Saturday, June 30, 2012

Low vitamin D levels linked to weight gain in some older women

Older women with insufficient levels of Vitamin D gained more weight than those with sufficient levels of the vitamin, according to a new study funded by the National Institutes of Health and published online in the Journal of Women's Health. The study of more than 4,600 women ages 65 and older found that over nearly five years, those with insufficient levels of Vitamin D in their blood gained about two pounds more than those with adequate levels of the vitamin.
30 jun 2012--"This is one of the first studies to show that women with low levels of Vitamin D gain more weight, and although it was only two pounds, over time that can add up," said study author Erin LeBlanc, MD, an endocrinologist and researcher at the Kaiser Permanente Center for Health Research in Portland, Oregon. "Nearly 80 percent of women in our study had insufficient levels of Vitamin D. A primary source of this important vitamin is sunlight, and as modern societies move indoors, continuous Vitamin D insufficiency may be contributing to chronic weight gain."
Vitamin D was in the news recently when a panel of primary care experts-- the US Preventive Services Task Force-- said healthy postmenopausal women may need higher doses of the vitamin to prevent fractures, and that there isn't enough evidence to recommend the supplements for younger people. Other expert groups, including The Endocrine Society, have a different take, saying many adults do need Vitamin D supplements to keep their bones healthy.
"Our study only shows an association between insufficient levels of Vitamin D and weight gain, we would need to do more studies before recommending the supplements to keep people from gaining weight," LeBlanc said. "Since there are so many conflicting recommendations about taking Vitamin D for any reason, it's best if patients get advice from their own health care provider."
She points out that this study was conducted among older women who, for the most part, were not trying to lose weight—though some of them did so as a natural result of aging. About 60 percent of the 4,659 women in the study remained at a stable weight (within 5 percent of their starting weight) over the 4.5-year study period, 27 percent lost more than 5 percent of their body weight, and 12 percent gained more than 5 percent of their body weight.
Most women in the study (78 percent) had less than 30 nanograms per millimeter (ng/ml) of Vitamin D in their blood—the level defined as sufficient by The Endocrine Society panel of experts who set clinical guidelines on Vitamin D deficiency. These women had higher baseline weight to begin with: 148.6 pounds, compared with 141.6 pounds for women whose Vitamin D levels were 30 ng/ml or above. Insufficient levels had no association with weight changes in the entire group of women, or in the group that lost weight. But in the group of 571 women who gained weight, those with insufficient Vitamin D levels gained more—18.5 pounds over five years—than women who had sufficient Vitamin D. The latter group gained 16.4 pounds over the same period.
Provided by Kaiser Permanente

Friday, June 29, 2012

Task force recommends screening all adults for obesity

Task force recommends screening all adults for obesity

Clinicians should screen all adults for obesity; and, there is a small health benefit for initiating behavioral counseling interventions in a primary care setting for adults without cardiovascular disease or its risk factors, according to two recommendation statements published online June 26 in the Annals of Internal Medicine.
29 jun 2012-- The U.S. Preventive Services Task Force released new guidelines Monday recommending that doctors screen all of their patients for obesity and when appropriate, refer them to a comprehensive lifestyle-management program to help them lose weight.
The government task force didn't recommend any weight-loss medications, nor did it address weight-loss surgery.
The task force also issued a second set of guidelines to help doctors identify which patients might benefit most from healthy lifestyle counseling to avoid heart health problems.
Both sets of guidelines appear in the June 26 online edition of the Annals of Internal Medicine.
"The obesity screening recommendations are an update of existing recommendations that we felt was necessary because the evidence has increased and strengthened the argument for physicians to screen all of their patients for obesity," explained task force member Dr. David Grossman, medical director of preventive care at Group Health Cooperative, in Seattle.
In addition, Grossman said, "The magnitude of the problem has increased, and the clinician plays an important role in helping to identify and get services for obesity. Even just a 5 percent weight loss can make a huge difference in someone's health."
The new guidelines recommend that physicians screen all of their patients for obesity by measuring height and weight to assess their body mass index. A BMI of 30 or more is considered obese, according to the U.S. Centers for Disease Control and Prevention. Below 25 is considered normal weight.
The guidelines also say that physicians can use waist circumference to assess obesity. That's because abdominal fat can be a predictor of obesity-related diseases, according to the CDC.
The task force did not advise physicians on how to counsel overweight (but not obese) patients -- those with a BMI of 25 to 29.9. Grossman said there just isn't enough evidence yet to provide clear recommendations for this group of people.
If someone has a body mass index of 30 or higher, the guidelines recommend that doctors refer them to an intensive, behavior-changing weight-loss program. 
Grossman and the task force didn't recommend any specific weight-loss plans, but he said plans should offer at least 12 to 26 sessions during the first year.
Other important components of a weight-loss and behavior-intervention program are nutrition counseling, physical activity and accountability, such as weighing in at regular intervals, counting calories and tracking activity levels. This can be done through weight-loss groups or individually, Grossman said.
Another important aspect in battling obesity is helping people address barriers to change. "We need to help people understand why they're not eating more healthfully or being more active, and help them solve those issues," he said. It's also important that any comprehensive program include a weight-maintenance component, Grossman said.
He said the task force guidelines couldn't address the cost-effectiveness or insurance reimbursements for such programs because there's not enough evidence out there. He added that Medicare is starting to pay for some of these services.
Nancy Copperman, director of public health initiatives at the North Shore-LIJ Health System in Great Neck, N.Y., said insurance companies don't reimburse for a lot of comprehensive weight programs. "Medicare will cover obesity counseling for obese seniors, but that counseling can only be given by primary care doctors, so that wouldn't necessarily meet the task-force recommendations," she said.
Copperman said that some insurers are starting to fund diabetes and heart-disease prevention programs, and that if insurers start to see a return on their investments, more reimbursed programs will likely be available.
The current guidelines only address obese adults. The task force has previously issued guidelines for obese children that are available on its website, according to Grossman.
The second set of guidelines issued by the task force was designed for people who have a normal or low risk of cardiovascular disease. Grossman said these were previously separate guidelines that addressed healthy eating and physical activity, but that the task force combined them into one recommendation on healthy lifestyle counseling.
But, the task force advised doctors that such counseling isn't appropriate for all patients. It said that doctors should consider patients' risk factors, as well as their readiness to make changes. Doctors should also consider how much social and community support an individual has, the guidelines say.
"For healthy people without a high risk of disease, moderate to intensive counseling nets a small return," Copperman said. "And, lifestyle changes can be a touchy subject. Doctors want patients to come back. They want to engage them, not alienate them."

Thursday, June 28, 2012

Exercise is key in the fight against Alzheimer's disease

In a recent Journal of Biological Chemistry "Paper of the Week," research led by Ayae Kinoshita at the Kyoto University Graduate School of Medicine in Japan reveals the benefits of exercise in combating Alzheimer's disease.
28 jun 2012--The most common cause of dementia, Alzheimer's disease results in the loss of cognitive faculty. In the majority of cases, Alzheimer's disease occurs after age 65, and factors such as diet and exercise appear to play a role in its development, with high-fat diets as a risk factor.
Kinoshita's research compared the effects of 1) diet control, 2) voluntary exercise and 3) diet control plus exercise in an Alzheimer's disease mouse model. The results showed that exercise was more beneficial than diet control in reducing β-amyloid formation (a defining characteristic of Alzheimer's disease) and restoring memory loss induced by a high-fat diet in these mice. Moreover, Kinoshita's team found that the effect of diet control plus exercise was not significantly different than exercise alone. They attribute the positive effects of exercise to increased degradation of β-amyloid deposits in the brain.
"Based on the results in this research," Kinoshita suggests, "exercise should be given priority to prevent Alzheimer's disease."
From the article: "Exercise is more effective than diet control in preventing high fat diet-induced β-amyloid deposition and memory deficit in amyloid precursor protein transgenic mice" by Masato Maesako, Kengo Uemura, Masakazu Kubota, Akira Kuzuya, Kazuki Sasaki, Naoko Hayashida, Megumi Asada-Utsugi, Kiwamu Watanabe, Maiko Uemura, Takeshi Kihara, Ryosuke Takahashi, Shun Shimohama and Ayae Kinoshita
Read the Paper in Press version here:
Provided by American Society for Biochemistry and Molecular Biology

Tuesday, June 26, 2012

Exercise with diet improves insulin sensitivity much more than diet alone

Obese older adults can reduce their chance of developing the metabolic syndrome by losing weight through dieting alone, but adding exercise to a weight loss program has even more benefit, a new study finds. The results, to be presented at The Endocrine Society's 94th Annual Meeting in Houston, show that a combination of diet-induced weight loss and frequent exercise almost doubled the improvement in insulin sensitivity compared with dieting alone.
26 jun 2012--The metabolic syndrome is a cluster of metabolic problems that raise the risk of Type 2 diabetes and heart disease: abdominal obesity as shown by a large waist circumference, disturbed lipids (low HDL or "good" cholesterol and high triglycerides), high blood pressure and high blood glucose (blood sugar). Although it is known that weight loss can reduce these risk factors, the most appropriate lifestyle treatment for obesity in older adults has been controversial, said the presenting author, Matthew Bouchonville, MD.
"It was not clear from prior studies in obese elderly adults whether the beneficial effects of diet and exercise are distinct from each other or have additive effects," said Bouchonville, an assistant professor at the University of Mexico Health Sciences Center and the New Mexico Veterans Affairs (VA) Health Care System in Albuquerque.
The researchers investigated the independent and combined effects of diet-induced weight loss and regular exercise in a one-year randomized controlled clinical trial, funded by the National Institute on Aging. They randomly assigned 107obese adults ages 65 and older to one of four groups: weight management using a calorie-restricted diet, exercise (three times a week for 90 minutes each) without dieting, combined dieting with exercise, and controls (no diet or exercise).
The primary outcome analyzed was the degree of change in the insulin sensitivity index. Insulin sensitivity is the body's ability to successfully clear glucose from the bloodstream and is often impaired in obese people. This index was measured from the oral glucose tolerance test, a blood test for diabetes after the patient drinks a sugary drink.
Other measures obtained included those for the components of the metabolic syndrome as well as C-reactive protein, a measure of inflammation. Research has linked chronic inflammation to diabetes and heart disease.
Ninety-three participants completed the study. In the intention-to-treat analysis of all 107 subjects, the insulin sensitivity index did not improve in the exercise-alone group or the controls. This index did improve on average by 40 percent in the diet group and by 70 percent in the combined diet-exercise group after controlling for relevant covariates, Bouchonville reported.
"This suggests a distinct complementary effect of exercise on diet-induced weight loss," he said.
Weight loss by diet alone also led to improvements in blood pressure and C-reactive protein. Without weight loss, exercise did not result in improvement in these risk factors, Bouchonville said. Other measures that did not improve in the exercise-only group or the controls but did improve in the other two groups included glucose and insulin response to the oral glucose tolerance test (levels of insulin and glucose trended over several time points after the sugar intake), waist circumference, abdominal visceral (deep belly) fat, triglycerides and adiponectin. Adiponectin is a protein produced in fat cells that improves insulin sensitivity.
Provided by The Endocrine Society

Sunday, June 24, 2012

Tai Chi increases brain size, benefits cognition in randomized controlled trial of Chinese elderly

Scientists from the University of South Florida and Fudan University in Shanghai found increases in brain volume and improvements on tests of memory and thinking in Chinese seniors who practiced Tai Chi three times a week, reports an article published today in theJournal of Alzheimer's Disease.
24 jun 2012--Findings were based on an 8-month randomized controlled trial comparing those who practiced Tai Chi to a group who received no intervention. The same trial showed increases in brain volume and more limited cognitive improvements in a group that participated in lively discussions three times per week over the same time period.
Previous trials have shown increases in brain volume in people who participated in aerobic exercise, and in one of these trials, an improvement in memory was seen. However, this was the first trial to show that a less aerobic form of exercise, Tai Chi, as well as stimulating discussion led to similar increases in brain volume and improvements on psychological tests of memory and thinking.
The group that did not participate in the interventions showed brain shrinkage over the same time period, consistent with what generally has been observed for persons in their 60s and 70s.
Numerous studies have shown that dementia and the syndrome of gradual cognitive deterioration that precedes it is associated with increasing shrinkage of the brain as nerve cells and their connections are gradually lost.
"The ability to reverse this trend with physical exercise and increased mental activity implies that it may be possible to delay the onset of dementia in older persons through interventions that have many physical and mental health benefits," said lead author Dr. James Mortimer, professor of epidemiology at the University of South Florida College of Public Health.
Research suggests that aerobic exercise is associated with increased production of brain growth factors. It remains to be determined whether forms of exercise like Tai Chi that include an important mental exercise component could lead to similar changes in the production of these factors. "If this is shown, then it would provide strong support to the concept of "use it or lose it" and encourage seniors to stay actively involved both intellectually and physically," Dr. Mortimer said.
One question raised by the research is whether sustained physical and mental exercise can contribute to the prevention of Alzheimer's disease, the most common dementing illness.
"Epidemiologic studies have shown repeatedly that individuals who engage in more physical exercise or are more socially active have a lower risk of Alzheimer's disease," Dr. Mortimer said. "The current findings suggest that this may be a result of growth and preservation of critical regions of the brain affected by this illness."
More information: James A. Mortimer, Ding Ding, Amy R. Borenstein, Charles DeCarli, Qihao Guo, Yougui Wu, Qianhua Zhao, Shugang Chu. Changes in Brain Volume and Cognition in a Randomized Trial of Exercise and Social Interaction in a Community-Based Sample of Non-Demented Chinese Elders, Journal of Alzheimer’s Disease 2012; 30 (4), published by IOS Press.
Provided by IOS Press

Saturday, June 23, 2012

Task force recommends new lung cancer screening guidelines

A lung screening and surveillance task force, established by the American Association for Thoracic Surgery (AATS) and led by medical professionals from Brigham and Women's Hospital (BWH), is strongly recommending new guidelines for lung cancer screening. The guidelines were published this week in the online edition of the Journal of Thoracic and Cardiovascular Surgery (JTCVS).
23 jun 2012--Recent research has shown low-dose computed tomography (LDCT) is beneficial in reducing deaths from lung cancer. So the AATS task force recommends an annual lung cancer screening using LDCT for:
Smokers and former smokers between the ages of 55 and 79 who have smoked the equivalent of a pack of cigarettes a day for 30 years. Smokers and former smokers between the ages of 50 and 79 who have smoked the equivalent of a pack of cigarettes a day for 20 years and have other factors that raise their risk of developing lung cancer. Long-term lung cancer survivors up to the age of 79 (to detect a second case of primary lung cancer).
David Sugarbaker, MD, the chief of the Division of Thoracic Surgery at BWH and president-elect of the AATS, conceived the idea of creating the guidelines. He said, "This work will result in a greater chance for patients stricken with early lung cancer to receive curative therapy."
These guidelines differ from the recommendations of other societies because they recommend screening for patients up to the age of 79. Other societies only recommend screening for patients up to the age of 74. These guidelines are also unique because they address lung cancer survivors. In total, under the AATS recommendations, 94 million Americans are now eligible for screening. The AATS task force recommends that screening should not be performed for individuals with conditions that would preclude successful treatment for lung cancer.
"Low-dose CT scanning has been proven to save lives," said Francine Jacobson, MD, MPH, a thoracic radiologist at BWH and a co-chair of the task force. "I hope this recommendation will encourage physicians to use low-dose CT scanning for a broader range of patients."
Michael Jaklitsch, MD, a thoracic surgeon at BWH and a co-chair of the task force said, "Lung cancer is an epidemic with over a quarter of a million new cases each year. Now, for the first time in history, there is a clear screening tool that identifies early stages of lung cancer, when treatment is most successful. Our analysis shows this tool of low-dose CT scans to be safe and very cost efficient. Lung cancer screening will save lives, save lungs and inspire many Americans to quit smoking."
The 14 member task force is made up of thoracic surgeons, thoracic radiologists, medical oncologists, a pulmonologist, a pathologist and an epidemiologist. They based their conclusion on a review of screening trials in the United States and Europe, an examination of current literature and discussions of clinical practices. The work of the task force was funded by the AATS.
Provided by Brigham and Women's Hospital

Friday, June 22, 2012

Vitamin D with calcium shown to reduce mortality in elderly

A study recently published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism (JCEM) suggests that vitamin D—when taken with calcium—can reduce the rate of mortality in seniors, therefore providing a possible means of increasing life expectancy.
22 jun 2012--During the last decade, there has been increasing recognition of the potential health effects of vitamin D. It is well known that calcium with vitamin D supplements reduces the risk of fractures. The present study assessed mortality among patients randomized to either vitamin D alone or vitamin D with calcium. The findings from the study found that the reduced mortality was not due to a lower number of fractures, but represents a beneficial effect beyond the reduced fracture risk.
"This is the largest study ever performed on effects of calcium and vitamin D on mortality," said Lars Rejnmark, PhD, of Aarhus University Hospital in Denmark and lead author of the study. "Our results showed reduced mortality in elderly patients using vitamin D supplements in combination with calcium, but these results were not found in patients on vitamin D alone."
In this study, researchers used pooled data from eight randomized controlled trials with more than 1,000 participants each. The patient data set was comprised of nearly 90 percent women, with a median age of 70 years. During the three-year study, death was reduced by 9 percent in those treated with vitamin D with calcium.
"Some studies have suggested calcium (with or without vitamin D) supplements can have adverse effects on cardiovascular health," said Rejnmark. "Although our study does not rule out such effects, we found that calcium with vitamin D supplementation to elderly participants is overall not harmful to survival, and may have beneficial effects on general health".
More information: The article "Vitamin D with calcium reduces mortality: patient level pooled analysis of 70,528 patients from eight major vitamin D trials", appears in the August 2012 issue of JCEM.
Provided by The Endocrine Society

Thursday, June 21, 2012

Study: 21 percent of newly admitted nursing home residents sustain a fall during their stay

One in five short-stay nursing home patients sustains a fall after their admission, and certified nursing assistant (CNA) staffing is associated with decreased fall risk, according to a study in the Journal of the American Geriatrics Society.

21 jun 2012--Researchers from the University of Southern California and Brown University analyzed the 2006 Minimum Data Set (MDS) assessments of all Medicare/Medicaid patients admitted to a nursing home for the first time. Among more than 230,000 patients in nearly 10,000 nursing homes across the country, the researchers found that 21% of newly admitted nursing home residents sustained at least one fall during their first 30 days in the facility.
To identify potential factors contributing to falls, the study also examined various organizational characteristics of nursing homes. Facilities with higher CNA-to-patient staffing ratios were associated with fewer falls, likely because CNAs provide much of the hands-on patient care during high-risk activities such as toileting, dressing, and ambulation.
While fall rates among long-term nursing home populations are well documented, the nationwide study is believed to be the first of its kind to specifically analyze fall rates among newly admitted nursing home residents. Because newly admitted nursing home residents are in a novel environment and are unfamiliar to staff, identification and management of fall risk poses a particular challenge.
Lead author Natalie Leland, a research gerontologist and occupational therapist at the University of Southern California, explains how this study highlights the unique health care goals of a rehabilitating population striving to get back to the community relative to those of long-term patients who reside in the nursing home.
"A fall can delay or permanently prevent the patient from returning to the community, and identifying risk of falling is essential for implementing fall prevention strategies and facilitating successful discharge back to the community."

Provided by University of Southern California

Tuesday, June 19, 2012

Study links loneliness in older individuals to functional decline, death

Loneliness in individuals over 60 years of age appears associated with increased risk of functional decline and death, according to a report published Online First by Archives of Internal Medicine.

In older persons, loneliness can be a common source of distress and impaired quality life, according to the study background.
Carla M. Perissinotto, M.D., M.H.S., of the University of California, San Francisco, and colleagues examined the relationship between loneliness and risk of functional decline and death in older individuals in a study of 1,604 participants in the Health and Retirement Study.
The participants (average age 71) were asked if they felt left out, isolated or a lack of companionship. Of the participants, 43.2 percent reported feeling lonely, which was defined as reporting one of the loneliness items at least some of the time, according to the study results.
Loneliness was associated with an increased risk of death over the six-year follow-up period (22.8 percent vs. 14.2 percent), the results indicate. Loneliness also was associated with functional decline, including participants being more likely to experience decline in activities of daily living (24.8 percent vs. 12.5 percent), develop difficulties with upper extremity tasks (41.5 percent vs. 28.3 percent) and difficulty in stair climbing (40.8 percent vs. 27.9 percent).
"Loneliness is a common source of suffering in older persons. We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline," the authors comment.
The authors conclude their study could have important public health implications.
"Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice. However, loneliness may be as an important of a predictor of adverse health outcomes as many traditional medical risk factors," the researchers note. "Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes."
In an invited commentary, Emily M. Bucholz, M.P.H., and Harlan M. Krumholz, M.D., S.M., of the Yale University School of Medicine, New Haven, Conn., write: "Social support – few concepts in epidemiology have proven more elusive to define."
"As we look forward to future studies on social support, the importance of clarifying the mechanisms by which this amorphous concept influences health becomes clear," they continue.
"Loneliness is a negative feeling that would be worth addressing even if the condition had no health implications. Nevertheless, with regard to health implications, scientists examining social support should build on studies such as those published in this issue and be challenged to investigate mechanisms as well as practical interventions that can be used to address the social factors that undermine health," the authors conclude.
More information: Arch Intern Med. Published online June 18, 2012. doi:10.1001/archinternmed.2012.1993
Arch Intern Med. Published online June 18, 2012. doi:10.1001/archinternmed.2012.2649
Provided by JAMA and Archives Journals

Monday, June 18, 2012

How aging normal cells fuel tumor growth and metastasis

It has long been known that cancer is a disease of aging, but a molecular link between the two has remained elusive.

17 jun 2012--Now, researchers at the Kimmel Cancer Center at Jefferson (KCC) have shown that senescence (aging cells which lose their ability to divide) and autophagy (self-eating or self-cannibalism) in the surrounding normal cells of a tumor are essentially two sides of the same coin, acting as "food" to fuel cancer cell growth and metastasis.
Michael P. Lisanti, M.D., Ph.D., Professor and Chair of Stem Cell Biology and Regenerative Medicine at Jefferson Medical College of Thomas Jefferson University and a member of the KCC, and his team previously discovered that cancer cells induce an oxidative stress response (autophagy) in nearby cells of the tumor microenvironment to feed themselves and grow.
In this study, senescent cells appear to have many of the characteristics of these autophagic cancer-associated fibroblasts and to be part of the same physiological process. In other words, normal neighboring cells that are becoming senescent or "old" are directly making food to "feed" the cancer. Aging literally fuels cancer cell growth.
Since senescence is thought to reflect biological aging, this research on autophagy-induced senescence may explain why cancer incidence dramatically increases exponentially with advanced age, by providing a "fertile soil" to support the anabolic growth of "needy" cancer cells.
The findings were reported in the June 15 issue of Cell Cycle.
"This research merges the two paradigms of aging and cancer, and it also brings in cell metabolism," said Dr. Lisanti. "We provide genetic support for the importance of 'two-compartment tumor metabolism' in driving tumor growth and metastasis via a very simple energy transfer mechanism. Senescence and autophagy metabolically support tumor growth and metastasis."
Simply put, aging is the metabolic engine that drives cancer growth.
To test this link, the researchers developed a genetically tractable model system to directly study the compartment-specific role of autophagy in tumor growth and metastasis. First, they took human fibroblasts immortalized with telomerase and transfected them with autophagy genes.
Next, they validated that these fibroblasts show features of mitophagy, mitochondrial dysfunction and a shift toward aerobic glycolysis, with increases in lactate and ketone production, mimicking the behavior of cancer-associated fibroblasts. They observed that autophagic-senescent fibroblasts promoted metastasis, when co-injected with human breast cancer cells, by more than 10-fold.
Thus, metastasis may be ultimately determined by aging or senescent cells in the tumor microenvironment, rather than by the cancer cells themselves. This finding completely changes how we view cancer as a disease.
This observation directly calls into question the longstanding notion that cancer is a cell-autonomous genetic disease. Rather, it appears that cancer is really a disease of host aging, which fuels tumor growth and metastasis, thus, determining clinical outcome. Normal aging host cells are actually the key to unlocking effective anti-cancer therapy.
In the study, the autophagic fibroblasts also showed features of senescence. What's more, the senescent cells shifted toward aerobic glycolysis, and were primarily confined to the tumor stromal compartment.
Autophagy action is also clearly compartment specific, since the researchers showed that autophagy induction in human breast cancer cells resulted in diminished tumor growth. Therefore, selective induction of self-cannibalism in cancer cells is a new therapeutic target for the prevention of tumor growth and metastasis. In this strategy, cancer cells actually eat themselves, reversing tumor growth and metastasis.
To stop tumor growth and metastasis, researchers will need to "cut off the fuel supply" which is provided by aging senescent cells, before it gets to cancer cells by targeting autophagy and senescence in the tumor microenvironment.
These findings are paradigm shifting and will usher in a completely new era for anti-cancer drug development, according to the researchers. Such approaches for targeting the "autophagy-senescence transition" could have important implications for preventing tumor growth and metastasis, and effectively overcoming drug resistance in cancer cells.
"Rapidly proliferating cancer cells are energetically dependent on the aging host tumor stroma," Dr. Lisanti said. "As such, removing or targeting the aging tumor stroma would then stop tumor growth and metastasis. Thus, the aging stroma is a new attractive metabolic or therapeutic target for cancer prevention."
A clear byproduct of this research would also be the development new anti-aging drugs to effectively combat, stop or reverse aging, thereby preventing a host of human diseases, particularly cancer.
More information: Key References: Capparelli et al.
http://www.landesb … ticle/20717/
http://www.landesb … ticle/20718/
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http://www.landesb … ticle/20964/

Saturday, June 16, 2012

Study links smoking to increased all-cause mortality in older patients

An analysis of available medical literature suggests smoking was linked to increased mortality in older patients and that smoking cessation was associated with reduced mortality at an older age, according to a report published in the June 11 issue of Archives of Internal Medicine.

16 jun 2012--Smoking is a known risk factor for many chronic diseases, including cardiovascular disease and cancer, however, the epidemiological evidence mostly relies on studies conducted among middle-aged adults, according to the study background.
"We provide a thorough review and meta-analysis of studies assessing the impact of smoking on all-cause mortality in people 60 years and older, paying particular attention to the strength of the association by age, the impact of smoking cessation at older age, and factors that might specifically affect results of epidemiological studies on the impact of smoking in an older population," Carolin Gellert and her colleagues from the German Cancer Research Center (DKFZ), Heidelberg, Germany, note in the study.
The authors identified 17 studies from seven countries (the U.S., China, Australia, Japan, England, Spain and France) that were published between 1987 and 2011. The follow-up time of the studies ranged from 3 to 50 years and the size of the study populations ranged from 863 to 877,243 participants.
In summarizing the results from the 17 studies, the authors note an 83 percent increased relative mortality for current smokers and a 34 percent increased relative mortality for former smokers compared with never smokers.
"In this review and meta-analysis on the association of smoking and all-cause mortality at older age, current and former smokers showed an approximately 2-fold and 1.3-fold risk for mortality, respectively," the authors note. "This review and meta-analysis demonstrates that the relative risk for death notably decreases with time since smoking cessation even at older age."
In a commentary, Tai Hing Lam, M.D., of the University of Hong Kong, writes: "Most smokers grossly underestimate their own risks. Many older smokers misbelieve that they are too old to quit or too old to benefit from quitting."
"Because of reverse causality and from seeing deaths of old friends who had quit recently, some misbelieve that quitting could be harmful. A simple, direct, strong and evidence-based warning is needed," Lam continues.
"If you have helped two smokers quit, you have saved (at least) one life," the author concludes.
More information: Arch Intern Med. 2012;172[11]:837-844.

Arch Intern Med. 2012;172[11]:845-846.
Provided by JAMA and Archives Journals

Thursday, June 14, 2012

Older women should not take calcium, vitamin D: task force

Older women should not take calcium, vitamin D: task force
Recommendations say evidence doesn't support benefit of low daily doses to prevent fractures.

14 jun 2012-- A leading U.S. government advisory panel has proposed that postmenopausal women not take low-dose calcium and vitamin D supplements daily to ward off bone fractures.
But the jury is still out on higher doses of these supplements, stated the U.S. Preventive Services Task Force (USPSTF), which issued the draft recommendations Tuesday. Public comment on the draft recommendations is invited until July 10.
The news was a bit of a bombshell, given that women have been told for so long to take calcium and vitamin D, said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. "What we're really seeing is no role for calcium for the prevention of osteoporotic fractures. At this point, there's no reason to be taking calcium," she noted.
But, the issue of which women should take which supplements is a complicated one and these preliminary recommendations are unlikely to change practice immediately, said Dr. Shiri Levy, service chief of endocrinology at West Bloomfield Henry Ford Hospital in Michigan, who already tells her patients to get calcium from food sources as much as possible.
"Taking calcium naturally in the diet is probably the best way for patients who don't have lactose intolerance and can drink milk and eat dairy products," she said. "For those not able to take dairy products regularly, then we would supplement to the degree that we can. I would individualize it for patients."
And, Levy pointed out, data from the landmark Women's Health Initiative study did indicate that women on supplements showed a decreased risk for fractures.
As Steinbaum noted, millions of women take vitamin D supplements with or without calcium in the hopes of diminishing the risk of fractures as they age.
According to previous research, half of postmenopausal women will suffer such a fracture in their postmenopausal years.
The USPSTF said there was no evidence to support using the low-dose supplements -- defined as 400 IU of vitamin D with 1,000 milligrams of calcium carbonate -- as protection against fractures.
There was "inadequate evidence" as to how higher doses -- meaning more than 400 IU of vitamin D paired with 1,000 milligrams of calcium -- might affect bone fracture risk, the task force noted.
And it's not clear at this point if vitamin D/calcium supplementation could help fight cancer and fractures in men and younger women, the recommendations added.
There can be a downside to taking such daily supplements, given that there may be a slightly heightened risk of kidney stones, the USPSTF stated.
Both supplements have garnered plenty of evidence for and against their use.
For instance, vitamin D might lower the risk of colorectal and other forms of cancer, according to some studies, while calcium recently has been linked to an increased risk of heart attacks.
The USPSTF recommendations say that vitamin D could still be useful in preventing falls in people aged 65 or older who are already at increased risk for falling.
Women at average risk for osteoporosis should have a baseline bone density scan at age 65, Levy said.
Women who have risk factors for the condition such as celiac disease, a family history of osteoporosis or premature menopause should have a baseline bone density test taken earlier, when they go through menopause, she added.
"If there is an increased risk, we do recommend a healthy lifestyle, appropriate diet including foods rich in calcium and vitamin D and weight-bearing exercise," Levy said.
In addition to natural food sources, many foods are now fortified with vitamin D and calcium.

More information: The draft recommendations can be viewed at the USPSTF website.

Wednesday, June 13, 2012

WHO target to cut early chronic illness deaths

The World Health Organization announced on Friday it was set to approve a new target to reduce premature deaths from chronic illnesses such as heart disease by a quarter by 2025.

Cardiovascular disease, diabetes, cancer and chronic respiratory conditions are known in medical terms as noncommunicable diseases (NCDs) and represent the world's biggest killers -- accounting for 63 percent of all deaths.
About a quarter of victims die prematurely, between the ages of 30 and 70.
Late Thursday, WHO member states meeting in Geneva made a "landmark" decision to fix the 25 percent reduction target which is expected to be formally adopted on Saturday, the UN health agency said.
It was agreed along with a raft of measures to address the prevention and control of NCDs, which have rocketed in developing countries in recent years.
About 80 percent of premature deaths from NCDs now occur in low and middle-income countries.
"The focus of attention of the world community on the largest killer is now on course," said Douglas Bettcher from the WHO's chronic diseases unit.
"The architecture to support developing countries in addressing NCDs and their risk factors is now in place."
NCDs also constitute a massive financial burden. A recent Harvard study found that left unattended they could result in lost productivity in low and middle income countries worth $7 trillion up to 2025.
"This is something that would, in an era of globalisation and ongoing financial crisis, have major effects for the entire world," said Bettcher.
In the resolution adopted by WHO member states but yet to be formally approved, countries also backed further work aimed at producing targets on NCD risk factors, namely tobacco use, alcohol abuse, unhealthy diet and physical inactivity.
They called for a formal meeting to be held before the end of October to conclude work on a "global monitoring framework" to prevent and control NCDs.
The World Heart Federation said the adoption of the target would be a "significant milestone" but much work remained to be done.
"Although we applaud the progress made at the World Health Assembly this week, the global target in isolation is not enough to tackle one of the most complex health challenges facing the world today," said chief executive Johanna Ralston.
"Further targets are needed to shape a framework for action against NCD risk factors, and we urge world leaders to agree on these targets promptly."

Tuesday, June 12, 2012

Final word: Task force recommends against PSA-based screening for prostate cancer

Following a period for public comment, the United States Preventive Services Task Force (USPSTF) released its final recommendation for prostate cancer screening. The Task Force now recommends against PSA-based screening for all men, regardless of age. The final recommendations are being published early online in the May 22 issue of Annals of Internal Medicine, the flagship journal of the American College of Physicians (ACP).

12 jun 2012--The Task Force last published recommendations on prostate cancer screening in 2008. At the time, researchers concluded that there was no evidence to support PSA testing for men over the age of 75. An independent panel of experts reviewed evidence published since 2008 and concluded that the harms of PSA testing outweigh the benefits regardless of age. The Task Force considers health benefits and harms, but not costs, when developing recommendations.
The primary goal of prostate cancer screening programs is to save lives and prevent symptomatic disease. The Task Force considered two major trials of PSA testing in asymptomatic men to assess the life-saving benefits of PSA testing. The first trial, conducted in the U.S., did not demonstrate any prostate cancer mortality reduction as a result of screening. The second trial, conducted in seven European countries, found a reduction in prostate cancer deaths of about one death prevented per 1,000 men screened in a subgroup of men aged 55 to 69 years, mostly in two countries. Five of the seven countries reporting results did not find a statistically significant reduction in deaths.
Strong evidence shows that PSA screening is associated with significant harms. Nearly 90 percent of men with PSA-detected prostate cancer undergo early treatment with surgery, radiation, or androgen deprivation therapy. Evidence shows that up to five in 1,000 men will die within one month of prostate cancer surgery and between 10 and 70 men will survive, but suffer life-long adverse effects such urinary incontinence, erectile dysfunction, and bowel dysfunction.
According to William J. Catalona, M.D., Medical Director of the Urological Research Foundation and author of an accompanying editorial, the Task Force recommendation has underestimated the benefits and overestimated the harms of prostate cancer screening. He and his co-authors argue that the Task Force -- whose panel does not include urologist or cancer specialists -- largely bases its recommendations on flawed studies with inadequate follow up time. In addition, the Task Force recommendations focus on mortality and do not take into consideration the substantial illness related to living with advanced cancer.
Editorial co-author, Dr. Henry Lynch, Director of the Hereditary Cancer Center at Creighton University, adds that the Task Force recommendations also leave out high-risk populations and younger men. The authors express concern that the new recommendations will take Americans back to an era when prostate cancer was often discovered at advanced, incurable stages.
"The recommendations of the USPSTF carry considerable weight with Medicare and other third-party insurers," Dr. Lynch said. "My colleagues and I strongly believe that the Task Force recommendations should not be used as justification by insurers, including Medicare, to deny diagnosis of prostate cancer to the male population at risk."
Yet, according to Otis W. Brawley, MD, MPH, Chief Medical Officer of the American Cancer Society, and author of a second accompanying commentary, overdiagnosis makes screening seem to save lives when it truly does not. Many men are diagnosed with prostate cancer that may never have progressed within their lifetime. Yet because they were screened and treated, they think screening saved their lives.
"Many people have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found," wrote Dr. Brawley. "There is little appreciation of the harms that screening and medical interventions can cause."
In October 2011, the Task Force posted its draft recommendations for public comment. At the time, the Task Force had given PSA screening a grade "D," meaning that physicians should not offer the test because the harms outweigh the benefits. Many people who commented on the recommendations urged the Task Force to change the recommendation to a grade "C," meaning physicians could provide the test to patients who request it. However, no new evidence was presented. The recommendation remains unchanged.
While the recommendation clearly states that physicians should not offer PSA screening, the Task Force says it leaves the ultimate power in the hands of the health care providers.
"The USPSTF recognizes that clinical, policy, and coverage decisions involve more considerations than evidence alone," said Task Force Chair, Virginia A. Moyer, MD, MPH of Baylor College of Medicine in Houston, TX. "Clinicians and health care providers should understand the evidence but individualize decision-making to the specific patient or situation."
Provided by American College of Physicians

Monday, June 11, 2012

Study: The epigenome of newborns and centenarians is different

What happens in our cells after one hundred years? What is the difference at the molecular level between a newborn and a centenary? Is it a gradual or a sudden change? Is it possible to reverse the aging process? What are the molecular keys to longevity? These central questions in biology, physiology and human medicine have been the focus of study by researchers for decades.

Today, the international journal Proceedings of the National Academy of Sciences (PNAS) publishes an international collaborative research led by Manel Esteller, director of the Epigenetics and Cancer Biology Program at the Bellvitge Biomedical Research Institute (IDIBELL), professor of Genetics at the University of Barcelona and ICREA researcher, which provides a vital clue in this field: the epigenome of newborns and centenarians is different.
While the genome of every cell in the human body, regardless of their appearance and function, is identical, chemical signals that regulate it, known as epigenetic marks, are specific to each human tissue and every organ. This means that all our components have the same alphabet (genome), but the spelling (epigenome) is different in every part of our anatomy. The surprising result of the work led by Dr. Esteller is that the epigenome varies depending on the age of the person, even for the same tissue or organ.
In the study published in PNAS, epigenomes from white blood cells of a newborn, a man of middle age and a person of 103 years have been fully sequenced. The results show that the centenary presents a distorted epigenome that has lost many switches (methyl chemical group), put in charge of inappropriate gene expression and, instead, turn off the switch of some protective genes.
"Extending the results to a large group of neonates, individuals at the midpoint and nonagenarians or centenarians we realized that this is an ongoing process in which each passing day goes by twisting the epigenome" explains the researcher. However, Dr. Esteller noted that "epigenetic lesions, unlike genetic ones, are reversible and therefore modifying the patterns of DNA methylation by dietary changes or use of drugs may induce an increase in lifetime."

More information: Heyn H, Li N, Ferreira HJ, Moran S, Pisano DG, Gomez A, Diez J, Sanchez-Mut JV, Setien F, Carmona FJ, AA Pucaf Sayols S, Pujana MA, Serra-Musach J, Iglesias-Plata I, Formiga F, Fernandez AF, Fraga MF, Heath S, Valencia A, Gut IG, Wang J, Esteller M. The Distinct DNA Methylomes of Newborns and centenarians. Proc Natl Acad Sci, 2012.
Provided by IDIBELL-Bellvitge Biomedical Research Institute

Saturday, June 09, 2012

McGill discovery: Alzheimer's drugs make bones stronger

09 jun 2012-- The drugs commonly used to treat memory loss in Alzheimer’s patients can make bones stronger, according to a recent study led by Faleh Tamimi, assistant professor at McGill University's Faculty of Dentistry.  The findings, published in Journal of Bone and Mineral Research and highlighted in Nature Reviews: Endocrinology, could help further research into the idea that bone strength is controlled centrally within the brain.

Two drugs frequently used to treat Alzheimer disease (AD), donepezil and rivastigmine, are known to stimulate a group of neurons in the brain that play a major role in maintaining memory. While these drugs have been widely used in the treatment of AD and other forms of dementia since the mid-1990s, their potential effect on bone biology had not been explored.
Recent research indicated that certain neurons can regulate bone metabolism and that their damage results in weaker bones. But little was known about the potential that increased activity by these neurons might have on bone. The McGill-led team determined that the use of donepezil and rivastigmine, two drugs that in theory could increase the activity of bone-regulating neurons, is associated with a beneficial effect on bone strength and a decreased risk of hip fracture in Alzheimer’s patients.
The researchers studied Alzheimer’s patients, aged 75 or older, who were treated at a single hospital in Spain.  Eighty recorded cases of hip fractures were compared with 2,178 patients without hip fracture (control group). The study showed that patients who were receiving donepezil and rivastigmine were associated with a lower risk of hip fracture.
"These findings improve our understanding of bone disease and open a new therapeutic window for the treatment of osteoporosis,” explained Prof. Tamimi. "An added value of this discovery is that the drugs we found to be beneficial for preventing hip fractures are readily available in pharmacies. Even though more tests are required to confirm our findings, the fact that donepezil and rivastigmine have been proven safe will facilitate the translation of our discovery into clinical application for treating patients suffering from osteoporosis.”
More information: To view the full paper in Journal of Bone and Mineral Research: http://www.jbmr.or … s_disea.html
To read the review in Nature Reviews: Endocrinology: http://www.nature. … 2012.68.html
Provided by McGill University

Thursday, June 07, 2012

Testosterone overprescribed, particularly for older men

07 jun 2012-- Testosterone prescriptions have surged since 2006 due to promotional activity, according to University of Sydney research which also found growing overuse in older men.
The research by Professor David Handelsman from the University and director of the ANZAC Research Institute, Concord Hospital has been published today in the Medical Journal of Australia.
It follows another recent study, led by Professor Handelsman and published in the journal of Clinical Endocrinology, which suggests testosterone decline in older men is not a result of ageing but of medical conditions and ill health that accumulate as men get older.
"This Healthy Man Study looked at very healthy men aged 40 and over and found that a decrease in testosterone was not associated with increasing age. Instead factors such as obesity or a history of smoking were strongly linked with any decrease," Professor Handelsman said.
The study supported the interpretation that diseases associated with ageing and not ageing itself affects testosterone levels in older men. It underlines the inappropriateness of the increasing sales of testosterone to older men which is highlighted in Professor Handelsman's MJA article.
The study in the MJA analyses data from the Pharmaceutical Benefits Scheme and IMS, a company that provides national sales data year by year.
"I found that stable market growth over 15 years was disrupted by sharp increases following the introduction of two new testosterone products - a gel and a long-acting injectable version by a single company which became a monopoly supplier," Professor Handelsman said.
"There is growing overuse of testosterone in older men as an anti-ageing tonic and non-specific treatment for sexual dysfunction, for which sound evidence is lacking. Yet at the same time genuine low-testosterone conditions due to diseases of the reproductive system remain underdiagnosed."
At present new uses of testosterone should be restricted to carefully designed clinical trials to determine whether there is any objective benefit from testosterone treatment for conditions such as obesity, diabetes or cardiovascular diseases that accumulate as men age, Professor Handelsman observed.
"The progressive increase appears to be due to promotion-driven marketing of products which do not comply with the Pharmaceutical Benefits Scheme prescribing criteria and suggest that more effective implementation of those criteria is needed."
Provided by University of Sydney

Saturday, June 02, 2012

In Brazil number of hip fractures expected to increase 32 percent by 2050

A new Audit report on fragility fractures, issued today by the International Osteoporosis Foundation (IOF), predicts that Brazil will experience an explosion in the number of fragility fractures due to osteoporosis in the coming decades.

Osteoporosis, a disease which weakens bones and makes them more likely to fracture, is thought to affect around 33% of postmenopausal women in Brazil. Fractures due to osteoporosis mostly affect older adults, with fractures at the spine and hip causing the most suffering, disability and healthcare expenditure.
Currently, about 20% of Brazil's population is 50 years of age or over and 4.3% is aged 70 or over. With average life expectancy projected to rise to 80 years in 2050, it is estimated that the total population will increase to 260 million. Around 37% will then be over 50 years of age, and 14% (around 36 million people) aged 70 years or over.
These projections serve as a dire warning to health authorities as well as to social institutions which care for the aged. In Brazil, around 153 to 343 hip fractures occur among every 100,000 people aged 50 and over. While today there are an estimated 121, 700 annual hip fractures, these numbers are predicted to increase by 16% in 2020, and by 32% in 2050.
Hip fractures are a major cause of suffering, disability, and early death in seniors. Various international studies show that around 20% of hip fracture sufferers will die within the year of fracture, but one study examining patients in various hospitals in Rio de Janeiro showed that as many as 35% died either in hospital or soon after discharge. Surviving hip fracture patients often remain disabled, and lose the inability to live productive and independent lives, thus becoming a burden on family or transferring to institutional care.
Dr. Bruno Muzzi Camargos, President of the Associação Brasileira da Avaliação da Saúde Óssea e Osteometabolismo (ABrASSO), stated, "Given the future projections, osteoporosis and fragility fractures have become a health issue of immediate concern. We must implement nation-wide measures for early prevention, while ensuring that people at risk –and especially people who have already suffered a fracture – are appropriately diagnosed and treated to prevent future fractures. This is the only way that we can slow the rising tide of costly fractures. "
The 'Latin America Audit: Epidemiology, Costs, and Burden of Osteoporosis 2012' was prepared by IOF in cooperation with IOF member societies . It includes data from 14 countries throughout Latin America, and reveals the following key findings in Brazil:
  • A 2010 study of more than 4,300 women aged 50 and over found that 11.5% had sustained some kind of osteoporotic fracture and that 33% were osteoporotic.
  • An estimated 2.9 million Brazilian women over the age of 50 may be living with vertebral fractures, mostly undiagnosed and untreated. Vertebral fractures cause pain and disability, often resulting in a stooped back.
  • Vitamin D, made in the skin upon exposure to sunlight, is essential for bone and muscle strength. Yet despite Brazil's sunny climate, vitamin D deficiency is widespread throughout the population. In a recent study 60% of the healthy adolescent participants did not have adequate amounts of vitamin D.
  • The cost of treating fractures is enormous and growing. The approximate direct cost of treating a hip fracture in Brazil ranges from 3900 to 12,000 USD in private hospitals, with an average 11 days spent in hospital. This does not include the indirect costs associated with post-fracture care, rehabilitation, loss of productivity and long-term need for nursing assistance.
  • As in other countries around the world, there is a widespread problem of under diagnosis and under-treatment, even after fracture. A fragility fracture indicates a high risk of further fractures and should immediately trigger an assessment for osteoporosis. However, one study showed that, of 123 hospitalized hip fracture sufferers, not a single patient was discharged from the hospital with a referral for bone density testing or osteoporosis treatment.
  • The urban- rural divide is reflected in both incidence of fractures and in accessibility to diagnosis and treatment. There is a higher incidence of fractures among women living in cities than in rural areas. On the other hand, people living in rural areas often have no access to bone densitometry for diagnostic testing.
On the positive side, Brazil is one of the few Latin American countries which has declared osteoporosis as a national health priority. Professor Christiano Zerbini, IOF Board Member and Director of the Paulista Clinical Research Center in Sao Paulo, commented, "Brazilian researchers and health professionals are working to find answers to the problem of osteoporosis and related musculoskeletal diseases. For example, an important new multicentre prospective study, BRAVOS (Brazilian Vertebral Osteoporosis Study), will gather much-needed epidemiological data from six research centres across the country. We hope this data will lead to the development of a WHO Fracture Risk Assessment model (FRAX) for Brazil – a tool to facilitate the identification of people at high risk of fracture. Among other necessary steps, this would be an important achievement in our efforts to reduce the burden of future fractures." The authors of the Audit report call for more public awareness campaigns, osteoporosis training programmes for doctors, better accessibility to low cost testing and treatment, and more epidemiological research.
IOF President John A. Kanis stated, "IOF joins concerned Brazilian doctors and patient societies to call for the channelling of health care resources towards the prevention and care of age-related musculoskeletal diseases and fragility fractures. This is an important investment in Brazil's future."
More information: Information about the Latin American Audit is available in English, Portuguese and Spanish at http://www.osteopo …
The report can also be downloaded from the IOF website at http://www.iofbone … ional-audits
Provided by International Osteoporosis Foundation

Friday, June 01, 2012

The Women's Health Initiative: An unforgettable decade

The 10-year anniversary of the historic Women's Health Initiative (WHI) Hormone Therapy Trial report, which radically changed the practice of women's health, will be commemorated in July 2012. In anticipation of this event, two of the world's leading experts in women's health, menopause, and hormone therapy are releasing an editorial in the journal Menopause, providing their perspective on this epic study and the lessons learned over the past 10 years.

01 jun 2012--JoAnn Manson, MD, MPH, DrPH, from Brigham and Women's Hospital (BWH), and Lubna Pal, MBBS, MRCOG, MSc, from Yale University School of Medicine, note that the WHI's 10-year anniversary is a good time to reflect on the pendulum swings and dramatic evolution in our thinking about estrogen and hormone therapy (HT), which changed the lives of millions of women. The authors state in their editorial, "The WHI is an historic trial that has changed clinical practice and, ultimately, has helped lead us towards a more rational interpretation of the place of hormone therapy in menopause management."
The WHI hormone trials were designed to assess the role of HT in the prevention of heart disease, as well as to evaluate the benefits and risks of HT when used for chronic disease prevention. The trials were done in postmenopausal women ages 50-79 (with a mean age of 63) and tested the types of HT (Premarin and Prempro) that were in common use at the time the study started. The estrogen plus progestin trial was stopped three years early because of an increased risk of breast cancer, heart disease, and concerns that the overall risks exceeded the benefits. The estrogen-alone trial (in women with hysterectomy) showed fewer risks but was stopped one year early due to an increased risk of stroke. Estrogen-alone did not appear to increase risk of heart disease or breast cancer. In fact, estrogen-alone seemed to lower the risk of heart disease in younger women (in the 50-59 year age group) and seemed to have a favorable benefit-risk profile in that age group. However, the harmful findings in the older women in both HT trials tended to be extrapolated to younger women, resulting in dramatic (>70%) reductions in prescriptions for hormone therapy.
Manson, one of the principal investigators of the WHI since the start of the study and current president of the North American Menopause Society, said, "The WHI deserves credit for stopping the growing clinical practice of prescribing hormone therapy to older women who were at very high risk of heart disease. In fact, these women did not receive heart benefit from estrogen therapy and may even have suffered harm. Unfortunately, the findings in older women were extrapolated to newly menopausal healthy women who tended to have a favorable benefit to risk ratio with HT."
At least 70% of newly menopausal women have hot flashes and/or night sweats, and about 20% have moderate-to-severe symptoms that disrupt sleep and impair quality of life. Over the past 10 years, research from the WHI and other studies has provided a critical mass of evidence for the timing hypothesis, which suggests that younger women closer to the onset of menopause tend to have better outcomes on hormone therapy than older women who are distant from menopause onset. The younger women are also more likely to have hot flashes and other menopausal symptoms, and thereby derive quality of life benefits. Manson said, "The recent findings highlight the importance of individualized care for women. The 'one size fits all' approach to decision making is no longer acceptable." Manson adds that it will also be important to understand whether different types and formulations of hormone therapy (such as patches, pills or lower doses of hormones) will have a different balance of benefits and risks.
Provided by Brigham and Women's Hospital