ATS: Meta-Analysis Confirms Statins' Anti-Thrombotic Effect

Research finds statins decrease risk of pulmonary embolism, deep venous thrombosis

31 may 2010-- The preponderance of evidence shows that statins do decrease the risk of venous thromboembolism, according to research presented May 16 at the annual international conference of the American Thoracic Society, held in New Orleans May 14-19, and published in the May issue of American Journal of Respiratory and Critical Care Medicine.

V. Agarwal, of the University of Connecticut Health Center, Hartford, and colleagues conducted a meta-analysis of 10 studies that evaluated the effect of statin drugs on deep vein thrombosis (DVT), pulmonary embolism (PE) or any venous thromboembolism (VTE), defined as DVT and/or PE. Only one randomized trial, JUPITER, met the inclusion criteria.

In JUPITER, the adjusted odds ratio (AOR) for VTE was 0.57; the AORs for DVT only and PE only were 0.45 and 0.77, respectively. Observational studies showed less risk reduction for VTE and DVT, but a larger risk reduction for PE. For all studies combined, the effect of statins was a 32 percent risk reduction for VTE, a 41 percent risk reduction for DVT only, and a 30 percent risk reduction for PE only.

"The totality of clinical study evidence suggests that statins can reduce patients' odds of developing DVT or PE," the authors write.

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Irregular Medication Use Puts Seniors At Risk For Falling

23 may 2010--Older adults increase their chances of falling by not taking their medications as directed, according to an article in the latest edition of the Journals of Gerontology Series A: Biological and Medical Sciences (Volume 65A, Number 5). This new information comes from a recent study of Boston-area residents over age 70, which found that those who sometimes neglected their medications experienced a 50 percent increased rate of falls compared with those who did not.

"Falls can now be added to the growing list of poor health outcomes associated with non-adherence to medication," said lead author Sarah D. Berry, MD, MPH, a research scientist with the Institute for Aging Research at Hebrew SeniorLife in Boston. "Because non-adherence is common and easy to screen for, health care providers should discuss this subject with their patients."

Berry and her co-authors are the first investigators to study the association between falls and medication adherence. The team used data gathered from subjects in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston (MOBILIZE Boston) Study, a community-based cohort of seniors recruited for the purpose of studying novel risk factors for falls. They examined responses from a total of 246 men and 408 women with an average age of 78. Between 2005 and 2008, 376 individuals in this group reported a total of 1,052 falls.

A participant was characterized as having low medication adherence if he or she answered yes to any of the following questions: Do you ever forget to take your medications? Are you careless at times about taking your medications? When you feel better do you sometimes stop taking your medications? Sometimes if you feel worse when taking your medication, do you stop taking it? High adherence was defined as a "no" answer to every question. In total, 48 percent of the respondents were classified as having low medication adherence.

Those in the low-adherence group experienced falls at an annual rate of 1.5 times that of the high adherence group. This association persisted after adjusting for other variables, including age, sex, cognitive function, and total number of medications.

The journal article's authors were supported by the Hartford Geriatrics Health Outcomes Research Scholars Awards Program, the Hebrew Rehabilitation Center for the Aged/Harvard Research Nursing Home Program funded by the National Institutes of Health, and an unrestricted grant from Pfizer, Inc.

Source:
Todd Kluss
The Gerontological Society of America

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Elderly Falls Linked to Altered Blood Flow in Brain

19 may 2010-- High blood pressure can alter the flow of blood in the brain and lead to falls among the elderly, new research suggests.

The findings stem from research led by Dr. Farzaneh A. Sorond of Brigham and Women's Hospital, Hebrew SeniorLife's Institute for Aging Research and Harvard Medical School in Boston.

Sorond and her colleagues focused on 419 men and women over the age of 65, all of whom underwent walking speed monitoring and ultrasound testing to gauge brain blood flow. All the seniors and their caregivers also indicated how many times the participants had fallen in the previous two years.

In the May 18 issue of Neurology, the authors report that those seniors who were among the 20 percent of participants who experienced the smallest brain blood flow changes were 70 percent more likely to fall than those among the 20 percent with the largest brain blood flow changes.

In other words, those with the highest blood flow rate fell on average fewer than once per year, while those with the smallest blood flow rate fell almost 1.5 times per year.

"At age 60, 85 percent of people have a normal walking ability," Sorond said in a news release. "However, by age 85, only 18 percent of seniors can walk normally."

"Our findings suggest there could be a new strategy for preventing falls, such as daily exercise and treatments for high blood pressure, since blood pressure affects blood flow in the brain and may cause falls," she added.

In the United States, unintentional falls prompt 1.8 million visits to the emergency room each year, and lead to more than 16,000 deaths, the researchers noted.

More information

For more on falls, high blood pressure and the elderly, visit the Foundation for Healthy Aging.

Spouses of dementia sufferers have a 6-fold increased risk of dementia onset

Husbands appear at higher risk than wives

Older married adults whose spouse has dementia are at significantly higher risk for developing dementia themselves, compared to similar older married adults whose spouse never develops dementia. This is the key finding of a study published today in the Journal of the American Geriatrics Society.

Informal dementia caregiving for a spouse is a natural marital obligation, and spousal caregivers often report positive feelings toward caregiving, yet it is difficult, requiring time, energy and usually physical exertion. Dementia caregivers have been shown to provide more assistance, and to report more personal sacrifices and stress, than those who care for physically-impaired elderly without dementia. While there are many published studies showing that dementia caregivers are at higher risk for health problems and depression, none have examined risk for dementia in the caregiver.

2,442 subjects (1,221 married couples) aged 65 and older from Northern Utah, USA, without dementia at onset were studied for up to 12 years to monitor for onset of dementia in husbands, wives or both. During this time, 125 cases of dementia only in the husband were diagnosed, 70 only in the wife, and 30 where both spouses were diagnosed (60 people).

The researchers, led by Dr. Maria Norton of Utah State University, USA, adjusted for socioeconomic status, a significant predictor of many health-related outcomes including dementia to control for shared environmental exposures that might influence risk for dementia in both spouses.

The results showed that incident dementia was significantly associated with older age, and having a spouse with dementia. Participants with a spouse who developed dementia were at a six times increased risk of developing dementia, net of the effect of age, gender, APOE genotype, and socioeconomic status, with higher risk in men (11.9) than women (3.7).

"Future studies are needed to determine how much of this association is due to caregiver stress compared to a shared environment," said Norton. "On the positive side, the majority of these individuals, with spouses who develop dementia, did not themselves develop dementia, therefore more research is needed to explore which factors distinguish those who are more vulnerable."

"Given the significant public health concern of Alzheimer's disease and other dementias, and the upcoming shift in population age composition, continued research into the causes of dementia is urgent," concluded Norton.

Pneumococcal Vaccine Not Found to Reduce Heart Risks

Study of men ages 45 to 69 shows no link between vaccination and reduced risk of MI and stroke

05 may 2010-- In older men, receipt of pneumococcal vaccine is not linked to a reduced risk of acute myocardial infarction (MI) and stroke, according to a study in the May 5 issue of the Journal of the American Medical Association.

Hung Fu Tseng, Ph.D., of Kaiser Permanente Southern California in Pasadena, and colleagues conducted a prospective cohort study of 84,170 participants ages 45 to 69 from the California Men's Health Study who were recruited between January 2002 and December 2003. The men were followed until Dec. 31, 2007.

After accounting for propensity score, the researchers found no evidence of an association between pneumococcal vaccination and reduced risk of acute MI or stroke (adjusted hazard ratios, 1.09 and 1.14, respectively). They also did not find an inverse association in men of different age and risk groups.

"Our findings are consistent with those reported by Smeeth et al, which showed within-person comparisons using the case-series method to study the risks of MI and stroke after common vaccinations and naturally occurring infections," the researchers write. "The authors concluded that acute infections are associated with a transient increase in the risk of vascular events. However, influenza, tetanus, and pneumococcal vaccinations do not produce a detectable increase in the risk of vascular events. Combined with the findings from our study, it appears that both short- and long-term risks of acute MI and stroke are not affected by pneumococcal vaccination"

The study was funded by California Cancer Research Program and Kaiser Permanente. Four authors disclosed financial ties to Merck and one to GlaxoSmithKline.

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Bad habits can age you by 12 years, study suggests

CHICAGO, 04 may 2010 – Four common bad habits combined — smoking, drinking too much, inactivity and poor diet — can age you by 12 years, sobering new research suggests.

The findings are from a study that tracked nearly 5,000 British adults for 20 years, and they highlight yet another reason to adopt a healthier lifestyle.

Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29 percent. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8 percent.

The risky behaviors were: smoking tobacco; downing more than three alcoholic drinks per day for men and more than two daily for women; getting less than two hours of physical activity per week; and eating fruits and vegetables fewer than three times daily.

These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group, said lead researcher Elisabeth Kvaavik of the University of Oslo.

The study appears in Monday's Archives of Internal Medicine.

The healthiest group included never-smokers and those who had quit; teetotalers, women who had fewer than two drinks daily and men who had fewer than three; those who got at least two hours of physical activity weekly; and those who ate fruits and vegetables at least three times daily.

"You don't need to be extreme" to be in the healthy category, Kvaavik said. "These behaviors add up, so together it's quite good. It should be possible for most people to manage to do it."

For example, one carrot, one apple and a glass of orange juice would suffice for the fruit and vegetable cutoffs in the study, Kvaavik said, noting that the amounts are pretty modest and less strict than many guidelines.

The U.S. government generally recommends at least 4 cups of fruits or vegetables daily for adults, depending on age and activity level; and about 2 1/2 hours of exercise weekly.

Study participants were 4,886 British adults aged 18 and older, or 44 years old on average. They were randomly selected from participants in a separate nationwide British health survey. Study subjects were asked about various lifestyle habits only once, a potential limitation, but Kvaavik said those habits tend to be fairly stable in adulthood.

Death certificates were checked for the next 20 years. The most common causes of death included heart disease and cancer, both related to unhealthy lifestyles.

Kvaavik said her results are applicable to other westernized nations including the United States.

June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity.

The findings don't mean that everyone who maintains a healthy lifestyle will live longer than those who don't, but it will increase the odds, Stevens said.

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On the Net:

Archives: http://www.archinternmed.com

Val Allele Linked to Protective Effect on Cognitive Function

Effect of the catechol-O-methyltransferase variant is observed in older adults

02 may 2010-- In older adults, the Val variant of the catechol-O-methyltransferase (COMT) gene is associated with a protective effect on cognitive function, according to research published in the April 20 issue of Neurology.

Alexandra J. Fiocco, Ph.D., of the University of California in San Francisco, and colleagues analyzed data from 2,858 black and white men and women aged 70 to 79 and free of dementia at recruitment. Participants' DNA was analyzed for the COMT gene; the COMT enzyme catalyzes the degradation of dopamine and is involved in cognitive function.

The researchers found that COMT genotype was not associated with baseline cognitive function using the Modified Mini-Mental State Examination or the Digit Symbol Substitution Test. However, they found that the Met variant of the COMT gene was linked to a greater cognitive decline over eight years of follow-up, and that the Val variant had a protective effect on cognition.

"Altogether, the present findings suggest COMT genotype is associated with change in global and executive cognitive function over an eight-year period in a biracial cohort of elderly men and women. We report an association between the Val allele and maintenance of cognitive function in black and white elders. Additional studies are needed to confirm the negative impact of the Met allele on cognitive decline in late life," the authors conclude.

A co-author disclosed financial ties to the pharmaceutical industry.

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