromboembolism (a blood clot that traveled to an organ), that history gives 2 points. This is doubled because nothing predicts a future stroke like a prior stroke.
• V – Vascular Disease (1 point): This refers to other artery diseases. If you have a history of vascular disease – for example, a previous heart attack, peripheral artery disease (poor circulation in the legs), or significant plaque in the aorta – add one point. These conditions indicate plaque build-up and a tendency for clots that can elevate stroke risk.
• A – Age 65 to 74 (1 point): Being in the 65–74 age range gives you one point. (Note: you count either this age category or the 75+ category, not both. So if you’re over 75, you already counted 2 points for A₂, and you wouldn’t add this one.)
• Sc – Sex Category (Female) (1 point): Women with AFib have a slightly higher stroke risk than men. If you are female, add one point. (You get 0 points for this category if you're male.)

Now, add up all the points that apply to you. The lowest score is 0 (for a young male with none of the above risk factors). The highest possible score is 9 (for an older female with multiple risk factors). Most people with AFib will fall somewhere in between.

It’s worth noting that the CHA₂DS₂-VASc score applies to non-valvular AFib. If your AFib is caused by valvular heart disease or you have an artificial heart valve, you generally need anticoagulation regardless of these risk factors. Your doctor will manage that situation differently.

How Your CHA₂DS₂-VASc Score Guides Stroke Prevention Treatment

Your CHA₂DS₂-VASc score plays a key role in deciding whether you need anticoagulant therapy to reduce your stroke risk with AFib. Here’s how treatment decisions typically break down:

High Risk (Score ≥ 2 in men or ≥ 3 in women)

• You’re strongly advised to start anticoagulants—such as warfarin or DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban). These medications can cut stroke risk by about 66% and are considered the gold standard for stroke prevention in patients with atrial fibrillation. If your score is high, the benefits of treatment far outweigh the risks.

Moderate/Borderline Risk (Score of 1 in men or 2 in women)

• This is a gray area. Your doctor will assess your risk factors, lifestyle, and medical history to determine the best action. Shared decision-making is key here. Some people may start blood thinners; others may hold off. The decision is made on a case-by-case basis.

Low Risk (Score of 0 in men or 1 in women)

• Anticoagulant therapy is usually not recommended. Your risk of stroke is low—around 1% per year—so the potential risks of blood thinners outweigh the benefits. Focus instead on managing heart health, blood pressure, and lifestyle factors.

In short, your CHA₂DS₂-VASc score helps identify who will benefit most from treatment. It’s a practical, evidence-based tool that allows your care team to match your AFib treatment options to your actual risk. Still, no two patients are exactly alike. If you have other health issues—like frequent falls or a high bleeding risk—your plan may differ.

Know Your Score, Know Your Options

Once you know your CHA₂DS₂-VASc score, the next step is acting on it. This might mean starting anticoagulant therapy, working with your doctor to build a personalized care plan, or simply keeping up with regular check-ups if your risk is low.

It's also important to stay on top of related health issues since each contributes to your overall stroke risk with AFib. And if standard treatment isn’t a fit, ask about alternative AFib treatment options or look into clinical trials for stroke prevention, especially if you're in a higher-risk category

Ready to Take the Next Step?

If your stroke risk with AFib is high, you may qualify for a clinical trial designed to explore new preventive treatments. Science 37 is currently recruiting participants for a study focused on stroke prevention in atrial fibrillation, especially those who can't tolerate traditional anticoagulants. Learn more or apply here Science 37’s Stroke Prevention Clinical Trial for AFib.

Did you know that heart disease is the leading cause of death for people age 65 and older? Studies show that almost 75% of older adults face a higher chance of heart attack or heart failure. These numbers may feel scary, but they do not have to define your story. You can stay heart-smart by making simple, steady choices, as discussed below.

Stay on Top of Your Checkups

Your primary care provider should be your go-to for all things heart health. They’ll help you track your cholesterol levels, blood pressure, and blood sugar—all of which play a big role in preventing heart attack and stroke.

If you’re at risk of AFib, your doctor might recommend tests to monitor your heart rhythm. Early detection is everything. And if you already have AFib, regular care helps you stay one step ahead of blood clotting, which is what often leads to stroke.

Friendly tip: Don’t wait for symptoms. Just schedule regular check-ins. Preventative care beats emergency care every time.

Improve Your Lifestyle

Your lifestyle plays a big role in how your heart functions. A healthy lifestyle has been shown to promote heart health. Here’s how to embrace a healthy lifestyle and why it’s important:

Make Your Plate Heart Healthy

A heart-healthy diet keeps your heart healthy and strong. It helps lower your cholesterol levels, stabilize blood sugar, and reduce your risk of heart failure or stroke. A healthy diet comprises of:

• More fruits and vegetables (they help reduce inflammation and support a healthy weight)
• Whole grains over white bread or pasta
• Less to no salt, sugar, and processed snacks
• Healthy fats like olive oil, nuts, and avocado
• Lean proteins like chicken, fish, or beans

Move Your Body (A Little Every Day)

In addition to your diet, you also need to work out to get the blood flowing nicely. And this doesn’t have to be strenuous. Just brisk walking for 20 to 30 minutes a day can:

• Improve blood circulation
• Reduce the risk of blood clots
• Support weight loss
• Lower blood pressure
• Boost your energy and mood

Other great options include light stretching, dancing in your living room, yoga, or even water aerobics. If it gets your heart rate up, it’s doing its job.

Bonus: Regular physical activity also helps reduce the risk of stroke, especially if you’ve been diagnosed with AFib.

Manage Your Weight in a Healthy, Gentle Way

Carrying extra weight, especially around the belly, can raise your risk for high blood sugar, high cholesterol, and high blood pressure—all of which can lead to stroke or heart attack. Even losing 5 to 10 pounds can make a big difference for your heart. If weight loss feels overwhelming, just start small:

• Swap sugary drinks for water
• Walk 10 more minutes each day
• Eat out a little less often

You’ll feel better and your heart will too.

Take Your Medications as Prescribed

If your doctor has prescribed medication—whether it’s for AFib, high blood pressure, or to prevent blood clotting—don’t skip doses or stop taking them without asking.

Know the Common Myths About Aging and Heart Disease

Some common myths include:

Myth #1: All Heart Attacks Come with Chest Pain or Obvious Warning Signs

We all picture heart attacks the same way—sudden chest pain, clutching your arm, struggling to breathe. And yes, those can be signs. But not always.

Sometimes, heart attacks are completely silent. About 45% of heart attacks show no clear symptoms at all. You might not feel chest pain. You might feel a little tired or dizzy—or nothing. These are called “silent” heart attacks, and many people don’t realize they’ve had one until a doctor finds it during a checkup for something else.

Myth #2: Heart Disease Mostly Affects Men

This one is everywhere—and it’s wrong.

Heart disease is the leading cause of death for both men and women. It doesn’t play favorites. In fact, many women miss the signs of heart trouble because they assume it’s not something they need to worry about. But the truth is, women are just as likely as men to develop heart disease, and the symptoms can show up differently.

Women might feel more fatigue, lightheadedness, or nausea instead of the “classic” chest pain. So don’t ignore what your body is telling you. It’s always worth checking in with your doctor if something feels off.

Myth #3: If Heart Disease Runs in Your Family, There’s Nothing You Can Do

Having a family history of heart problems can be scary—but it doesn’t mean it’s your fate. Yes, your genetics matter. But your choices matter more.

You can reduce your risk by taking care of yourself. That means eating a heart-healthy diet, staying active, managing your cholesterol levels and blood sugar, and not smoking. Those things can lower your chances of heart problems—even if they run in the family.

Myth #4: Irregular Heartbeats are Nothing to Worry About

Most of us have felt our heart skip a beat now and then—maybe after climbing stairs too fast, getting nervous, or even drinking too much caffeine. That’s normal, but not all irregular heartbeats are harmless.

If your heart races, feels like its fluttering, or beats out of rhythm often, it could be a sign of something more serious—like AFib (atrial fibrillation). AFib can increase your risk of stroke and other heart problems, especially if you’re 65 or older.

So, if something doesn’t feel right, don’t brush it off. A quick checkup can help you figure out what’s going on—and if there’s anything you need to do about it.

Myth #5: Everyone 65 and Older has Heart Problems

Not true at all.

Getting older doesn’t mean your heart is doomed. Yes, your risk for things like heart failure or stroke goes up with age—but many older adults still have strong, healthy hearts. And that’s not just luck. It’s the result of smart, consistent habits.

When you eat well, stay active, manage stress, and keep up with your checkups, you give your heart the best chance to stay healthy—no matter your age.

Myth #6: High Cholesterol is Just Part of Getting Older

This one’s easy to believe, especially if you’ve been told “your numbers just go up with age.” But that doesn’t mean you have to live with high cholesterol.

Your body may change as you age, but much of your heart health is still in control. Eating more fruits and vegetables, choosing healthier fats, losing weight (if needed), and moving your body can all help lower your cholesterol levels—without needing medication in some cases.

Even small changes add up. Your numbers aren’t set in stone.

The Future of Heart Health

There’s a lot to be excited about when it comes to heart health—especially if you’re 65 or older. Thanks to new research, doctors are finding better ways to prevent stroke, manage AFib, and treat heart failure.

Clinical trials are leading the charge, testing safer, more effective, and more personalized therapies to your age and health history. And the best part? These breakthroughs are happening right now. Some treatments focus on lowering stroke risk without heavy blood thinners, while others explore how to help your heart pump better or manage cholesterol and blood sugar more naturally.

If you want more options—or just want to stay ahead—it’s worth exploring clinical trials. Companies like Science 37 make it easy to join a study without leaving home. It’s a simple, safe way to access cutting-edge care while helping shape the future of heart health. We’re in a new era where aging doesn’t mean slowing down—it means getting smarter, staying informed, and giving your heart the best shot at staying strong for years to come.

Seasons come and go, and for most people, it’s just a matter of adjusting to the weather and moving on. But if you live with chronic conditions like atrial fibrillation, asthma, or an autoimmune liver disease like PBC or PSC, you know that season changes shift things within the body and can worsen symptoms you’ve worked hard to manage.

Spring, in particular, brings a wave of new challenges. Pollen levels rise, temperatures swing, and humidity creeps in. Even the sunlight feels stronger. And while these changes seem harmless, they can trigger real health issues for you.

How Seasonal Shifts Affect Chronic Conditions

Let’s explore how the spring season brings a range of risk factors that can be tough when managing a chronic condition.

Asthma – Pollen and Allergens in the Air

Spring makes it harder to manage asthma because there’s so much more pollen. Trees and flowers bloom, and that triggers allergies, which then mess with your breathing. You might notice more tightness in your chest, coughing, or even needing your inhaler more often.

Humidity also plays a role. Moist air makes it harder for your lungs to breathe freely, while sudden cold fronts can tighten your airways. Even a simple walk outside can turn uncomfortable if the air is thick with allergens and your body temperature shifts quickly.

Atrial Fibrillation – Temperature Swings and Heart Rhythm

Seasonal changes can disrupt your heart’s rhythm. AFib affects the upper chambers of the heart, causing an irregular heartbeat. When the weather fluctuates quickly — warm one day and cold the next — your body works harder to regulate its internal temperature. That stress can increase your heart rate and trigger episodes of AFib.

Rising heat can also cause dehydration, which thickens your blood and affects circulation. Add that to increase UV rays exposure, and your heart may be working harder than usual without you even noticing.

Autoimmune Liver Diseases: PBC, PSC, and Liver Health

Spring can be rough on your liver, especially if you're living with something like PBC or PSC. The extra sun, heat, and humidity can mess with your energy and make symptoms worse. You might feel more tired than usual or notice your skin acting up for no clear reason.

If you're dealing with nonalcoholic fatty liver disease, even small changes in your routine — like eating out more, moving less, or just adjusting to the season — can affect how your liver works. These shifts impact liver cells and may lead to flare-ups. When your body is under stress, scar tissue can build up faster.

How to Manage Symptoms as the Weather Warms Up

Spring doesn’t have to throw you off. When you adjust your routine early, you stay ahead of flare-ups. Here are steps you can take now to manage asthma, AFib, and autoimmune liver diseases as the season shifts.

1. Pay Attention to the Weather

Check pollen levels and temperature changes every morning and plan your day around them. If pollen is high, stay indoors during peak hours (usually mid-morning to afternoon). If the temperature is swinging, dress in layers so your body doesn’t have to work hard to stay balanced. This is especially important if you have an irregular heartbeat or high blood pressure or if body temperature regulation is already difficult.

2. Hydrate — More Than You Think You Need to

Drink plenty of water, even when you’re not very active. Dehydration affects heart rhythm, liver function, and lung health. It raises your risk of chest pain, especially if you live with AFib or have a history of high blood pressure.

Keep water close and sip regularly — not just when you feel thirsty. This is one of the easiest ways to stay hydrated and avoid unnecessary stress on your system.

3. Adjust Your Meds if Needed — Don’t Wait for a Flare-up

Spring can change how your body responds to medication. Talk to your doctor about whether you need to tweak your asthma inhaler routine, adjust your treatment for atrial fibrillation, or monitor your liver function more often. Don’t wait for symptoms to get worse. Schedule a check-in and update your plan early. Innovative treatment strategies that weren’t part of your care plan may be available.

4. Make Space for Rest

Fatigue is a common warning sign — especially with autoimmune liver disease. If you feel drained or foggy, listen to that. Build quiet breaks into your day. You don’t have to wait until you crash. Your energy is already stretched from managing symptoms, so protect what you have.

5. Track How You Feel Day by Day

Use a simple health journal or app to record symptoms. Note when you feel tightness in your chest, irregular heartbeat, shortness of breath, or skin irritation. These patterns help you and your care team spot what’s triggering flare-ups—whether it's UV rays, pollen, or temperature swings. They also help you notice patterns tied to risk factors like dehydration or lack of sleep.

6. Get Your Screenings — Don’t Skip Them

Now’s a good time to schedule health screenings. Blood pressure, liver enzyme levels, and heart rhythm all need monitoring, especially with chronic conditions. If you haven’t had your routine labs or check-ins recently, book them. Screenings help catch issues before they get serious and give a clearer view of how your liver cells and heart are holding up this season.

7. Support Your Mental Health

Spring can bring emotional ups and downs, especially when your body doesn’t feel steady. Chronic conditions take a toll physically and mentally. Talk to someone if you feel overwhelmed. Keep a simple routine that makes you feel grounded — a short walk, journaling, or even just slowing down your mornings. Mental health isn’t separate from the rest. It’s part of how you manage symptoms.

8. Keep Moving Forward — With Intention

Managing chronic conditions takes daily effort, but you’re not starting from scratch. You already know your body. You already have tools. Now, it’s about adjusting them to match the season. Make changes early. Talk to your doctor. Stay consistent. And if something feels off — trust that signal and act on it.

9. Look into Clinical Trials and Newer Treatment Options

A lot is happening in the background of medical research — and most people never hear about it. Right now, clinical trials are testing new ways to manage AFib, autoimmune liver diseases like PBC and PSC, and asthma. Some are focused on easing tough symptoms, while others are working toward long-term solutions for conditions that don’t have a cure yet.

Science 37 is one platform that runs clinical trials for all of these. It’s worth checking out, especially if you feel like your current treatment isn’t doing enough. These trials can open up access to options you wouldn’t normally get through a regular doctor’s visit. You can always talk to your care team to see if something like this makes sense for you. Innovative treatment strategies don’t just help manage symptoms — they’re also helping shape the future of care.

Your DNA contains thousands of genes that direct how your body functions. Each gene contains instructions for making proteins essential for different processes—like building cells, transmitting signals in your brain, and supporting physical growth. These genes are arranged along 23 chromosome pairs, which you inherit from your parents.

When a genetic mutation occurs—meaning a gene is deleted, duplicated, or changed—it can affect the production or function of these proteins. In some cases, the gene variant disruption leads to a rare genetic disorder. These mutations may be inherited or can arise spontaneously (de novo mutations). The result often depends on which gene is affected, how it's changed, and how that change affects the body.

In rare diseases, mutations usually impact essential systems—like the nervous system, immune response, metabolism, or muscle development. One of the clearest and most studied examples of this is Fragile X syndrome (FXS)

Fragile X Syndrome

FXS is the most common inherited cause of intellectual disability and a significant genetic contributor to autism spectrum disorder. It is caused by a mutation in the FMR1 gene located on the X chromosome. This gene is responsible for making a protein called FMRP, which plays a huge role in regulating synaptic plasticity—how neurons communicate and form connections in the brain.

In people with FXS, a portion of the FMR1 gene contains a repeated DNA sequence (CGG triplet repeat). While most people have fewer than 45 repeats, those with Fragile X have nearly over 200. This large expansion leads to a process called methylation, which switches off the gene entirely. As a result, the body doesn’t produce FMRP, impairing brain development and function.

Common Features of Fragile X Syndrome

A person with FXS may experience different developmental and behavioral issues like:

• Features of autism spectrum disorder - like social challenges and repetitive behaviors
• Developmental delay, especially in language and speech
• Learning disabilities and difficulty with abstract thinking
• Behavioral issues like hyperactivity, attention problems and anxiety
• Physical features like a long face, large ears, flat feet, and flexible joints
• In males, macroorchidism (enlarged testicles) after puberty

Not everyone experiences all these features. Boys tend to have more severe symptoms because they have only one X chromosome. Girls who have two X chromosomes often have milder symptoms or may be asymptomatic carriers.

How Fragile X Syndrome Is Inherited

Fragile X syndrome follows an X-linked dominant inheritance pattern. Since the FMR1 gene is on the X chromosome, the condition affects males and females differently:

• A female carrier (with one mutated FMR1 gene) has a 50% chance of passing it on to each child. Sons who inherit the full mutation usually develop Fragile X; daughters may be carriers or have milder symptoms.
• A male carrier passes the gene only to his daughters, who all become carriers. Sons do not inherit their father's X chromosome, so they are not affected.

Some individuals have a premutation—between 55 and 200 CGG repeats. This does not usually cause Fragile X syndrome itself, but it can lead to other health issues like Fragile X-associated tremor/ataxia syndrome (FXTAS) or primary ovarian insufficiency. More importantly, the premutation can expand into a full mutation when passed to the next generation, especially through maternal inheritance.

This explains why genetic counseling is critical for those with a history of Fragile X. It helps identify carriers, understand reproductive risks, and guide testing decisions.

Genetic Counseling and Family Planning

For families affected by Fragile X or other rare genetic disorders, genetic counseling provides essential guidance. A counselor helps you understand the condition, assess family risk, and explore options like:

• Carrier testing for relatives
• Reproductive options (e.g., IVF with genetic screening)
• Emotional support and resource referrals

Counseling also helps families prepare for what to expect and connect with support organizations—like the National Fragile X Foundation—which offer tools, networks, and advocacy.

The Importance of Early Diagnosis and Early Intervention

Many children with Fragile X show signs of developmental delay by age 1 or 2, but the condition is often not diagnosed until later. Delays in speech, poor eye contact, sensitivity to sound, and behavioral problems are often early clues—but without genetic testing, they may be misattributed to general developmental disabilities or other conditions like autism.

A DNA blood test can confirm a Fragile X diagnosis by identifying the number of CGG repeats and whether the FMR1 gene is silenced. Testing is recommended for children with:

• Intellectual or learning disabilities
• Symptoms of autism
• A family member with history of Fragile X or related conditions

Once diagnosed, early access to services makes a significant difference. Early intervention may include:

• Speech and language therapy
• Occupational therapy for sensory and motor challenges
• Behavioral therapy to manage anxiety, aggression, or hyperactivity
• Special education programs tailored to learning needs

These supports don’t cure Fragile X, but they do improve quality of life and long-term outcomes.

Clinical Trials and Emerging Treatments for Fragile X Syndrome

There is currently no cure for Fragile X syndrome. However, clinical research is rapidly evolving, and several promising treatments are under investigation.

Gene therapy is one promising area. Its goal is to help address root cause of FXS by correcting the underlying genetic mutation. Techniques like CRISPR gene editing are being tested in laboratories to repair or replace the defective FMR1 gene, potentially restoring its normal function.

Researchers are also looking into protein replacement therapies designed to provide the missing FMRP protein directly to brain cells. This approach could alleviate symptoms by correcting the disrupted protein production in neurons. Other research efforts focus on correcting genetic processing errors, where treatments aim to reactivate silenced genes or prevent abnormal gene expression through novel molecular methods.

Platforms like Science 37 are facilitating patient participation in these cutting-edge clinical trials, making it easier for families to access innovative therapies without extensive travel or disruption. Participating in these trials not only offers potential treatment benefits but also contributes significantly to scientific progress and improved understanding of Fragile X syndrome.

Stress can be helpful. However, too much stress can harm your health and increase your risk of stroke and heart attack. A mounting body of evidence links stress – particularly psychological stress – to an increased risk of all types of stroke, including hemorrhagic and ischemic stroke in adults.

Psychological stress comes from our daily interactions and can stem from different areas of life, including home, work, and finances. It can also be triggered by major life events such as:

• Violence
• Losing a job or retiring
• Marital separation
• Serious conflicts within the family
• Business failure or financial loss
• Major injury or illness
• Death of a spouse
• Severe illness or loss of a close family member

Research shows that experiencing a major stressful life event can increase the risk of a first stroke by 17%. If someone goes through two or more major stressors, the risk jumps to 31%. This link remains strong across different types of stress, whether from financial struggles, home life, or work-related pressures.

Interestingly, the cohort study also found that people who feel they have some level of control over their circumstances may be less affected by psychosocial stress, highlighting the importance of stress management in reducing stroke risk.

The Link Between Chronic Stress and Stroke Risk

Chronic stress sparks a chain reaction in your body that directly affects the cardiovascular system. Stress hormones like cortisol and adrenaline surge whenever you feel threatened, preparing you to react. While this response is helpful in short bursts, keeping it switched on for too long leads to harmful changes that increase your stroke risk.

High Blood Pressure and Inflammation

Chronic stress often keeps blood pressure elevated longer than it should be. When you’re under stress, your sympathetic nervous system kicks in, increasing your heart rate and blood vessels to narrow. Over time, this extra strain raises the risk of hypertension, which can lead to stroke.

Stress that persists also promotes inflammation, damaging blood vessels and making them prone to blockages or rupture. These same factors can contribute to atrial fibrillation (AFib)—an irregular heartbeat that further amplifies stroke risk by allowing blood to pool and form clots in the heart.

Disruptions in the HPA Axis and Immune Function

Ongoing stress can throw off the normal function of the hypothalamic-pituitary-adrenal (HPA) axis. This axis manages how your body responds to stress, but when it’s always “on,” it interferes with healthy immune function, raises oxidative stress, and contributes to problems in your blood vessels’ lining. These issues block healthy circulation and make blood clots more likely, directly increasing the chances of an ischemic stroke.

Metabolic and Behavioral Changes

Stress also affects your metabolic health by fueling insulin resistance. It can trigger unhealthy habits like poor eating, little exercise, and lack of sleep. Combined, these factors increase the likelihood of obesity, diabetes, and cardiovascular disease—all of which raise stroke risk. Research further shows that overstimulation of the amygdala, the part of the brain tied to emotions, can boost arterial inflammation, another step toward stroke.

The Role of Inflammation and Arterial Health

Psychological stress, especially when paired with other stroke risks, speeds up the breakdown of vascular health. People dealing with chronic stress often have elevated levels of pro-inflammatory cytokines. These molecules help form arterial plaques and heighten the risk of both ischemic and hemorrhagic stroke.

The Latest in Stroke Prevention Research

Efforts to prevent stress-related strokes are advancing rapidly. Medical researchers are looking beyond traditional risk factors and investigating how stress management can directly lower stroke risk. Ongoing clinical trials focus on mental health, inflammation control, and innovative interventions aimed at protecting the brain and heart.

One promising study is the Science 37 stroke prevention in patients with Atrial Fibrillation Clinical Trial. This trial is designed to find better ways to prevent strokes in people with atrial fibrillation. AFib is linked to heightened stroke risk, and stress can trigger AFib episodes.

Other trials examine the effectiveness of mindfulness interventions, relaxation techniques, and medications that help regulate the body’s response to stress. Research into lifestyle modifications, such as improved sleep and structured stress reduction programs, is also gaining attention as a potential tool for lowering stroke risk.

Advancements in stroke research continue to push the boundaries of prevention. With each new study, the medical community moves closer to developing innovative stroke treatments that may redefine how we approach stroke prevention in individuals experiencing chronic stress.

The Role of Internal Medicine in Stress-Related Stroke Prevention

Internal medicine specialists play a crucial role in addressing the complex relationship between chronic stress and stroke risk. These physicians are trained to manage a wide range of conditions, including hypertension, diabetes, and cardiovascular disease—all of which are exacerbated by chronic stress.

By taking a holistic approach, internal medicine doctors can help patients identify and mitigate stress-related risk factors through personalized treatment plans. This might include prescribing medications to control blood pressure, recommending lifestyle changes to reduce inflammation, or referring patients to mental health professionals for stress management. Their expertise in connecting the dots between stress, chronic illness, and stroke prevention makes them invaluable in the fight against stress-related cardiovascular events.

Stress-Reducing Therapies and Lifestyle Modifications

If stress is affecting your health, making lifestyle changes can help lower your risk of stroke. Here are some stress-reducing therapies and lifestyle modifications that researchers believe can make a difference:

• Mindfulness and meditation: Studies show mindfulness-based stress reduction (MBSR) techniques can help lower blood pressure, reduce inflammation, and improve overall mental health.
• Physical activity: Regular exercise improves mood, strengthens your heart, and lowers stress-related inflammation.
• Sleep management: Poor sleep is linked to higher stress levels and increased risk of cardiovascular disease. Improving sleep quality can help regulate your body’s stress response.
• Cognitive Behavioral Therapy (CBT): Therapy can help individuals develop better coping mechanisms for handling stress, reducing its long-term health effects.
• Medical interventions: Some medical centers are studying new treatments that target the biological effects of stress on the body, potentially reducing stroke risk.

Why You Should Participate in Clinical Trials

Clinical trials offer access to cutting-edge advancements in stroke research while contributing to developing life-saving treatments. These studies explore innovative ways to manage chronic stress, improve heart health, and prevent strokes before they happen.

If you’re at risk for stroke or dealing with high levels of stress, looking into clinical trials at a leading medical center may provide access to promising new treatment options before they become widely available.

Chronic stress is a serious but often overlooked factor in stroke risk. The latest stroke research is uncovering new ways to reduce this risk, from lifestyle changes to innovative stroke treatments. With the help of stress-reducing therapies and medical advancements, you can take control of your health and lower your chances of stroke.

AFib has no cure yet. So, a diagnosis like this might leave you feeling a little unsettled—maybe even scared or frustrated. You may worry about your irregular heartbeat, what it means for your future, and how it will affect your daily life. The fear associated with the condition, as well as potential complications like stroke, heart failure, and blood clots, can add another layer of anxiety and stress.

This explains why about 4 in 10 people with AFib experience mental health challenges like depression, anxiety, or issues with memory and thinking. For older adults, research shows that number can climb to 6 in 10. So, if you’ve been feeling off—mentally and emotionally—you’re not imagining it. The reality is that when your heart rhythm feels unpredictable, it can leave you feeling mentally and emotionally off-balance, too.

The Connection between AFib and Mental Health

AFib is unpredictable, and that unpredictability can be stressful. One minute, you’re fine. The next, your heart is racing, pounding, or skipping beats. Even if an episode only lasts a few minutes, the fear can linger much longer. You might start thinking:

• What if it happens again?
• What if it gets worse?
• Could this lead to a stroke or heart failure?
• Is this going to shorten my life?

These thoughts can build up over time, leading to chronic stress, anxiety, and even depression. You might start avoiding activities you love or feel like you’ve lost control over your own body.

AFib and Anxiety

AFib and anxiety often go hand in hand. When your heart beats irregularly, your nervous system goes into overdrive. Your body reacts like you’re in danger, releasing stress hormones that make your heart race even more. It’s a cycle that can be hard to break.

Some people start experiencing symptoms of anxiety even when their AFib isn’t active. It’s not just the episodes themselves—the constant fear of when the next one will strike. This is especially common if you have paroxysmal atrial fibrillation, where episodes come and go unpredictably. The uncertainty can make everyday life feel stressful.

Common signs of AFib-related anxiety include:

• Feeling on edge or restless
• Trouble sleeping because of worry
• Racing thoughts about your health
• Avoiding activities out of fear of triggering an episode
• Constantly checking your pulse or symptoms

AFib and Depression

While anxiety is about fear, depression can feel like exhaustion—both mental and physical. If you’ve been feeling hopeless, disconnected, or like you’ve lost interest in things you once enjoyed, AFib may be taking a toll on your mental health.

AFib can make you feel like you’re losing control of your life. Maybe you’ve had to change your daily routine, cancel plans, or limit physical activity. This can make you feel isolated, frustrated, or even angry. Some people with AFib also experience a type D personality, meaning they tend to hold in negative emotions instead of expressing them.

Common signs of AFib-related depression include:

• Feeling tired or unmotivated
• Losing interest in hobbies or socializing
• Feeling hopeless or stuck
• Trouble concentrating
• Thinking about worst-case scenarios or even suicidal thoughts

Why AFib Feels So Overwhelming

AFib is emotionally draining for so many reasons:

• It increases the risk of stroke, blood clots, and heart failure, and that’s a lot to process.
• It leaves you with uncertainty. Not knowing when an episode will strike can make you feel like you’re always on edge.
• It forces you to make lifestyle changes. If your doctor has told you to cut back on caffeine, alcohol, or specific activities, you might feel like you’re missing out.
• It can make you feel alone. Not everyone understands what living with AFib is like. You might feel like you have to explain yourself constantly or avoid certain situations.
• It disrupts daily life. AFib can make simple activities feel stressful. Plans get canceled. Exercise feels risky. Sleep is often disrupted.

And if you also have heart disease, congenital heart disease, or other cardiovascular diseases, you might worry about AFib making things worse. The thought of needing more medications, procedures, or even hospitalization adds another layer of anxiety.

How to Manage AFib and Mental Health

You don’t have to struggle through AFib alone. There are ways to manage your heart and mental health to feel more in control.

1. Get the Right Treatment for Your Heart

Managing AFib properly can reduce stress and improve your mental health.

• Medications can help control your heart rate and reduce the risk of stroke.
• AF ablation may help restore a normal rhythm and decrease episodes.
• Lifestyle changes, like avoiding caffeine, staying hydrated, and improving sleep, can help stabilize your heart and nervous system.

If your treatment isn’t working or you’re still feeling anxious, talk to your doctor. You deserve a plan that works for you.

2. Don’t Keep It In—Talk About It

AFib can feel overwhelming, but talking about it can help.

• Therapy can help with anxiety and depression linked to AFib. Cognitive behavioral therapy (CBT) is one approach that helps many people manage stress.
• Support groups connect you with others who understand what you’re going through.
• Talk to loved ones about how you’re feeling so they can support you.

3. Calm Your Nervous System

AFib and anxiety are connected. Calming your nervous system can help reduce symptoms.

• Deep breathing can slow your heart rate and reduce stress.
• Meditation or mindfulness can help clear your mind and keep you grounded.
• Gentle exercise, like walking or yoga, can improve physical and mental health.

4. Pay Attention to Your Mental Health

Your mental health is just as important as your physical health.

• Get enough sleep. Poor sleep can trigger AFib episodes and worsen symptoms of anxiety.
• Reduce stress triggers. Cut back on caffeine, screen time, and anything that increases anxiety.
• Seek professional help if needed. If you’re feeling stuck, reach out to a doctor or therapist.

5. Consider Clinical Trials

Clinical trials are exploring new ways to address the mental health issues that come with AFib. Some studies focus on integrated care models, where doctors and mental health professionals work together to support your heart and mind. Others test psychological support programs to ease anxiety and depression. Some clinical trials also focus on innovative therapies like:

• New medications that regulate heart rate and improve mood stability
• Wearable devices that monitor AFib symptoms and track emotional triggers
• Digital health tools, like mobile apps for stress management and meditation

These studies help doctors understand the best ways to support AFib patients beyond medication and procedures.

Ask your doctor about clinical trials that could provide innovative treatments for managing AFib and improving your quality of life.

Science 37 Offers AFib Clinical Trials

Science 37 conducts clinical trials for stroke prevention in patients with AFib, giving participants access to emerging treatments and expert-led care. Visit our website to learn more or see if you qualify.

It’s not uncommon for your skin to feel dry or itchy occasionally. Changes in weather, allergies, drug side effects, or even stress can cause temporary irritation. But when itching becomes persistent and doesn’t seem to have an obvious cause, it may be a sign of something more serious. One of the lesser-known reasons for chronic itching is liver disease.

Itching (pruritus) is a common sign of chronic liver disease. It can be a localized itch on your lower arm or an all-over itch. Either way, it can result in a distracting and overwhelming desire to scratch.

Why Does Liver Disease Cause Itching?

Your liver plays a major role in detoxifying your body. When it’s not working properly, toxins and bile acids can build up in your bloodstream. Researchers believe these imbalances may contribute to itching, but they’ve yet to pinpoint a single cause. Instead, multiple factors could be at play, including:

• Bile salts: Some people with liver health issues accumulate bile salts under their skin, triggering itchiness. However, not everyone with high bile salts experiences itching, making this connection complex.
• Histamine levels: Some people with liver disease have higher histamine levels, which can contribute to itching. Oddly, antihistamines don’t always provide relief.
• Serotonin imbalance: Serotonin, a neurotransmitter that affects mood, may also influence how you perceive itching. This could explain why certain antidepressants, like selective serotonin reuptake inhibitors (SSRIs), help some people with liver disease-related pruritus.
• Hormones: Itching sometimes worsens during pregnancy or with hormone replacement therapy, suggesting that female sex hormones play a role.
• Serum alkaline phosphatase (ALP): High ALP levels are often linked to itch-related liver diseases like primary biliary cirrhosis (PBC).
• Lysophosphatidic acid (LPA) and autotaxin: Elevated LPA levels may increase itch intensity, making this a key focus of medical research.

Which Liver Diseases Cause Itching?

Not all liver conditions cause itching. It’s rarely associated with alcohol-related liver disease or nonalcoholic fatty liver disease (NAFLD). However, if you have any of the following conditions, persistent itching could be a sign that your liver function is declining:

• Primary Biliary Cirrhosis (PBC): A progressive disease that damages the bile ducts, often causing itchy skin as an early symptom.
• Primary Sclerosing Cholangitis (PSC): A chronic condition that leads to scarring of the bile ducts, increasing bile acid levels in the bloodstream.
• Intrahepatic Cholestasis of Pregnancy (ICP): A pregnancy-related liver disorder that causes intense itching, especially on the hands and feet.
• Cholestasis: Any condition that slows or blocks bile flow, leading to bile buildup and skin irritation.
• Hepatitis (B or C): Some viral infections affect liver function and can cause itching and other liver disease symptoms.
• Cirrhosis: As the liver becomes more damaged, long-term itching may worsen due to reduced bile flow.

How Liver Disease-Related Itching Affects You

The itching sensation is deep, persistent, and impossible to ignore. It’s not the kind of itch you can scratch away. No amount of rubbing, pressing, or scratching brings real relief. Instead, the more you scratch, the worse it gets.

Many people scratch until their skin bleeds, leaving raw, painful wounds and skin lesions that take longer to heal. This can lead to skin infections, scarring, and constant discomfort. Even simple things like showering, wearing certain fabrics, or being in warm temperatures can make the itching worse.

But the effects go far beyond your skin. Sleep becomes a battle—just as you try to rest, the itching flares up, keeping you awake for hours. The next day, exhaustion hits hard, leaving you feeling drained, foggy, and irritable. Tasks that used to feel easy suddenly feel impossible when you’re running on little to no sleep.

Then there’s the emotional toll. Itching that never stops can make you feel anxious, frustrated, and even hopeless. It’s exhausting to deal with something so relentless—especially when people around you don’t fully understand what you’re going through. Over time, your quality of life takes a serious hit.

How to Manage Liver-Related Itching

Liver-related itching usually doesn’t go away on its own, but there are ways to manage it. Because the exact cause isn’t fully understood, treatments vary, and what works for one person might not work for another. It often takes a mix of therapies and some trial and error to find relief.

Here are some things that might help:

Try Not to Scratch

Scratching may feel good in the moment, but it makes things worse. It can damage your skin and lead to infections. Keep your nails short, wear loose clothes, and use a cold compress when the itching gets bad.

Use Anti-Itch Creams or Lotions

Some creams and lotions can help calm the itch. Look for fragrance-free options with menthol or calamine. If over-the-counter products don’t work, your doctor might prescribe a stronger cream.

Take Prescription Medications

Doctors sometimes prescribe medications that help with itching. Some, like Rifampicin or cholestyramine, work by lowering bile acid levels, while others, like Naltrexone, change how your brain processes the itch. If one medication doesn’t help, your doctor might try another.

Use Antihistamines for Sleep

Antihistamines don’t usually stop the itching but can help you sleep better. If the itching keeps you up at night, taking one before bed might give you some much needed relief.

Consider Light Therapy

Light therapy (phototherapy) can help some people. It exposes your skin to controlled UV light, reducing the itch by affecting nerve signals.

Talk to Your Doctor About a Liver Transplant

If your liver disease is severe and other treatments don’t work, a liver transplant might be the best option. This is usually only for advanced cases, but it can completely stop the itching if your new liver is healthy.

If you’re dealing with liver-related itching, don’t ignore it. Talk to your doctor, try different treatments, and find what works best for you. Relief is possible—you just need the right plan.

Why Early Detection Matters

Persistent itching might be the first sign that your liver is struggling. If you also notice fatigue, yellowing skin (jaundice), dark urine, or unexplained nausea, don’t ignore it. Early detection of liver disease gives you the best chance of preventing further damage and maintaining your quality of life.

Emerging Therapies and Clinical Trials

Research into emerging therapies for pruritus is ongoing. Scientists are exploring new medications that block the pathways responsible for itching. Some clinical trials are testing drugs that specifically target LPA and autotaxin, which could lead to breakthroughs in symptom management.

Science 37 also offers clinical trials for people with PBC and PSC to test an investigational medication called Volixibat. Researchers want to find out if this treatment can safely and effectively reduce itching caused by these liver diseases.

If traditional treatments haven’t worked, joining a clinical trial could give you access to cutting-edge therapies. Clinical trial participants help advance groundbreaking research and get a chance to try innovative solutions before they become widely available.

Interested? Learn more about the trial and see if you’re eligible. Your participation could help improve treatment options for countless others with liver-related itching.

Atrial fibrillation (AFib) is a common heart condition that increases the risk of stroke. It accounts for about half a million hospitalizations a year in the US and leads to more and more deaths with each passing year.

Many people with AFib do not experience symptoms, which makes early detection and treatment essential. Without proper management, AFib can lead to serious complications, including ischemic stroke and heart failure.

How AFib Increases Stroke Risk

A healthy heartbeat pushes blood through the heart’s chambers in a steady, organized pattern. In AFib, the upper chambers of the heart beat irregularly. This disrupts normal blood flow and creates areas of slow-moving blood. According to experts, these sluggish areas allow blood clots to form more easily. When a clot travels out of the heart and into the brain, it can block an artery and cause an ischemic stroke. According to the NIH, 15 to 20% of all ischemic strokes are caused by AFib.AFib-related strokes tend to be more severe than other strokes, partly because clots can form in hard-to-detect areas of the heart (like the left atrial appendage) and then break off. Studies also indicate that people with AFib may be up to five times more likely to experience a stroke than to those with normal heart rhythms.

How to Reduce Stroke Risk

AFib has no cure. But it can be treated. Treatments can help manage symptoms and reduce the risk of complications.

Prevent Blood Clots with Blood Thinners

Your doctor may recommend blood thinners (anticoagulants) to lower your risk of stroke. Anticoagulants make it harder for blood clots to form, reducing the chance of a blockage in your brain.

• Warfarin works well but requires regular blood tests to ensure the right dosage.
• Direct Oral Anticoagulants (DOACs), like apixaban or rivaroxaban, offer strong protection with fewer dietary restrictions.

Not everyone with AFib needs a blood thinner, but if your risk of stroke is high, these medications help prevent dangerous complications. Your doctor will help you decide if they’re right for you.

Control Your Heart Rhythm and Rate

You also want to keep your heart rhythm as stable as possible to improve blood flow and lower your risk of stroke.

• Calcium channel blockers and beta-blockers and slow your heart rate, making it easier for blood to circulate.
• Antiarrhythmic drugs help restore and maintain a normal rhythm.

If medications don’t work well enough, your doctor may suggest a procedure:

• Catheter ablation targets the areas in your heart that cause AFib and helps restore normal rhythm.
• Pacemakers help regulate heart rate in people with persistent arrhythmias.

Manage High Blood Pressure and Other Health Conditions

High blood pressure makes it easier for blood clots to block your arteries. So, you should keep it within a healthy range to protect your heart and lower your stroke risk.

Other conditions can also increase your risk:

• Heart failure makes it harder for your heart to pump blood properly.
• Vascular disease causes narrowing or damage to your blood vessels.
• Diabetes increases inflammation and stiffens your arteries.
• A history of transient ischemic attack (TIA) means you’re at a higher risk for a future stroke.

Managing these conditions through regular check-ups and treatment helps keep your heart and blood vessels healthy.

Make Lifestyle Changes That Support Your Heart

A healthy lifestyle strengthens the heart and supports long-term stroke prevention. Daily choices play a major role in lowering stroke risk:

• Follow a heart-healthy diet with vegetables, fruits, lean proteins, and whole grains. Reduce processed foods, salt, and sugar to prevent high blood pressure and vascular damage.
• Stay active with doctor-approved movements. Even moderate activity improves heart function and circulation.
• Limit alcohol and caffeine to avoid sudden changes in heart rhythm.
• Quit smoking to reduce artery damage and avoid clot formation.

Recognize Stroke Symptoms and Act Fast

A stroke is a medical emergency. Call your doctor if you or someone around you experiences:

• Sudden numbness or weakness in the arm, leg or face
• Trouble speaking or understanding speech
• Vision changes in one or both eyes
• Dizziness or loss of balance
• A severe headache with no known cause

Advancements in AFib Treatment

Advancements in technology now make it easier to monitor and treat AFib before it causes major problems. With the right plan, you can manage your heart rhythm, reduce symptoms, and protect your quality of life. The sooner you take action, the more options you have.

Let’s have a look at the new ways to monitor and treat AFib:

• Smartwatches Help Detect AFib Sooner – You no longer need to rely only on doctor visits for an AFib diagnosis. Many FDA-cleared smartwatches can track your heart rhythm and detect irregular beats. This means you can catch AFib early—before it leads to a stroke.
• Ablation Is More Precise and Effective – Ablation has been around for years, but today’s technology makes it safer and more effective. Doctors now use advanced mapping systems and improved catheters to find and treat abnormal electrical signals in the heart with better accuracy. This helps restore normal heart rhythm while minimizing damage to surrounding tissue.

Researchers are also testing a new non-heated method called pulse field ablation, which uses electrical energy instead of heat. This approach protects healthy tissue and may lead to faster, safer treatments for AFib.

• Next-Generation Blood Thinners Reduce Bleeding Risk – Newer blood thinners prevent strokes while lowering the risk of excessive bleeding. These medications provide a safer alternative for people who cannot take traditional oral anticoagulants like warfarin.
• Left Atrial Appendage Closure (LAAC) Offers an Alternative to Blood Thinners – Some people with AFib cannot take long-term blood thinners due to bleeding risks. LAAC is a minimally invasive procedure that seals off the left atrial appendage, where most blood clots form in AFib patients. This reduces the risk of stroke without the need for anticoagulants.

Clinical Trials for AFib Patients

If your doctor has advised against oral anticoagulants due to health concerns, you may qualify for a clinical trial that offers alternative stroke prevention options. Science 37 is currently conducting a clinical trial for people with AFib who cannot take blood thinners.

The purpose of the study is to test the safety and effectiveness of an investigational drug for preventing stroke and systemic embolism. If you qualify, you will receive expert medical care and access to a potential new treatment that may improve long-term outcomes for patients with AFib.

What This Means for You

A systematic review of AFib treatments shows that the best approach combines medication, procedures, and lifestyle changes to reduce stroke risk. New advancements may offer more options for people who cannot take standard treatments. If you want to learn more about clinical trials and whether you qualify, ask your doctor about available studies. These trials help improve future treatments and may offer a better alternative for your condition.

Asthma can be unpredictable. One day, you’re breathing fine; the next, you’re struggling to catch your breath. That’s why having an asthma action plan is so important. It helps you stay in control, manage asthma symptoms, and know exactly what to do if things worsen.

Without a plan, it’s easy to panic when an asthma attack happens. But with the right steps in place, you can act fast, avoid unnecessary trips to the emergency room, and breathe easier knowing you’re prepared.

Let’s break down an asthma action plan, why it matters, and how it can help you live with fewer flare-ups and less worry.

What Is an Asthma Action Plan?

An asthma action plan is a personalized guide that outlines how to manage asthma daily and what to do when symptoms get worse. When you create an asthma action plan, it has to include:

• Your daily asthma medicines - what to take and when
• Early warning signs - how to recognize a problem before it gets worse
• Steps to take - What actions (like increasing medication or calling for help) you should follow if your symptoms worsen.
• Emergency instructions - Clear instructions on when to go to the emergency department or call 911 if your breathing becomes severe.

An action plan helps people with asthma catch symptoms early and avoid serious breathing problems. It also reduces the risk of needing emergency care or hospitalization.

How an Asthma Action Plan Keeps You Safe

Asthma symptoms don’t always follow the same pattern. Some days, you might feel completely fine. On other days, something as simple as dust, pollen, or exercise can make breathing difficult.

An asthma action plan:

• Helps you act quickly: The earlier you recognize symptoms, the better. Your plan guides you on what to do when you start feeling chest tightness, shortness of breath, or wheezing. Catching these early signs allows you to adjust your treatment before symptoms get severe.
• Keeps you out of the hospital: Many emergency room visits happen because symptoms were ignored or mismanaged. Your action plan helps you take the right steps early—like using quick-relief medication or adjusting your routine—to prevent serious asthma attacks requiring emergency care.
• Eliminates guesswork: Asthma symptoms can change from mild to severe quickly. Without a plan, it’s easy to panic and not know what to do. An asthma action plan provides clear instructions for every stage so you always know whether to take extra medication, rest, or seek medical attention.
• Gives you more control: A plan gives you structure and confidence. When you know how to manage your symptoms, you feel more in charge of your health, reducing stress and uncertainty.

The Three Zones: Green, Yellow, and Red

Most plans use a three-zone system: Green, Yellow, and Red. These work like traffic lights: green means go, yellow means caution and red means stop and take immediate action.

Green Zone: Breathing is Normal (Feeling Good)

This is where you want to be every day. When you're in the green zone, your asthma is under control, and your breathing feels normal.

Symptoms

• No coughing, wheezing, chest tightness, or shortness of breath.
• You can exercise, work, and do daily activities without any breathing problems.
• You sleep well without waking up due to asthma symptoms.

What to Do

• Keep taking your regular asthma medicines as prescribed. These include your daily controller medications (if prescribed) to prevent symptoms from developing.
• Monitor your breathing regularly to catch any early signs of trouble before they progress to the yellow zone.

When you're in the green zone, your asthma is stable, but it's still important to stay consistent with your treatment to keep it that way.

Yellow Zone: Warning Signs – Pay Attention

The yellow zone is a sign that your asthma is getting worse. It doesn’t mean an emergency, but you must act before things escalate.

Symptoms

• You notice mild asthma symptoms, like coughing, wheezing, or chest tightness.
• You feel short of breath, even during everyday activities.
• Symptoms may get worse at night or with exercise.
• You may need to use your quick-relief inhaler more often.

What to Do

• Use your quick-relief inhaler (rescue medication) as directed. This helps open your airways and improve your breathing.
• Monitor your symptoms closely. If they don’t improve or worsen, move to the red zone and take action.
• Adjust your medication if your asthma action plan recommends it. Some plans suggest temporarily increasing certain medicines during the yellow zone to prevent worsening symptoms.

Think of the yellow zone as an early warning sign. Catching symptoms at this stage can help prevent an asthma attack and keep you from needing emergency care.

Red Zone: Danger – Act Immediately

The red zone is a serious emergency. This means your asthma symptoms are severe, and you need immediate medical attention.

Symptoms

• Severe breathing difficulty, even when resting.
• Your rescue inhaler isn’t helping or is only providing short-term relief.
• You can’t talk in full sentences or walk without feeling out of breath.
• Your lips or fingernails may turn blue or gray (a sign of dangerously low oxygen).

What to Do

• Use your quick-relief inhaler immediately. If you don’t feel better after the first dose, follow your action plan for emergency medication instructions.
• If symptoms continue to worsen or do not improve within 15 minutes, call 911 or go to the emergency department right away.
• Do not wait! Severe asthma attacks can be life-threatening. If you are struggling to breathe, seeking emergency care could save your life.

The red zone is a critical situation requiring fast action. If you ever reach this stage, do not hesitate to get help.

How to Reduce Emergency Room Visits

Most asthma-related emergency visits happen because symptoms aren’t addressed early enough. To stay in control, follow your daily treatment plan, even when you feel fine. Pay attention to small changes in your breathing and use a peak flow meter to track how well your lungs work.

If symptoms get worse, adjust your treatment immediately by following your asthma action plan. Acting early prevents severe attacks and keeps you out of the emergency room.

The Role of Clinical Trials in Asthma Care

It’s one thing to manage the symptoms and another to find a long-term solution. Clinical trials help develop new treatments that could make asthma easier to control and reduce the risk of severe attacks. These research studies test innovative medications and therapies under the guidance of health professionals, ensuring safety and effectiveness before they become widely available.

As a study participant, you get early access to potential breakthrough treatments while contributing to the future of asthma care. Your involvement helps researchers understand what works best for people with asthma, leading to better options for everyone. If you’re interested in participating, explore Science 37’s Asthma Trials and see how you can help shape the next generation of asthma treatment.

If you’ve been diagnosed with Primary Sclerosing Cholangitis (PSC) or Primary Biliary Cholangitis (PBC), you probably have many questions. You may feel overwhelmed, uncertain about what’s next, or even scared. That’s completely understandable. These are rare, chronic liver diseases, and not many people—even within the medical community—fully understand them.

But you should know that you are not alone, and there is a way forward.

In this blog, we aim to help you understand what’s happening in your body, what you can do to manage your condition, and how you and your caregiver can work together to keep you feeling as well as possible. We’ll also share practical ways to cope—physically and emotionally—so that you can take control of your health with confidence.

Understanding PSC and PBC: How These Rare Liver Diseases Affect You

When you hear the term “rare liver disease,” you might feel confused, worried, or even a bit lost. Knowing more about PSC and PBC can help you gain control over your health and ease some of the anxiety that comes with an unfamiliar diagnosis. Both PSC and PBC affect the bile ducts in your liver, but they do so in different ways and can lead to distinct challenges and complications.

• PSC is a chronic, progressive liver disease that causes bile ducts to become inflamed and scarred, leading to blockages that can damage the liver. It also increases the risk of liver failure, colon cancer and portal hypertension (high blood pressure in the liver’s veins).
• PBC is an autoimmune condition where the immune system mistakenly attacks the small bile ducts in the liver. Over time, this can lead to liver damage and may require primary biliary cholangitis treatment to slow progression.

Risk factors for both conditions include sex, environmental factors and genetics. PSC and PBC diagnosis usually involves blood tests, including alkaline phosphatase levels, imaging, and sometimes a liver biopsy to assess damage.

PBC and PSC Treatment

There’s no cure for both conditions yet, but there are ways to manage symptoms and slow progression.

For PBC, doctors often prescribe ursodeoxycholic acid (UDCA). This medication helps bile flow better and reduces liver damage. It works well for many people, but some may need additional treatments. New drugs, like obeticholic acid, are being tested in clinical research studies to see if they can help where UDCA isn’t enough.

PSC is trickier because no medication stops or reverses the disease. Treatment focuses on managing symptoms and preventing complications. Some people may take bile acid medications to ease itching or antibiotics to treat infections in the bile ducts. If PSC leads to portal hypertension, doctors may suggest procedures to relieve pressure. In advanced cases, a liver transplant becomes an option.

Why Support is Critical

It’s not easy living with a condition that has no cure. Some days, you feel fine. Other days, fatigue, discomfort, or frustration takes over. It’s hard to explain to people who haven’t been through it. That’s why having support matters.

Talking to People Who Get It

Friends and family care, but they don’t always understand what it’s like to wait on blood test results or manage constant fatigue. A support group connects you with people who do. You can share experiences, ask questions, and get advice from others facing the same challenges. Just knowing you’re not alone makes a big difference.

Real-Life Tips That Actually Help

Support groups aren’t just for emotional support. They’re full of people who have been where you are. Need a doctor's recommendation? Looking for ways to ease symptoms or drug side effects? Trying to explain your condition to your employer? Someone in the group has been there and can offer real advice.

Staying Informed and Getting Involved

Support groups also connect you to the latest information. Many work with researchers to answer specific research questions about PSC and PBC. You can learn about the latest research and ways to access them through these groups.

Stress Management Techniques

Stress messes with your mood and takes a toll on your body, too. When you’re dealing with PSC or PBC, the last thing you need is extra inflammation, making things worse. You can’t avoid stress altogether, but you can find ways to keep it from running the show.

Breathe, Move, Rest

When everything feels overwhelming, take a few deep breaths. Slow, steady breathing calms your nervous system and allows your body to reset. Moving your body also helps, even if it’s just a short walk or gentle stretching. It keeps your circulation flowing and can help with fatigue.Additionally, sleep is crucial. When your body works harder because of liver damage, pushing through exhaustion only worsens things. Rest when you need to—this isn’t about being lazy; it’s about staying strong.

Find What Helps You Feel Grounded

You know yourself best. Maybe music helps you relax. Maybe you find comfort in reading, spending time outside, or sitting quietly with a pet. Stress piles up when there’s no break, so finding small moments of peace throughout the day makes a real difference. Even five minutes of quiet time can help reset your mind and body.

How Your Diet Affects Your Liver

What you eat matters. Your liver works hard daily, and it’s already under extra strain with PSC or PBC. The right foods help support your liver, keep your energy steady, and prevent further damage.

What to Avoid

Some foods make things harder on your liver.

• Fried and processed foods overload your liver with unhealthy fats and increase inflammation.
• Too much sugar causes fat buildup in your liver, making it work even harder.
• Alcohol damages your liver cells, even in small amounts. Avoiding it completely is safest.
• Raw shellfish carries bacteria your liver struggles to filter out, increasing your risk of infections.

What to Eat More Of

Some foods help your liver function better and keep your body strong.

• Lean protein from chicken, fish, eggs, and tofu keeps your muscles strong without stressing your liver.
• Healthy fats from avocados, nuts, and olive oil help reduce inflammation.
• Fiber-rich foods like whole grains, fruits, and vegetables help with digestion and bile flow.
• Water is essential—staying hydrated keeps everything running smoothly.

If you also have ulcerative colitis, some high-fiber foods may trigger symptoms. Pay attention to how your body reacts and adjust as needed. A doctor or dietitian can help you find the best balance for your liver and gut health.

Why You Need a Good Liver Specialist

PSC and PBC aren’t common, so not every doctor knows how to treat them properly. You need a hepatologist—a liver specialist—who understands what to look for and how to manage your condition. An experienced hepatologist will monitor your liver health closely, manage symptoms and complications, adjust treatment plans as needed, and discuss liver transplant options if necessary. They may also point you to clinical research studies that could open new doors for treatment.

One current study through Science 37 is testing a medication called volixibat to see if it can help with one of the most frustrating symptoms of PSC and PBC—chronic itching. Your hepatologist will know if you qualify for a study like this and whether it fits you well.Having the right specialist in your corner makes all the difference. They help you stay ahead of the disease, adjust your care as needed, and ensure you have access to every possible option for the best quality of life.