Gracia Fahed, MD

All Publications

• Race, Genetics, and Social Determinants of Health in Transthyretin Cardiac Amyloidosis: A Literature Review and Call to Action. Current cardiology reports Fahed, G., Collins, B. N., Cai, N., Jimenez, J. I., Kitakata, H., Pino Moreno, J. E., Alexander, K. M. 2025; 27 (1): 66

  Abstract

  Recent evidence suggests that transthyretin cardiac amyloidosis (ATTR-CM) is significantly more common than once believed, yet it remains frequently under- and mis-diagnosed. With effective treatments now available, early and accurate diagnosis has become critical for better patient outcomes. Understanding the interplay between genetics, race, and social determinants of health (SDOH) in influencing both ATTR-CM diagnosis and management is essential for bridging the current gaps.Our analysis reveals multiple barriers affecting ATTR-CM care. Specifically, we discuss how clinician awareness, regional differences in clinical practice, and limited access to health care and specialty centers contribute to diagnostic delays. Additionally, we identify several management obstacles, such as inadequate diversity in clinical trials, high cost of available treatments, and limited ancillary resources. We examine these challenges in detail and provide practical solutions to address them. While disparities in heart failure outcomes have been well-documented, those specific to ATTR-CM remain underrepresented in the literature. This review establishes a structured approach to understanding how biological, structural and SDOH-related disparities impact ATTR-CM diagnosis and management while offering concrete strategies to overcome these challenges. We emphasize the need for enhanced SDOH identification and advocate for coordinated, multidisciplinary efforts to improve ATTR-CM patient outcomes.

  View details for DOI 10.1007/s11886-025-02220-z

  View details for PubMedID 40042763

  View details for PubMedCentralID 6233639

• The Impact of Social Determinants of Health on Timely Detection in Transthyretin Cardiac Amyloidosis. JACC. Heart failure Fahed, G., Jimenez, J. I., Adrianzen Fonseca, M. I., Hu, J., Spencer-Bonilla, G., Haddad, F., Pino Moreno, J. E., Witteles, R. M., Alexander, K. M. 2025; 13 (3): 530-532

  View details for DOI 10.1016/j.jchf.2024.11.022

  View details for PubMedID 40044389

• Socioeconomic and Geographic Disparities in the Reported U.S. Amyloidosis Mortality From 2018-2022: A Persistent Underdetection? JACC. Heart failure Fahed, G., Jimenez, J. I., Cai, N., Wu, X., Edmonds, A., Shah, K., Kitakata, H., Haddad, F., Witteles, R. M., Alexander, K. M. 2025; 13 (3): 533-535

  View details for DOI 10.1016/j.jchf.2024.11.021

  View details for PubMedID 40044390

• The lived experiences of patients with cancer during the COVID-19 pandemic: a qualitative study. Ecancermedicalscience Fahed, G., Fares, A. H., Ghosn, A., Greige, A., Hebbo, E., Naja, K., Moukarzel, P., Haddad, S., Finianos, A., Honein, G., Akl, E. A. 2023; 17: 1598

  Abstract

  The objective of this study was to explore the impact of COVID-19 on the lived experiences of patients with cancer in Lebanon.We adopted a descriptive phenomenological approach. We included adults who had been diagnosed with cancer before the pandemic and undergoing treatment at the American University of Beirut Medical Centre. We conducted virtual, semi-structured in-depth interviews with either video or audio recordings. Two team members coded the transcripts independently and identified common themes and patterns.We recruited 11 participants for the study. The analysis identified the following six themes: perceived seriousness of COVID-19, fear of COVID-19 versus fear of cancer, coping mechanisms, treatment availability and accessibility, compliance with public health and social measures and precautionary measures in the healthcare system. The coping mechanisms included staying positive, seeking normalcy, using family support, religiosity and fatalism.Faced with many challenges during the COVID-19 pandemic, patients with cancer resorted to a range of coping strategies.

  View details for DOI 10.3332/ecancer.2023.1598

  View details for PubMedID 37799953

  View details for PubMedCentralID PMC10550325

• The Lung Microbiota and Lung Cancer: A Growing Relationship. Cancers Bou Zerdan, M., Kassab, J., Meouchy, P., Haroun, E., Nehme, R., Bou Zerdan, M., Fahed, G., Petrosino, M., Dutta, D., Graziano, S. 2022; 14 (19)

  Abstract

  The lung is home to a dynamic microbial population crucial to modulating immune balance. Interest in the role of the lung microbiota in disease pathogenesis and treatment has exponentially increased. In lung cancer, early studies suggested an important role of dysbiosis in tumor initiation and progression. These results have helped accelerate research into the lung microbiota as a potential diagnostic marker and therapeutic target. Microbiota signatures could represent diagnostic biomarkers of early-stage disease. Lung microbiota research is in its infancy with a limited number of studies and only single-center studies with a significant methodological variation. Large, multicenter longitudinal studies are needed to establish the clinical potential of this exciting field.

  View details for DOI 10.3390/cancers14194813

  View details for PubMedID 36230736

  View details for PubMedCentralID PMC9563611

• Mechanisms underlying the effects of caloric restriction on hypertension. Biochemical pharmacology Al Attar, A. A., Fahed, G. I., Hoballah, M. M., Pedersen, S., El-Yazbi, A. F., Nasser, S. A., Bitto, A., Orekhov, A. N., Eid, A. H. 2022; 200: 115035

  Abstract

  Hypertension is a major risk factor for cardiovascular disease (CVD) as well as a major contributor to all-cause mortality and disability worldwide. The pathophysiology of hypertension is highly attributed to a dysfunctional endothelium and vascular remodeling. Despite the wide use of pharmacological therapies that modulate these pathways, a large percentage of patients continue to have uncontrolled hypertension, and the use of non-pharmacological interventions is increasingly investigated. Among these, caloric restriction (CR) appears to be a promising nutritional intervention for the management of hypertension. However, the mechanisms behind this effect are not yet fully understood, although an evolving view supports a significant impact of CR on vascular structure and function, specifically at the level of vascular endothelial cells, vascular smooth muscle cells along with their extracellular matrix (ECM). Accumulating evidence suggests that CR promotes endothelium-dependent vasodilation through activating eNOS and increasing nitric oxide (NO) levels through multiple cascades involving modulation of oxidative stress, autophagy, and inflammation. Indeed, CR diminishes phenotypic shift, and suppresses proliferation and migration of VSMCs via pathways involving NO and mTOR. By regulating transforming growth factor-β and matrix metalloproteinases, CR appears to reduce ECM and collagen deposition in vascular walls. Here, we offer a detailed discussion of how these mechanisms contribute to CR's influence on reducing blood pressure. Such mechanisms could then provide a valuable foundation on which to base new therapeutic interventions for hypertension.

  View details for DOI 10.1016/j.bcp.2022.115035

  View details for PubMedID 35427570

• Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. International journal of molecular sciences Fahed, G., Aoun, L., Bou Zerdan, M., Allam, S., Bou Zerdan, M., Bouferraa, Y., Assi, H. I. 2022; 23 (2)

  Abstract

  Metabolic syndrome (MetS) forms a cluster of metabolic dysregulations including insulin resistance, atherogenic dyslipidemia, central obesity, and hypertension. The pathogenesis of MetS encompasses multiple genetic and acquired entities that fall under the umbrella of insulin resistance and chronic low-grade inflammation. If left untreated, MetS is significantly associated with an increased risk of developing diabetes and cardiovascular diseases (CVDs). Given that CVDs constitute by far the leading cause of morbidity and mortality worldwide, it has become essential to investigate the role played by MetS in this context to reduce the heavy burden of the disease. As such, and while MetS relatively constitutes a novel clinical entity, the extent of research about the disease has been exponentially growing in the past few decades. However, many aspects of this clinical entity are still not completely understood, and many questions remain unanswered to date. In this review, we provide a historical background and highlight the epidemiology of MetS. We also discuss the current and latest knowledge about the histopathology and pathophysiology of the disease. Finally, we summarize the most recent updates about the management and the prevention of this clinical syndrome.

  View details for DOI 10.3390/ijms23020786

  View details for PubMedID 35054972

  View details for PubMedCentralID PMC8775991

• Analysis of Antiplatelet/Anticoagulant Agents Exposure in Patients With Positive Fecal DNA Test Inaganti, A., Fahed, J., Fahed, G., Huq, N., Affi, A. LIPPINCOTT WILLIAMS & WILKINS. 2019: S144-S145

  View details for DOI 10.14309/01.ajg.0000590524.84529.12

  View details for Web of Science ID 000509756000249

• Is Stool DNA Test More Specific for Proximal or Distal Neoplasia? Inaganti, A., Fahed, J., Fahed, G., Huq, N., Affi, A. LIPPINCOTT WILLIAMS & WILKINS. 2019: S145

  View details for DOI 10.14309/01.ajg.0000590528.92152.05

  View details for Web of Science ID 000509756000250

• Real Life Impact of Physician Awareness of a Positive Stool DNA Test on Subsequent Colonoscopy Outcome in Colorectal Cancer Screening Huq, N., Fahed, G., Affi, A., Fahed, J. LIPPINCOTT WILLIAMS & WILKINS. 2019: S1561

  View details for DOI 10.14309/01.ajg.0000600860.16593.c4

  View details for Web of Science ID 000509756006332

• Colonoscopy Outcome Similarities and Differences Between GI Providers and Non-GI Providers in Patients Who Undergo Colonoscopy Following a Positive Stool DNA Test Huq, N., Fahed, G., Inaganti, A., Affi, A., Fahed, J. LIPPINCOTT WILLIAMS & WILKINS. 2019: S167-S168

  View details for DOI 10.14309/01.ajg.0000590676.24883.90

  View details for Web of Science ID 000509756000287

• What Differences Are There Between Early and Delayed Colonoscopy Following a Positive Stool DNA Test? Huq, N., Fahed, G., Inaganti, A., Affi, A., Fahed, J. LIPPINCOTT WILLIAMS & WILKINS. 2019: S169

  View details for DOI 10.14309/01.ajg.0000590688.70624.78

  View details for Web of Science ID 000509756000290

• Real-Life Experience with More Than 20,000 Stool Dna Tests May Change Your Mind Fahed, J., Fahed, G., Affi, A. 2019

  View details for DOI 10.1016/S0016-5085(19)38978-4